ADHD continues to occur at epidemic levels in our society. Thirty-five years ago, only a handful of children and teens were considered to have what at the time was called ‘’hyperkinesis’’ or ‘’minimal brain dysfunction.’’ Now, the diagnosis takes in almost 10% of all children and teens. Most of these kids (62%) are taking ADHD drugs such as Adderall, Strattera, Ritalin, and Concerta. In fact, a diagnosis of ADHD and a prescription of one or more of these drugs seem in most people’s mind to go hand in hand. But a diagnosis of ADHD doesn’t automatically mean that the individual should be prescribed drugs. As you’ll see in the following list, ADHD medications are not a walk in the park but entail some troubling and potentially injurious side effects, and are best avoided if at all possible. Here are 10 reasons why ADHD medications should usually be given only as a last resort:
- They send a message to kids that the best solutions to life’s problems are to be found in a bottle of pills. This can set them up later on in life to turn immediately to (illegal or legal) drugs when things get tough.
- ADHD drugs are heavily marketed and often not closely monitored. While ADHD prescriptions by physicians by definition are medically legitimate, there are also strong unseen influences related to the marketing of these drugs by multinational corporations that play a hand in the diagnosing and prescribing. In addition, in some cases, diagnoses are made by physicians after only a 15-minute visit and then not closely monitored thereafter.
- ADHD drugs are highly addictive. The U.S. government’s Drug Enforcement Administration (DEA) lists most ADHD medications as schedule II drugs (out of five schedules), which they define as: “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.’’ (In addition to Ritalin and Adderall, Schedule II drugs include cocaine and methadone).
- ADHD drugs don’t actually work as intended in the long run. One of the best-known and most-respected studies examining the effectiveness of ADHD treatments was the National Institute of Mental Health’s Collaborative Multisite Multimodal Treatment Study of Attention-Deficit Hyperactivity Disorder in Children with Attention-Deficit/Hyperactivity Disorder (MTA), a longitudinal study initiated in 1992 and which determined in 2001 that medication was the best treatment for ADHD. Eight years later, however, researchers concluded that the type of treatment used in the study did not predict functioning six- to- eight years later. One of the authors of the study, James Swanson, concluded: “I don’t know of any evidence that’s consistent that shows that there’s any long-term benefit of taking the medication.”
- There are common side effects to the use of these drugs that make things unpleasant for the child or teen. Some common side effects of psychostimulants include decreased appetite, insomnia and other sleep difficulties, abdominal pain, nausea and vomiting, headaches, and anxiety. While these side effects are usually minor and can often be eliminated by changing the dosage and/or the drug itself, they still are not fun for kids while the doctor is figuring out what to do next.
- ADHD drugs can in rare instances adversely affect the cardiovascular system. Studies have reported the occurrence of abnormal cardiovascular events from psychostimulants like Adderall and atomoxetine (Strattera), including increases in blood pressure and heart rate, and rarely, myocardial infarction, stroke, and even sudden cardiac arrest.
- ADHD drugs can in rare instances result in psychotic episodes, especially in families with a history of mental illness. In one study, researchers compared two groups of children aged six to twenty-ones years, all of whom had one or both parents with major depressive disorder, bipolar disorder, or schizophrenia. Psychotic symptoms (most often, hallucinations) were present in 62.5 percent of youth who had taken stimulants compared with 27.4 percent of participants who had never taken stimulants.
- ADHD drugs may harm bone health. One study discovered that children on ADHD medication had lower bone mineral density (BMD) in the femur, femoral neck, and lumbar spine, compared to the children who were not taking ADHD drugs.
- ADHD drugs may be involved in rare instances of unexplained sudden death. A survey of mortality data for children ages aged seven- to nineteen-years-old revealed a higher incidence of psychostimulant use preceding unexplained sudden death compared to individuals who had never taken psychostimulants and died in auto accidents.
- Children or teens taking ADHD drugs may be at increased risk of being bullied. One study explained that ‘adolescents with ADHD could be at particular risk for negative peer interactions in which the adolescents with ADHD feel pressured to divert their prescription stimulants’’ (e.g. give their prescribed drugs to others for street use).
Important note: you should never discontinue a medication that your child is currently taking or change the dosages except under the direction and supervision of a licensed medical doctor (family doctor, pediatrician, general practitioner, psychiatrist, etc.).
There may be instances where the use of one or more ADHD medications should be prescribed right from the start, especially when the behaviors of the child or teen are proving to be dangerous to themselves or others, or to the property of others, or in other crisis situations where it makes sense to immediately get the child or teen out of a vicious circle of ever more troubling behaviors. However, in most instances, before ADHD medications are turned to, it makes sense, given the negatives listed above, to try non-drug alternatives first. Unfortunately, most physicians who prescribe these drugs have very little knowledge of what types of non-drug alternatives are out there.
