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Troubling news on attention-deficit medication for young people

Doctors are resorting to drugs to treat conditions for which they are not even approved by Health Canada


 

hitthatswitch/Flickr

Just a few days ago the issue of psychiatric drugs being prescribed to kids having trouble concentrating in class arose in a private conversation I had with friends of high school-aged children. This morning the sorts of troubling questions we talked about were on the front on my morning Ottawa Citizen and an opinion piece prominently featured in the Sunday New York Times.

The Citizen’s story, by health reporter Sharon Kirkey, reported on a Canadian Journal of Psychiatry study that showed a dramatic increase in the prescribing of the latest generation of antipsychotic drugs to kids in Manitoba, a trend the researchers suspect is happening across the country. Most troubling is the finding that doctors are resorting to drugs to treat conditions for which they are not even approved by Health Canada. The scale is disturbing:

“Researchers looked at the number of prescriptions for antipsychotics dispensed for those aged 18 and younger between 1998 and 2008,” Kirkey writes of the Manitoba study. “Overall, antipsychotic use increased from 1.9 per 1,000 in 1999, to 7.4 per 1,000 in 2008. The total number of prescriptions for the newer antipsychotics also increased significantly, from 2,746 in 1999, to 21,320 in 2008.”

In the Times, L. Alan Sroufe,  professor emeritus of psychology at the University of Minnesota, points to reasons doctors might be so inclined to try putting kids on drugs—and on why this tendency to prescribe isn’t, in the long run, good medicine. He cites finding published in 2009 from a study that had been going on for more than a decade:

“The study randomly assigned almost 600 children with attention problems to four treatment conditions,” Sroufe writes. “Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.”

Parents and teachers in my circle, and I suspect across the continent, will find these stories deeply unsettling. It’s not the first time these concerns have been brought to light, but clearly the healing professions and health policy leaders need to take a closer, critical look at what’s going on.


 

Troubling news on attention-deficit medication for young people

  1. I would like to thank Mr. Geddes for raising this important issue, which should be troubling to parents and non parents alike.  Such “new studies” are important to focus on because we all know that science is rarely an unchanging field.  New studies challenge the old, and what was once acceptable, through the rigours of scientific debate and scrutiny, becomes unnacceptable or at least questionable. 

    Above all it is important for the media to duly inform the populace of these important events.

    So sad that regarding the science of man-made global warming, all of the above is erased.   The blind dogma and near religious like adherence makes the above type of reporting impossible.  Just the other day there was another study published in a highly reputable science journal casting doubts on the AGW theory.  A story (among many of late) which should have grabbed headlines around the world, kept secret by the agenda driven media.

    ADHT is a politically safe topic to write about.  AGW?  Not so much.

    • The politicization and hysteria over AGW has reached a point where it’s not longer possible to discuss it rationally.

      When one side of an argument says we will all die unless we do what he says, then there’s no point in arguing at all.  Not only that, you can bet the one side claiming armageddon will do everything he can to silence the other side everywhere that he can.

      However, the truth will always come out, and after another decade with no warming like the last one, it will eventually become impossible for the armageddon crowd to be taken seriously.

    • I am sorry, but talking about global warming and blind dogma however important it is, has nothing to do with medications to helping children and families when there is no other help offered.

  2. Another cultural construct that is doing us immense harm. Now we’re drugging our boys into zombiedom.

    • There is no disciplining going on and then children become impossible to deal with so parents believe they must be mentally ill and need to be sedated.  If you read the Ottawa Citizen article, 70% of the prescribing of antipsychotics is being done by family physicians….many times for something called “conduct disorder”….a nice term for “out of control kid”.

      • I agree….girls are much more controlled and disciplined by their families,  whereas we think ‘boys will be boys’ and let them go….even though all children have ‘high spirits’ and will riot on a regular basis.

        Then when boys are out-of-control, and it causes problems at school….they drug them!

