Sometimes It’s Okay

ADHD RemixIn the realm of medically recognized disorders Attention Deficit Hyperactivity Disorder, or ADHD, is considered to be in its infancy. The disorder was not clinically classified until 1987. Since then the number of individuals diagnosed with ADHD has steadily risen from year to year.    Today, it is the one of the most common childhood “neurobehavioral disorder”.

The history of Attention Deficit Hyperactivity Disorder, or ADHD, begins in the 18th Century when teachers and physicians noticed a “mental restlessness” occurring among school-age children. Initially this restlessness was attributed to the child’s unfortunate character, “a morbid defect of moral control”. Behaviors and actions, like fidgeting and inattentiveness, were labeled as maliciousness, disobedience, and/or laziness. Still, research continued to search for ways to correct this problem of morality. Melchior Adam Weikard – the German physician credited with first recognizing ADHD – prescribed exercise and solitary confinement as early methods of treatment; “he is to be kept solitary, in the dark, when he is too active.”  Can you imagine trying that today? Approximately 5% of the children in the U.S. would be locked away.

Perhaps the most compelling piece of evidence that gave ADHD a fighting chance with the medical community was a German children’s story published in the 1840s. The Story of Fidgety Phillip by Heinrich Hoffman is a short poetic narration about a child who cannot keep still at the dinner table. The story includes a variety of behaviors typically associated with those who suffer from ADHD. A portion of Fidgety Phillip was cited in the most prestigious medical journal of 1904 in a report believed to be the first medical report on the condition.  From this point on ADHD received recognition among the medical community as something more that a condition of morality. Psychiatrists, physicians, and scientists started to acknowledge the troubling behaviors as a pathological condition.

The causes of Attention Deficit Hyperactivity Disorder have been linked to a combination of factors such as brain trauma, environmental factors, nutrition, and genes. Research as shown that an individual’s genes play the largest role. The study mapped out the genes of over 1400 children and found that those with ADHD had areas of tissue in the brain that was thinner than the average individual. This thinned out or missing DNA is thought to lead to symptoms of the disorder such as forgetfulness, daydreaming, and squirming. However this “was not permanent”  as most reflected normal ranges of brain tissue by adulthood. Even with “reduced brain volume in the left pre-frontal cortex”  routinely found in children diagnosed with ADHD some scientist continue to argue that it is impossible to know from where ADHD is triggered.

The lack of cohesion among the medical and scientific community about the biology of ADHD has drawn criticism. Some continue to deny its existence, labeling it as a “fictitious disease” that will only lead to a lifetime of troubles. The consensus among these critics follows the thinking of  Melchior Adam Weikard. ADHD is nothing more than a difficulty in life – a challenge of faith -that cam be overcome with good character and hard work. It seems unlikely that these skeptics have ever had any interaction with a child living with the disorder. Trying hard is not an option.

Attention Deficit Hyperactivity Disorder is defined by a wide range of symptoms. While one individual may suffer from impulse control or excessive frenzied energy another will struggle with unstoppable daydreaming and delayed ability to process information. These are not children whose parents have failed to discipline them. To condemn ADHD as a fabrication is what will lead to a troubled life.

In truth the majority of criticism appears to stem from the methods of treatment used for ADHD especially those involving medication. The stereotypical form of treatment prescribed by ADHD is with “methylphenidate hydrochloride and other [medical] stimulants”. These drugs help to regulate impulsive and/or inattentive behavior. Drugs such as Ritalin and Adderall work within the brain to increase dopamine levels in order to sharper motor and attention skill. Such stimulant-based medications create, at once, both a calming and more focus effect on the minds of ADHD sufferers. While it is a paradox, it is one that works. Of course for individuals who do not live with ADHD the effects are extremely different, primarily enhancing the brain’s pleasure receptors.

The medications used to treat Attention Deficit Hyperactivity Disorder can considered highly addictive. For this reason the DEA has labeled these types of drugs as Schedule II Controlled Substances that may only be prescribed by government-approved facilities through a strict set of procedures. Prescriptions come at a high cost. The average cost of a month’s supply of generic versions of the stimulants range from the low 40s to the mid-100s. According to some, amphetamines have become the bread and butter of the pharmaceutical industry. This is why ADHD diagnosis remain steady.

Recently a doctor who once led the drive to legitimize Attention Deficit Hyperactivity Disorder has begun speaking out about the disorder as a pharmaceutical publicity stunt to maintain their industry. In the last ten years prescriptions for stimulants have quintupled, reaching an all time high of $8 billion in sales. Proponents of ADHD drug treatment view these astronomical profits as the bases for companies zeal to only treat the disorder with their medications. With the learning about ADHD still in the early years among the medical community there is fear involving the long-term effects of stimulant-based treatments. This is especially prominent when dealing with individuals who become addicted to the drugs.

It is important to remember that the propensity of a society to over diagnose a disorder does not mean that it isn’t real. The same is true when scientific and medical communities can not come to a common agreement on its point of origin. Children with ADHD are not simply bad seeds but individuals who suffer from a “real neurological problem”. We have to be willing to recognize that more effort might not make the difference. Sometimes it requires a little help from our friends. Although medication may not be the right choice for every child, it can make a difference for some. Pharmaceutical companies will always find ways to make a buck. That is why in the end it is our responsibility to do the research and work together with our medical providers to establish the best line of treatment for each individual.

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