The truth is that there are an ever-growing number of cutting edge non-drug strategies that can be tried before resorting to a trial of ADHD medication. These include diet (e.g. a Mediterranean diet), cognitive-behavioral therapy, exercise, time in nature, plenty of sunlight, mindfulness meditation, parent training, yoga, martial arts, attention training video games and neurofeedback programs, proper sleep hygiene, experiential learning in school, and many more besides (see my post on how Omega fish oil supplements may work as well as medications for some kids). The important thing is that these alternatives carry no negative side effects, are associated with a generally healthy lifestyle, and have benefits that go far beyond the quelling of ADHD symptoms.
For a complete description of 101 non-drug alternatives, see my book: Thomas Armstrong, The Myth of the ADHD Child, Revised Edition: 101 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels, or Coercion
(Tarcher/Perigee). The book includes a questionnaire to help parents (and educators) determine which strategies make the most sense for specific kids.
This page brought to you by Thomas Armstrong, Ph.D. and www.institute4learning.com.
Follow me on Twitter: @Dr_Armstrong
10 Reasons Why This Article is Ridiculous
1) This article perpetuates the stigma that children who need medication for their ADHD are “relying on a bottle of pills to solve life’s problems” when, in fact, they are treating a scientifically proven disorder that causes a deficit in the pre-frontal cortex of neurotransmitters that stimulants can improve.
2) This article presents statements about ADHD medication, such as “ADHD medications are often not closely monitored” without citing any evidence or studies to support its claims
3) This article brings up the drug classification and reminds readers that cocaine and methadone are on the same class level (Schedule II) as ADHD medications. This is a false analogy, and is obviously designed to strike fear into people that have no knowledge of how the drug classification systems works. If you wanted to argue the claim in reverse, you could show that opium, ketamine, and LSD are schedule III and, as such, are less dangerous than ADHD medications.
4) This article claims that a scientist who participated in a study of ADHD medications made a claim of its ineffectiveness long-term and used an advertisement for an alternative to ADHD medication as it’s citation of the claim. Furthermore, the quote from said scientist on that advertisement failed to cite any evidence to its claim that this scientist made such a statement
5) This article states the side-effects of ADHD medication without citing any supporting articles or papers to the actual side-effects of the medications.
6) This article makes a claim that ADHD medications can “in rare instances adversely affect the cardiovascular system.,” and cited a study that contradicted its claim. In fact the study concluded that there was “no evidence that current use of an ADHD drug was associated with an increased risk of serious cardiovascular events.”
7) This article claims that “ADHD drugs can in rare instances result in psychotic episodes, especially in families with a history of mental illness,” and cites a study who’s aim was only to imply correlation, and the sample size of this study was well under the necessary number of people to even imply correlation, having only surveyed this study was well under the necessary number of people to even imply correlation, having only surveyed 141 children. Furthermore, the study only surveyed children who’s parents had been diagnosed with a mental disorder and, as such, the claim made “especially in families with a history of mental illness” is, at the very least, misleading, if not outright false.
8) This article claims that “ADHD drugs may harm bone health.” The “study” cited was not a study, but rather anecdotal. It did quote some people refencing a study, but did not cite the actual study itself. Furthermore, the “study” concluded that “findings are too early to suggest a change in practice,” and suggested that the nutritional deficits may rather be the cause.
9) This article claims that “ADHD drugs may be involved in rare instances of unexplained death.” The study cited, like all of the actual studies cited on this remarkably misleading article, were case-control studies which can only be used to identify correlations, and are not scientifically accepted to show actual causation. Even if you ignore the inherent limitation of the study cited, the study and it’s authors admitted that it was a flawed study, with numerous contradiction, the most notable being that their survey could not conclude whether any of the children were diagnosed with ADHD. Not only that, but the study was based on patients where were prescribed Methylphenidate, and before slow release, extended release and other safer forms of stimulants had become available.
10) This article claims that “Children or teens taking ADHD drugs may be at increased risk of being bullied,” and quotes the study as saying that adolescents on ADHD medication “could be at a greater risk for negative peer interaction” because they “feel pressure to divert their stimulants.” Yet the study says (and I quote) “Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription”
In conclusion I submit that this article and its author only make evident how they view the intelligence (or lack thereof) of their audience, consumers, and readers. Being that the article was brought to us by what appears to be a board-certified physician, and author of many books, I was astonished at the level of deceit and moral ambiguity. I look forward to reading and writing reviews of this doctors books, I am sure I will be even more astonished.
I want to thank you for your point-by-point refutation of my arguments in this blog post about ADHD and drugs. I must say you were quite thorough, and I’m glad to see someone actually engage with the text of what I’ve written. I’ve been getting a lot of responses that are simply ”you @$#” or ”I couldn’t even make it past the first paragraph” etc. But you’ve clearly read and thought about this blog post and I stand in admiration of you. You raise the issue that the points I made are debatable and not fixed in stone, and that, of course, is true. No point of view is absolute. In a way, I’m almost glad to get your refutations, because they suggest that ADHD drugs are not as bad as I’ve painted them to be. This would mean that the threat to children that ADHD represents, may be less than I portrayed them to be, and I would want our children to be safe. Whether this is the case, however, is debatable. My role has been to get people to think about the issues critically, and you have responded in kind, and I thank you for this!