      • If you are a healthcare insider, then you are well aware that physicians can nOT prescribe antipsychotic medication, it is illegal for them to do so. A psychiatrist or psychologist can only do this. I wudn’t say that parents take out of control kids or neglect to parent their kids or discipline right because they medicate. Some children need the medication to help them. You obviously either have NO kids or none with disabilities or ADHD. I have gone from doctor to doctor, clinic to clinic, assessment after assessment, programs out the ying Yang and so on for my son, and there is still no conclusion as to what is the under lying problem and disability he has because he has still 3 – 6 months before he can get a psychological assessment that he has been on a wait list for for 4 years now! There are next to no programs or help offered to kids with disabilities under 10 years old in most cities. If there are any, the wait lists are just disgusting. This is a bigger problem than medication.

        • I am not sure where you got your information Megnfly1978 but family physicans can and do prescribe antipsychotics.  In fact if you read the source document for this article you will see that is the concern of the author in the psychiatric journal.  Also, has been a concern in the past because family physicians have been prescribing antipsychotics for elderly confused people with nasty side-effects.
          Psychologists cannot prescribe medications…they only provide therapy.  My daughter did have ADHD…the problem with attending (no hyperactivity) as a child….I had it too.  Neither of us have it as adults.  I am a psychiatric nurse. 
          If you re-read my comment, you will see that I was discussing a diagnosis called “conduct disorder”, not ADHD.  Maybe you could read up on conduct disorder before chatising me about the comment.
          As for your assertion that their is a dire lack of psychiatric services for children, I am in total agreement.  Funding is very short.  I have nothing but sympathy for the parents of children whose needs are not being met.

    • You have a very poor comprehension of the issue if you think a stimulant such as Ritalin turns our kids into zombies. 

      Even more so if you think ADHD is a cultural construct.

      ADHD has been observed and diagnosed before the most prominent scapegoats causes such as television, video games and food coloring were invented. Even then it is still a poorly understood affliction.

      You would do best read on the subject.

      • I think you’d best do some reading on what countries it occurs in…..and what a recent phenom it is.

      • True, but I’ve long suspected that we’ve been overusing drugs like Ritalin as a supposed “quick fix” that really isn’t. This study suggests my hunch, shared by many I know, may be correct.

        ADHD is real (if perhaps overdiagnosed), but drugs alone are no miracle cure.

        • I know even the people who prescribe stimulants know it’s going to adversely affect the child in one way or the other. They end up considering the effects of not being medicated such as an entire childhood wasted being labeled dysfunctional, suddenly a little stimulant tolerance is not so bad.

          The data from the 20 years research into the lifetime effects of ADD is starting to come in and the results are grim. Lower self-worth, lower level of education, lower wage, higher use of drugs, higher prevalence of violent and impulsive behavior. 

          Suddenly, to a therapist, the point that children develop stimulant tolerance becomes moot. It is just a quick fix, but until we either master brain development or change the entire structure of society, it is a fix nonetheless.

  3. Aside from the good points raised here is the additional problem of medication shortages. As young people become dependent on these medications to “help” them overcome attention deficits, they’ll have even more trouble as shortages of stimulant medications continue in 2012. 

    We need to be helping people of all ages to build their inner “toolboxes” of ways to address issues of attention, and not just try to medicate away the problem.

  4. The “off-label” use of atypical antipsychotics is very troublesome.  As far as the use of stimulants to treat ADHD, I went to a talk given by a child psychiatrist in 2009 and he told a very different story than Dr. Sroufe (who as a Psychologist does not prescribe or use medications in his practice).  This psychiatrist explained how PET scans had shown that children with ADHD’s brains were not “firing” the same way that other children’s brains were and that they had to expend immense energy to keep attention directed on tasks that other kids did not.  As a result, they became fatigued just due to trying to pay attention and keep their minds from wandering during school.  Boys tend to have the hyperactivity component; girls tend to just daydream and never disturb a class.  They all perform poorly and are likely to end up dropping out of school.  They tend to have low self-esteem; many end up abusing substances.  Most of them grow out of ADHD when they reach adulthood.  I do not doubt that therapy is needed.  I am also not surprised that the brain because accustomed to the medication….”poop-out” syndrome is common with many medications.  I think someone should request a referral to a children’s psychiatrist before accepting a diagnosis for their children and definitely before starting their children on any treatments.

