Back-to-School, Back-to-Adderall – An Editorial
This month, 55+ million children and adolescents are returning to their classrooms in public and private schools around the country. Out of this number, 6.4 million students have been diagnosed as having ADHD and most of them take psychostimulants or other drugs to control their symptoms. And while parents scurry around anxiously to get their ADHD diagnosed kids ready for school by putting together organizational tools (color-coded folders, calendars, desk organizers), tweaking their sleep routines, scheduling meetings with teachers to fill them in on their children’s federally-mandated 504 plan or Individualized Educational Program (IEP), and meeting with doctors to discuss the best time to get their kids back on meds after a summer drug holiday (25-70% of parents take their kids off medications during the holidays), there are a number of issues that parents and educators should be considering concerning these drugs and this allegedly neurobiological condition which as neurologist Richard Saul points out is defined almost entirely by its three primary symptoms: hyperactivity, distractibility, and/or impulsivity.
The first question would be, why do so many parents take their kids off meds in the summer? The answer would seem to be that summer is a time of fun, games, play, sports, hiking, trips, dreaming, and enjoying life, while school is a time of schedules, deadlines, testings, homework, and discipline. But this raises the question whether ADHD drugs are a type of academic adjustment drug or school performance pill, not unlike the steroids that athletes take to boost their physical capacity. As it turns out, this is not quite the whole truth, because recent evidence from the longest running federal study on the effectiveness of ADHD medications suggest that over the long haul these drugs are actually ineffective, and in addition, on average slow down kids’ growth in height by about two inches. If you add to this research that has linked ADHD drugs to bone loss, cardiovascular problems, the risk of psychosis, and unexplained sudden death, you begin to wonder why parents are plunking down from $288 to $6588 per year for these medications.
The answer, of course, is that parents are desperate for solutions to assist their out-of-control kids, and are helped along by direct-to-consumer ads from pharmaceutical companies that promise, as one Adderall ad does: “Finally! Schoolwork that matches his intelligence. Family hours that last for hours. Friends that ask him to join the group. A trusted solution for ADHD to consumers.’’ But there are a number of other ways to improve behavior and attention span that parents and educators ought to consider. And they don’t involve ineffective and expensive drugs, medical visits, or special education services. These solutions usually aren’t found in the literature being pushed by drug companies and ADHD organizations. Here are four of them:
- If your child is entering first grade from kindergarten and will be one of the youngest kids in the class, consider retaining him in kindergarten for another year. Research shows that the youngest children in a class are 30% more likely to be identified as ADHD and medicated, quite apart from any symptoms they may or may not have (proviso: if your child is young for grade beyond 1stgrade, retaining them for another year may create social and self-esteem problems that are counterproductive). Brain scan studies suggest that the brains of children diagnosed with ADHD develop normally but mature two to three years later than typically developing kids, so they need extra time to catch up within a supportive environment.
- Make sure that your child enrolls in a classroom where there is active learning. One study that compared kids labelled ADHD with neurotypical students under two conditions, passive learning (listening to a lecture, silently reading a book, looking at a worksheet), and active learning (reading aloud, writing stories, interacting with teachers), found that in the active learning condition, there were no differences between the two groups – in other words, the active learning condition normalized the behavior and achievement of kids in the ADHD group. Active learning, of course, should go beyond these things to include teaching academics through games, role plays, field trips, multi-media, and other interactive methods. Meet with your child’s teacher during the first week of school, visit the class when it’s in session, and if you see lots of passive learning, then find another learning environment for your child. You wouldn’t want your child to be in a classroom that makes him physically ill. Why would you accept having your child in a classroom that makes him ADHD? Unfortunately, studies have revealed that the increases in standardized testing and accountability standards in America’s classrooms are one big reason for the 42 percent increase in the number of kids diagnosed with ADHD from 2003 to 2011, the last dates for which official figures are available.
