Afternoon Inquisition 10.22.08

In the 1950s, approximately 7,500 children were believed to have mental disorders that required medication. Today, one in ten children has been diagnosed with an attention disorder and prescribed stimulants for treatment. And this figure doesn’t include kids that have been prescribed antidepressants, antipsychotics, or sedatives. In total, about 1,000 times more kids are on medication for mental disorders than were 50 years ago**.

Have kids changed that much over the last 50 years? Or are other factors at play?

Much of the social landscape has changed over the last five decades. Dual income homes are common now, and parents are often tired and stretched thin before even coming home to spend time with their kids. The pharmaceutical industry is allowed to advertise, encouraging self-diagnosis and patient-initiated medical requests. And the diagnostic criteria for mental disorders have been altered to include behavior once considered normal. Is it possible that it isn’t kids that have changed, but simply the environment in which today’s kids live?

Certainly, some children have legitimate disorders that are best addressed with medication. But are we drawing the line in the right place, so that we are medicating only those that truly need it?

**Skeptical Inquirer Vol. 32 No. 6, page 32 (not available online yet)

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  1. Is it possible that it isn’t kids that have changed, but simply the environment in which today’s kids live?

    That’s a False Dichotomy. I am seriously enraged and I refuse to answer the question. I am outraged. I am Indignant. I am superfluous.

    I am a Hedge

  2. I see four options with regard to that question:

    – kids have changed
    – society has changed
    – both kids and society have changed
    – neither kids nor society have changed

    There’s no dichotomy. It’s just a question.

  3. My own unjustified belief is that the increase in medication is mostly due to less stigma associated with mental disorders and a change in attitude from “just suck it up”. However, I do think that some are diagnosed too casually so that the line is now slightly over what is proper.

  4. Perhaps medicating children has become ubiquitous because:

    1. We are aware of a much greater range of mental and emotional problems than we were in the 1950s.

    2. Drugs to treat such conditions are now available, whereas many of them were not available yet in the 1950s.

    3. Attitudes toward mental/emotional illness have changed, making them less stigmatized.

    4. Parents aren’t allowed to beat their kids anymore, so what else is left besides drugs?



  5. Up until relatively recently, there were very few drugs which were applicable to kids. You could argue that either a) in the past, no drugs existed for many common disorders (i.e. you can’t prescribe what doesn’t exist) or b) currently avalable drugs are over-prescribed and a “solution in search of a problem”. It’s probably a little of both.

  6. You can now get antidepressants for your dog.

    If this doesn’t indicate an over-prescribed society, I don’t know what does.

  7. This one hits close to home for me. Both of my sons have been diagnosed with ADHD. My older son also has a diagnoses of Aspergers and my younger son has a diagnoses of dyslexia which seems to run in my family.
    For a long time I resisted putting my kids on any kind of medicine to treat the ADHD. About 6 years ago I relented and they were put on Straterra. It had a wonderful effect. Two boys that I couldn’t get to sit still long enough to help them with their homework were suddenly asking follow up questions when I would try to explain something. It was wonderful. At the beginning of this school year both boys asked to come off the medicine. They think they can function without it. They haven’t taken it since school started. I can see they are struggling but they are making it.
    I think they drug allowed them time to see how other kids acted and now they are using that to model their own behavior. I hope that this works becuase I have never liked giving them a drug to regulate their behavior.

    To answer the question. I think that both society and kids have changed. We have better options for treatment now. A kid who had trouble sitting still when I was in school was beaten. I know. I was often that kid. Now they have the opportunity to take a pill that allows them to sit still and learn what the teacher is teaching. I think that is positive.

    We have better record keeping than we used to, also there is less stigma attached to mental illness than there once was. I think that is positive also.

    Yes, some people are puting their kids on drugs so that they don’t have to be parents. That hasn’t really changed. People used to pour cough syrup down their kids throats to shut them up or gave them alcohol or television or just ignored them. Nothing is perfect.

    I think it is better but I think it still needs a lot of work. Especially for boys. I think it is much worse for boys now.

  8. How much of this “they can’t sit still” is due to inactivity coupled with sugar intake???

    Children are like cocker spaniels: Ya gotta let ’em run around for 2-3 hours a day to burn off all that excess energy or else they just destroy your furniture.

  9. I know that my brother was grievously misdiagnosed with ADD. He was on Ritalin for years, and it made him sick and miserable, and made me sick to have to see it.

    I think that part of the problem is a school system that doesn’t have the time, energy, or resources to accommodate any kids except the lump in the middle of the curve.

    The dialogue about my brother went like this:

    Parents: He has ADD!

    Me: How do you know?

    Parents: He’s bored in school all the time!

    Me: Yeah! Because school is boring!

  10. One day I “predict” that we’ll come to realize that many pathologies in children are actually externally caused, rather than internally caused. For instance, we take 30-40 kids, stuff them in one classroom to be treated as if they’re all exactly the same. When there are kids that are inevitably *not* inclined to sit for 8 hours a day and stare and listen, they have a “problem”. Now of course, there are certainly children that are poor self-regulators and do require extra intervention, but I suspect the number of those children is probably far less than the number of children who are diagnosed with those issues. And sometime it’s a matter of “the school system is what it is, it’s much easier to mold the child to fit that with medication than revamp the whole school system” — which I think is a major societal issue that needs to be addressed.