    • Sounds like the work of Russel Barkley. Just to add to your explanation, Dr. Barkley explained that the key culprit in both ADHD and ADID is dopamine. Kids with ADD don’t get the same release of dopamine that a normal kid does when they get mental stimulation. The result is that, to compensate for that lack, they must either increase physical activity which results in hyperactivity, or increase mental activity which results in day dreaming. Either way the result is a child with behavior considered abhorrent for the normal classroom format. It’s also why in both cases the children are prone to impulsive behavior; acting on impulse releases more dopamine than acting on instruction or habit. It’s also why they are prone addiction, especially to drugs which stimulate dopamine release.

      The bottom line is we still have a lot to understand about the mechanism of ADD before we can lock in on a definitive treatment, but until then it is important not to demonize them as out of control children and cast them off as useless children, because research also shows that there’s a higher percentage of children with ADD who also has a higher than normal intelligence.

    • Your comments are just about dead on, except most DO NOT grow out of it. It just becomes directed inward, and the mind still races. I have this condition, however don’t tell anyone as there are just too many misinformed opinions, and I don’t need to hear all day long “that’s your add again…”  as always, most people would use it to label you so you fit in a nice little box in their world.

      It is also not a “deficit” disorder, it’s a “distraction” disorder. I have no deficits I am aware of. I waited until mid life to get help. I was trying to control it without drugs. You can’t. It was getting so bad I couldn’t have too many people around because I just couldn’t focus with too much noise/talking etc.

      When I finally went to get help, I told the doctor I had gotten this far without drugs, and he said with a disarming smile ” how is that workin’ for ya?”

      Of course it wasn’t working…..now I take the meds, much better thanks. Nuff said……

      • The children’s psychiatrist also said ADHD is “difficulty attending” disorder, just as you are saying but he did maintain that the majority of children do not have this problem in adulthood although there are definitely who do not grow out of this and he sees them as adults with this problem who he sees when he treats their children.  (I am only repeating what the specialist said in his presentation).
        I also attended a talk given by a psychiatrist at UBC who was a specialist in Bipolar Disorder.  She found her practice that she was treating alot of patients who ended up with a dual diagnosis of ADHD and Bipolar Disorder.
         

    • Actually, most do not outgrow it. That was an old myth from the 70s and 80s that has not been borne out by subsequent follow-up studies. 

    • I have a son who is 6 yeas old and has a lot of problems in school because of his ADHD and learning disabilities. He tends to fall asleep in class, be disruptive, wanders the halls if left unattended, and can’t focus. He is on adderal xr and an antipsychotic, neither of which have shown any improvement in him. Yet his psychiatrist says to keep giving it to him. His sleep patterns are so far out of whack, he is hyper as can be and has many learning disabilities. He got his report card today and in reading, writing and language skills he got an ‘R’. That is a grade so low it is not gradeable! Yet in science, where he is hands on he got a ‘C’. He can not read, he can not write and he can not count past 11. He has no concept of time, has no long term memory, has speech delays and attention problems. This is not something I take lightly or put off and would say doesn’t need help from a psychiatrist or medications. I wouldn’t want him on them long term, but I also know what he is like without medication. He can be aggressive, have very bad tantrums, he is overly forgetful and has a hard time comprehending most things said to him. I would suggest if you have a child like this that is 7 years or older, get them a hearing test for auditory sensory disorder. ( I think that is the right name for it). This can tell you in great detail if there is more to why they are acting out the way they are, sometimes it has a lot to do with their hearing and how they hear things. Regular doctors are not able to prescribe antipsychotics, it is illegal, so if one is prescribing them, I would be turning him in!! Because a doctor doesn’t know the first thing about psychotics, that is why there are professionals called psychiatriste and psychologists!
      I have seen other kids who live in my area who also have ADHD and they are bad, bad, bad! They get in trouble with the police, fire department, school… they are just off the wall and these are the ones who do not tke medication or don’t take it as prescribed. I know a boy just 9 years old removed fom his mom’s care because he set fire to a school, was stealing, and worse! And he was on meds! So, I think it is a lot to do with the right meds for the right problem/disability for the right child. It’s hit and miss… no one is the same and ni one reacts the same to the same things.

  5. Perhaps the problem is a pathalogical education paradym that requires druging a subgroup of the normal variations in human personality in order to fit into their one sized fits all education mess.