- Stop taking your child to MacDonald’s. For three decades, many parents swore by the Feingold diet or an allergy-free diet as the best way to control hyperactivity. But studies revealed that only a few children were positively helped, and the program required a great deal of family cooperation in sticking to the highly restrictive diet. More recently, a number of international studies have revealed an easier fix. They found that a typical Western junk food diet is associated with ADHD behaviors when compared with a more nutritious diet such as a Mediterranean Diet or one that includes adequate amounts of Omega 3 and Omega 6 oils (oils found in fish like salmon, tuna, trout, herring and sardines).
- Cut way back on your child’s exposure to entertainment media. The average child or adolescent spends over seven and a half hours on video games, TV, the internet, texting, and other high-tech diversions. Studies are now converging on the negative impact this high level of stimulation has on children with an ADHD diagnosis. Consider cutting your child’s entertainment media use back to one to two hours per day (educational media is okay), with no violent media at all, and no media after 8:00 pm when it can disturb sleep patterns. Instead of media, consider reading or playing games together as a family, habits which are associated with higher literacy rates.
Some parents and educators might think these changes are too extreme. I might remind them that what they actually represent is a return to a healthier and more sane life style for our families, and a better education for our kids in school. Would you rather do that, or instead keep giving your child ineffective and potentially dangerous drugs? (Note: Always consult with your child’s doctor before making any changes related to your child’s medication).
- Projected 2017 statistics on 55+ million children and adolescents coming back to school in America come from: ‘’Table 105.20. Enrollment in elementary, secondary, and degree-granting postsecondary institutions, by level and control of institution, enrollment level, and attendance status and sex of student: Selected years, fall 1990 through fall 2025,’’ Digest of Education Statistics, retrieved from https://nces.ed.gov/programs/digest/d15/tables/dt15_105.20.asp?current=yes.
- Figure of 6.4 million children and adolescents diagnosed with ADHD (with most children taking medications – 6.1% now taking meds, 11% have ever had a diagnosis) is from ‘’Attention-Deficit / Hyperactivity Disorder (ADHD): Data & Statistics,’’ Centers for Disease Control and Prevention, Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html.
- Statistics on 25-70% of parents who give their kids a drug holiday is from Ibrahim K, and Donyai P, ‘’Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades’’ Journal of Attention Disorders, 2015 Jul;19(7):551-68. A 2004 survey by Eli Lily & Company indicated 50% of parents of kids with ADHD plan to reduce or discontinue their child’s ADHD medication over school vacations,, reported on Dr. Ned Hallowell’s website: http://www.drhallowell.com/add-adhd/add-students/discontinue-adhd-medication-during-school-vacation/.
- Long-term study on the ineffectiveness and growth stunting effects of ADHD drug use is in; James M. Swanson, L. Eugene Arnold, Brooke S.G. Molina, Margaret H. Sibley, Lily T. Hechtman et al., ‘Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression,’’ The Journal of Child Psychology and Psychiatry,Volume 58, Issue 6, June 2017 Pages 663–678.
- Evidence of serious heart problems associated with ADHD drugs is given in William O. Cooper, Laurel A. Habel, Colin M. Sox, K. Arnold Chan, et al., ‘’ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults,’’ The New England Journal of Medicine, vol. 365, no. 20, November 17, 2011, pp. 1896-1904; The American Heart Association’s guidelines for assessing heart risk before administering ADHD drugs is reported on in Lisa Graham, ‘’AHA [American Heart Association] Releases Recommendations on Cardiovascular Monitoring and the Use of ADHD Medications in Children with Heart Disease,’’ American Family Physician, vol. 79, No. 10, May 15, 2009, pp. 905-910. Evidence of the influence of ADHD drugs on psychotic symptoms is provided in Lynn E. MacKenzie, Sabina Abidi, Helen L. Fisher, Lukas Propper, et al., ‘’Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness,’’ Pediatrics, 137, No. 1, January, 2016, e20152486. The association between ADHD drugs and bone problems is reported on in Megan Brooks, ‘’ADHD Drugs May Harm Bone Health: Study,’’ Psych Congress Network, Thompson Reuters, 2016, retrieved from: http://www.psychcongress.com/article/adhd-drugs-may-harm-bone-health-study-26693.
