A distracting diagnosis

On the battlefield of university academia, students often struggle under the immense pressure of exams.  Among coffee spills, textbooks, and too many deadlines lie pharmaceuticals that offer saviour to those in their darkest hour:  Adderall, Ritalin, and Dexedrine, to name a few.  The abuse of these wonder-stimulants can ensure focus and serenity, and at McGill, there is often no hesitation when it comes to the decision to take a study pill in the week before midterms. However, an alarming trend in North America suggests the same is being done systematically among adolescents.

In a landmark 1999 clinical study conducted by the Archives of General Psychiatry in the United States, 600 children diagnosed with Attention Defecit Hyperactivity Disorder (ADHD) were found to respond much better to stimulant medication alone than they were to behavioural therapy.  While many use this information to justify prescription, the information must be buttressed by the fact that, according to the University of Michigan, at least one in five of all children living in North America are misdiagnosed with ADHD.

Government-funded regulatory institutions such as Health Canada have already noted a large number of cases describing side effects with regard to the medication and children. In 2006, an official advisory from the organization was issued describing the possibility of adverse psychiatric effects as well as a warning for patients with preexisting liver problems and overactive thyroid glands with regard to many ADHD medications on the market. Drugs like these are processed by the liver, and while a grown adult could handle it, adolescent livers may have some difficulty coping with a constant supply of a drug, increasing risk of organ failure or altered metabolism.

The past ten years in Canada have seen nearly 600 cases of negative reactions to these drugs, of which one-third were situations of severe depression in children under the age of 15. Each case is recorded, organized, and then filed into Health Canada as an adverse reaction report. Analysis provided by the Toronto Star found that the stimulants Strattera and Concerta were the second and third highest suspected causes of reported serious side effects suffered by Canadian kids taking any of the drugs during the ten-year span.

While there are no doubt negative side effects for some, there are many other children who enjoy the benefits of the drugs without any substantial side effects. A research study posted in the British Medical Journal on November 4 cited that consumption of the drug will not incur short term cardiovascular damage.  Children under the watch of proper doctors are in fact expected to flourish with their ADHD under control.

There are many risks to the introduction of such a powerful drug agent during a period where behavioural development is important, often resulting in mood swings or suicidal tendencies. In addition to its risk, the introduction of drug dependence at such an early age could lead to abuse at later ages of a variety of substances. Children begin to learn that problems should be dealt with the application of an external substance and thus relate drugs with solutions to challenges. It comes to no surprise that these medications are listed by the U.S. Drug Enforcement Administration as Schedule II Controlled Substances, implying a risk of dependence and addiction.

Pharmaceutical companies will of course prioritize sales of such drugs above safety and put responsibility upon government agencies to conduct the proper tests. However, federal regulatory agencies are only responsible for approving a drug on the basis of its fatality and toxicity, both of which are often provided by the pharmaceutical companies themselves. Furthermore, regulatory agencies often re-direct the responsibilities back to the companies claiming that since it is their product on the market, it is their responsibility. Health Canada, for example, is often criticized for its dearth of in-house pharmaceutical safety research.

Ultimately, the decision to medicate children or not comes down to parents. A recent article in the New York Times reported a tendency to prescribe stimulants to low-income children without ADHD as an easy solution to improve performance in school.  As one prescribing physician quoted in the article said, “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

British psychiatric researcher Malcolm Peet has another solution: nutrition. An incredibly large amount of psychiatric issues can stem from something as basic as blood sugar levels. Too much sugar, for example, can result in  short-term depression; too little and brain function decreases dramatically.  Dr. Lendon Smith, a best-selling author, reinforces this simple notion by linking lack of essential nutrients such as vitamins and minerals to a variety of different ailments.  Should the right diet be applied, according to Peet, many of the human body’s own hormonal organs can easily resolve symptoms such as lack of attention.  While these answers are the results of proper research, large-scale, long-term clinical studies to fully validate the proposals are still lacking.

In summation, ADHD and their respective medications still present a large ethical issue in which only continual, stringent research and enhanced social policy can resolve.  Until then, a more reliable prescription of a proper diet, good rest, and watchful mentors can aid children in need.