  6. For instance,  the following reportage is kept safely on the fringes.  No global warming for the last 15 years (despite a massive rise in man made CO2), the obvious flaws in the “computer models” predicting global warming, and strong evidence of the Sun’s impact on Earth’s temperatures, is being widely studied by some of the best scientists in the world.  Don’t expect that to be in headlines for some time.  Fair reporting of studies contra AGW will likely get a journalist uninvited to the next coctail party and the cold shoulder treatment in the newsroom:

    http://www.dailymail.co.uk/sciencetech/article-2093264/Forget-global-warming–Cycle-25-need-worry-NASA-scientists-right-Thames-freezing-again.html

     

    • This thread is about ADDs, not GW….something already well known and accepted, so give it a rest.

      • “Troubling news” about a science related study important to many of us, seemed like a good opportunity to juxtapose the press’ unwillingness to do the same vis their pet issue of AGW.

        You are free to not read my points, and doubly free not to take the time to comment on them.  As a likely AGW supporter, I understand your frustration in the public’s unwillingness to take their cues from the still compliant media on this issue – to “give it a rest”.

        But given the frequency with which such revelations are now occuring, you may find it less frustrating to simply accept this new evidence (or at least ignore it as most in the press are doing) rather than attempt to thwart the public airing of it.   Just a suggestion.

        • No….you just have your half-baked talking points and want to insert them everywhere.

          Stop it.

        • I still have an open mind re AGW – not 100% convinced either way. But here’s what I’ve noticed about the anti-AGW side: they tend to be driven by a fear of what it will cost them if true. They want their energy and resource consumption to go on unabated and with no increase in cost. It seems a very self-focussed viewpoint.

          Many of the things proposed by thr AGW proponents are good ideas in terms of stewardship of the planet and its resources even if AGW is a myth. The antis by and large seem not so much interested in the truth or falseness of the theory as much as they are in their own self-interest. Navel-gazing in extremis.

          • Our modern way of life is wholly dependent on affordable energy.  Everything in our homes and offices, was mined, developed, and transported via fossil fuels.  Everything.  From the toothbrush we use in the morning, to our beer we drink in the evening is dependent on it.

            Placing an artificial cost on the use of fossil fuels will have a single effect – it will lower the standard of living of most, and absolutely devasate those in the lowest socio economic order.

            Like the good intentioned banning of DDT which caused the deaths of millions in malaria, the fallacy that doing “something, anything” is better than nothing lays bare the truth that the road to hell was paved with good intentions.

          • Economics 101…for centuries

            Find a cheaper, better, alternative.

          • There is plenty of middle ground, but people like you simply don’t care to listen. In the long run, the cost to our health and the environment will be much higher if we just bury our heads in the sand.

            I drive a car because I need one – and I like the freedom. But it’s a fuel-efficient one in part for environmental reasons and in part because it saves me money. I try to reduce my waste; I recycle or reuse as much as I can. I generally look for ways to reduce the amount of environmental damage I do – within my ability to do so. I can’t always afford the greenest choice.

            Do all the proposals of the ardent greenies make sense? Are they all affordable? No. But too many people (and you seem to be one based on your comments here) seem intent on throwing the baby out with the bathwater.

            We need our dreamers; we need our pragmatists. Finding a balance moves us forward in a way we can afford. It may cost more than you’d like and may mean less radical change than the more ardent would like. But we will change; the question is, will we choose it and control it, or will we wait until it is forced, by necessity, upon us? The latter will give you a few more years of gluttony, but will likely make the inevitable change more painful & costly.

            Forget about whether AGW is real or not; in the long run we will still have to change our ways. Live with your head up your butt & you’ll get left behind.

    • Oh good grief.

      Look, unless or until someone in the “denier” group is prepared to offer an explanation as to why the standard model of particle physics would somehow be wrong regarding the LONG ESTABLISHED Green House Gas effect, in addition to being able to dispute the only existing model that explains why the earth has maintained liquid water on its surface for billions of years, i.e. the CO2 Rock-weathering Thermostat Model, then I will continue to ignore them.