- Reports of sudden death from psychostimulants is given in M.S., Gould, B.T. Walsh, J.L. Munfakh, M. Kleinman, et al., ‘’Sudden death and use of stimulant medications in youths,’’ American Journal of Psychiatry, vol. 166, No. 9, September, 2009, pp. 992-1001.
- Figures for per year costs of ADHD drugs is taken from Consumer Reports Health: Best Buy Drugs: ‘’Evaluating Prescription Drugs Used to Treat Attention Deficit Hyperactivity Disorder (ADHD): Comparing Effectiveness, Safety, and Price,’’ 2012. Retrieved from http://consumerhealthchoices.org/wp-content/uploads/2012/08/BBD-ADHD-Full.pdf.
- Adderall ad quoted (which shows a mother hugging her son) is displayed in Amanda Marcotte, ‘’Who Wouldn’t Want an Adderall Prescription?’’ Slate, December 16, 2013. Retrieved from: http://www.slate.com/blogs/xx_factor/2013/12/16/selling_adhd_new_york_times_reports_on_the_big_business_of_attention_deficit.html.
- Studies showing a greater likelihood of being diagnosed (and prescribed meds) with ADHD if the child is youngest in class comes from Richard L. Morrow, E. Jane Garland, James M. Wright, Malcolm Maclure, et al., ‘’Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children,’’ Canadian Medical Association Journal (CMAJ), vol. 184, no. 7, April 17, 2012, pp. 755–762; see also, M.H. Chen, W.H. Lan, Y.M. Bai, K.L. Huang KL. et al., ‘’Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Taiwanese Children,’’ Journal of Pediatrics, vol. 172, May, 2016, pp. 162-167; and Helga Zoëga, Unnur A. Valdimarsdóttir, and Sonia Hernández-Díaz, ‘’Age, Academic Performance, and Stimulant Prescribing for ADHD: A Nationwide Cohort Study,’’ Pediatrics, vol. 130, no. 6, December 2012, pp. 10112-1018.
- Study on the long-term disadvantages of retention in first grade and beyond is in: Wei Wu, Stephen G. West, and Jan N. Hughes, ‘’Effect of Grade Retention in First Grade on Psychosocial Outcomes,’’ Journal of Educational Psychology, 2010 Feb; 102(1): 135–152.
- Studies on cortical delay in children diagnosed with ADHD include: P. Shaw, K. Eckstrand, W. Sharp, J. Blumenthal, J.P. Lerch, et al., ‘’Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation,’’ Proceedings of the National Academy of Science, U S A., Vol. 104, No. 49, December 4, 2007, pp. 19649-54; Katya Rubia, ‘’Neuro-anatomic evidence for the maturational delay hypothesis of ADHD,’’ Proceedings of the National Academy of Sciences of the United States of America, December 11, 2007; and Chandra S. Sripada, Daniel Kessler, and Mike Angstadt, ‘’Lag in maturation of the brain’s intrinsic functional architecture in attention-deficit/hyperactivity disorder,’’ Proceedings of the National Academy of Sciences of the United States of America, 111, no. 39, September 30, 2014, pp. 14259–14264.
- The importance of active learning for ADHD-diagnosed kids is in Rosemary E. Vile Junod, George J. DuPaul, Asha K. Jitendra, Robert J. Volpe, and Kristi S. Cleary, ‘’Classroom observations of students with and without ADHD: Differences across types of engagement,’’ Journal of School Psychology, vol. 44, no. 2, April 2006, pp. 87–104.
- The link between accountability laws and a rise in ADHD diagnoses and drug prescriptions is from Farasat A.S. Bokhari and Helen Schneider, ‘’School accountability laws and the consumption of psychostimulants,’’ Journal of Health Economics, vol. 30, no. 2, March, 2011, pp. 355-72; and, Brent D. Fulton, Richard M. Scheffler, and Stephen P. Hinshaw, ‘’State Variation in Increased ADHD Prevalence: Links to NCLB School Accountability and State Medication Laws,’’ Psychiatric Services, Vol. 66, No. 10, October 01, 2015, pp. 1074-1082.
- Statistic on 42% increase in ADHD over past decade taken from: ’Attention-Deficit / Hyperactivity Disorder (ADHD): Data & Statistics,’’ Centers for Disease Control and Prevention, Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html.
- The international research linking fast-food consumption with ADHD symptoms is reported in L. Azadbakht and A. Esmaillzadeh, ‘’Dietary patterns and attention deficit hyperactivity disorder among Iranian children,’’Nutrition, vol. 28, no. 3, March, 2012, pp. 242-9; D. Woo, D.W. Kim, Y.S. Ho ng, Y.M. Kim, et al. ‘’Dietary Patterns in Children with Attention Deficit/Hyperactivity Disorder (ADHD),’’ Nutrients, vol. 6, no. 4, April, 2014, pp. 1539–1553; A.L. Howard, M. Robinson, G.J. Smith, G.L. Ambrosini, J.P. Piek, and W.H. Oddy, ‘’ADHD is associated with a “Western” dietary pattern in adolescents,’’ Journal of Attention Disorders, vol. 15, no. 5, July, 2011, pp. 403-11; Ríos-Hernández A, Alda JA, Farran-Codina A,et al. The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics. 2017;139(2):e20162027.
- Statistics on amount of time children and adolescents spend on media is taken from: Victoria J. Rideout, Ulla G. Foehr, and Donald F. Roberts, ‘’GENERATION M2: Media in the Lives of 8- to 18-Year-Olds,’’ A Kaiser Family Foundation Study, January, 2010.
- The association between media addiction and ADHD is from Ju-Yu Yen, Chih-Hung Ko, Cheng-Fang Yen, Hsiu-Yueh Wu, and Ming-Jen Yang, The Comorbid Psychiatric Symptoms of Internet Addiction: Attention Deficit and Hyperactivity Disorder (ADHD), Depression, Social Phobia, and Hostility, Journal of Adolescent Health, Volume 41, Issue 1, July, 2007, pp. 93–98; and C.S. Andreassen, J. Billieux, M.D. Griffiths, D. J. Kuss, Z. Demetrovics, E. Mazzoni, and S. Pallesen, The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychology of Addictive Behaviors, Vol 30(2), Mar 2016, 252-262.
- A study linking violent media with ADHD is Sanne W. C. Nikkelen, Helen G. M. Vossen, Patti M. Valkenburg, Fleur P. Velder, et al. ‘’ Media Violence and Children’s ADHD-Related Behaviors: A Genetic Susceptibility Perspective,’’ Journal of Communication, vol. 64, 2014, pp. 42–60;
- A study showing a small but significant link between ADHD-related behaviors and regular media use is: Sanne W. C. Nikkelen, Patti M. Valkenburg, Mariette Huizinga, and Brad J. Bushman, ‘’Media Use and ADHD-Related Behaviors in Children and Adolescents: A Meta-Analysis,’’ Developmental Psychology, vol. 50, no. 9, September, 2014, pp. 2228-2241.
- A study on the negative impact of early viewing (before age 3) of both violent and non-violent entertainment television (and the nil impact of educational television) is: Frederick J. Zimmerman and Dimitri A. Christakis, ‘’Associations Between Content Types of Early Media Exposure and Subsequent Attentional Problems’’ Pediatrics, vol. 120, no. 5, November, 2007, pp. 986-92.
- The positive influence of non-technological family activities on reducing hyperactivity are reported on in John Mark Froiland and Mark L. Davison, ‘’Home literacy, television viewing, fidgeting and ADHD in young children,’’ Educational Psychology, May, 2014, pp. 1-17.
- Negative impact of night screen time on adolescent sleep cycles is in: Yvan Touitoua, David Touitoub, and Alain Reinberga, ‘’Disruption of adolescents’ circadian clock: The vicious circle of media use, exposure to light at night, sleep loss and risk behaviors,’’ Journal of Physiology-Paris, Available online 12 May 2017.
Thomas Armstrong, Ph.D. is an educator and the author of The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span without Drugs, Labels, or Coercion (Tarcher/Perigee).