      The simple fact is that the CO2 Rock-weathering Thermostat Model is the only existing model for a reason. No one has even suggested another model because the evidence has become overwhelming in favour of the existing model. Talk to a paleo-geologist or paleo-climatologist if you want the skinny on that, or check out this lecture.

      http://www.agu.org/meetings/fm09/lectures/lecture_videos/A23A.shtml

      The only area in which there is any debate is the predictive modeling. Over the short term it is very difficult to predict the progression and timing, because we don’t understand fully all the micro-level interactions.

      Over the long term however, there is little doubt that we are heating the planet, and that we may trigger some very startling tipping point effects. The fact that we can’t predict the progression is therefore actually a further reason to be concerned, rather than the anti-evidence the “deniers” believe it to be.

    •  Be careful about your sources. The Daily Mail is a terrible source of real news let alone scientific information.
      There was no citation of where the graphs or the information for the graphs came from, they were just interspersed about random quotes from many different authors.
      Compare the job they did with the information found here,
      http://data.giss.nasa.gov/gistemp/graphs_v3/

      Your sources make your argument. Even with a scientist writing the article editors and the like can force revisions that while sexying up the article introduce certainties where there were none and scares where non were intended originally.

    • How does AGW make it into a conversation about ADD/ADHD? You’ve got your acronyms mixed up. 

  7. If we don’t want parents to be skipping vaccines for their kids, then we need doctors to avoid the quackery and over-reliance on drugs as described in this article.  You can’t be faulting parents for their skepticism in one area while there are clear reasons for skepticism in other areas.

  8. “points to reasons doctors might be so inclined to try putting kids on drugs”

    Overwhelmed and over Oprah’ed misandrist single moms, prodded by overwhelmed and over Oprah’ed feminist grade school teachers?  The vast majority of those drugged up kids are boys – it’s straight up war on boys and your article should have mentioned that.  Women should never be given custody of boys, as an evidence-based analysis confirms that they are really bad at raising them.

    • Ah yes, it’s all the fault of women.

      ‘Blame yer mom’….the age-old cry of wimps.

      • Midol’s a hell of a drug.

        • I wouldn’t know….I never tried it, and I’m now 65.

          Kindly get a grip.

    • Hahahaha….please provide the study info that “confirms that women are really bad at raising” boys.  Given that approximately 95% or more of the world’s “boys” were raised by women while men went and worked, played golf, hunted, fished and did whatever else it is that they did outside the home…..that is truly an assinine statement.

      Why do doctors medicate kids??  You mean the kids who are failing in school…kids who cannot sit in their seats;  kids who spend all of their time sitting outside in the hallway or in the principal’s office….kids who have no friends because they are irritating and impulsive and are always in other kids’ faces and their parents are always being called to the school….and now their parents are at the end of their tether and want to drop them off at the hospital or give them up to social services….  Gee, my guess is that the doctor is making a diagnosis of ADHD and is prescribing the accepted treatment of stimulants hoping the child and family will experience peace and success.

  9. I have a child with ADHD who is on 2 medications. One for his AdHD and an antipsychotic. I don’t think the problem is the number of children being given these drugs, it is disturbing how many children NEED it. There are hardly any programs out there to help young children suffering from disabilities or ADHD. All the resources have wait lists that are years long. My sin has been on one with the Hospital for almost 4 years and we just got a call today saying he can get an assessment through them in 3 – 6 months! School’s don’t provide a whole lot of help, options and or programs. If you ask for help with assessments, they tell you they won’t do it until they are at least in grade 3. And they only sponsor 2 kids per year per grade… depending on the school. Other places like Luthorwood, The front door program, etc… also all have wait lists either months or years long. In the mean time, your child and yourself are struggling to live each day in the unknown of what to do and what is really wrong. Sometimes medication is good. If other kids are like mine and are little hyper people with so much energy, aggression and frustration all the time, then you do what you must until the cities you live in and doctors get their shit together and offer more help and options for young children in need of the help. Don’t be so quick to bash the drugs that help children just because you dn’t think they are good, or these damn politicians who either do Not have kids or have a child with ADHD open their yaps about something they have NO experience in!

  10. i was a ritalin zombie for 8 nightmarish years. i barely remember my childhood. never again

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