    Now…can we establish some rules for the AIs? I propose a moratorium on such comments as:
    1) Fake/real complaints of false dichotomies.
    2) Fake/real complaints of the terms being ill-defined.

    I still love you all, but seriously stop bitching and just answer the frigging question…or not.

  11. I have to agree with mxracer652. We have to look at what we’re putting into our bodies. Kids eat way too many sugar/processed foods and they aren’t getting outside to play as much. This could explain a lot of the not being to concentrate/extra energy. I have the same philosophy as my mom. When they told her I had too much energy and I should be prescribed ritalin, she told them no. She felt I was just being an average kid. I quickly grew out of it and became a great student. Most kids between the age of 4-12 shouldn’t be expected to sit still for hours at a time and not daydream or wish they were at recess.

    I think this issue is completely different from drugs that are used for mental health issues. Part of me thinks they are more prominant today because of the scientific advances in the area, but there is always that underlying thought that they are being pushed and fueled mostly because of doctor/drug rep relationships, pharmaceutical greed, etc. I need to look into some studies about this, now I’m curious!

  12. The question of whether ADHD is being over-diagnosed is best left to scientific study rather than people’s opinions.

    However, I would like you to consider the other alternative for a second.

    I always found schoolwork to be super easy, but social situations were very difficult. I was endlessly trying to interact with people, and being frustrated by my inability to maintain friendships. I could have a great five minute conversation with anyone, but that was always as far as it went. Then, after a lifetime of frustration and depression, I went to a psychologist and discovered that I had undiagnosed ADHD. Now I’m on medication, and my ability to think straight in social situations has drastically improved. But 35 years of social awkwardness is difficult to fix, and I am often overcome with the thought of how my life could have been different if I had gotten the help I needed when I was young enough for it to matter.

    ADHD affects a person’s ability to THINK. It changes the way the brain works. And being able to think is kind-of important. All this talk of “they just need exercise” is totally misinformed.

  13. With no evidence to back me up, just based on my interactions with students, parents, and instructors as the “helpful hubby” of a public-school teacher, I have a few ideas.

    I think the change in diagnosis has a few factors working in concert:

    1. We have learned a lot about the brain and the mind in the past 50 years, leading to better diagnostic tools and treatment regimens.

    2. We’ve had a cultural shift: it’s not such a big deal to be on medication for a mental disorder. We no longer assume that all mental disorders mean someone is stupid, nor do we feel the need to hide it when our children have something wrong with them.

    3. Teachers and parents are aware that these things exist, and teachers in particular are trained to look for signs and report them to parents and officially. While intended to make sure that a kid with a learning disability of some kind (and ADD and its ilk do count) gets help as early as possible, the system also produces a lot of false positives.

    4. It’s much easier for a parent that’s having a difficult time with their child to get medication than it is for them to get and implement parenting assistance (e.g. qualified advice). This is, in part, because no parent wants to believe that their child’s behavior problems could be the result of mistakes they’re making.

    These factors combine to make it much more likely that a parent will seek out medical assistance for a child with behavioral or learning problems, and have the side-effect of substituting pharmacology for training in far too many cases. Since the disease is difficult to diagnose accurately, the fastest diagnosis path is often to prescribe the meds and see what happens.

    Unfortunately, parents often see what they believe to be “marked improvement” and never return for followup work.

  14. @Gabrielbrawley: I agree with your point that the way we treat children has certainly changed. I think part of why ADHD was less diagnosed is something like what’s going on with autism — we didn’t know what it was and when kids had issues we just beat it out of them, hid them away, etc. Medication certainly is progress in that regard.

    However, are we sure that there aren’t alternatives (such as changing the structure of the school day, changing the sensory and motor stimulation provided through out the day, etc) that could be implemented in school to reduce medication dependence and associated financial burden, particularly in milder cases?

  15. If anyone heard Classrooms to Power (BBC Radio 4 Sunday 10.45pm) going through the school days of Churchill it’s clear he would have been chemically coshed with Ritalin if it’d been around then.

    He went to a school which had the express purpose of breaking the boys both physically and emotionally. Once for stealing some sugar at the age of 8 he was beaten bloody and to within an inch of his senses. What was his response? Did he keep his head down and behave? No, he broke into the Headmaster’s office, stole his hat and spent a day in the woods kicking it! And was only EIGHT!

    The problem is we just want kids to placid zombie, especially the boys. What were once considered positive qaulities such as being energetic, assertiveness, leadership and so on now seem to be frowned upon.

    I don’t think it’s the diet, at least in the UK, as our diet has improved since the 70’s (people ate lard daily, DAILY, back then).

    Personally, I think its a combination of the decline of competitive sport in schools (PE used to be something you did every day) and paradigm shift from “90% Male ex-army and or industry teachers who could deal with teenage boys” to “90% female pschology graduate teachers, who went from school to uni straight back to school without any work experience, who think the best way to deal with testosterone filled boys is to talk about ‘feelings’ ”

    Thats why we turn out 18 year olds who can barely add two numbers together, but can write poems about how they feel about that all day long and grown men who cry at the first sign of adversity

  16. Many kids are diagnosed by family doctors who do not have the expertise but the parents and school WANT SOMETHING DONE. So if you look at the DSM4 and realize that the best research indicates that about 3 to 4% of children could reasonably be diagnosed with ADD/ADHD (real impairment of interpersonal and academic functioning) and that the medications have been proven to be extremely effective and safe then the only reasonable conclusion is that there ire far to few children being appropriately treated for ADD/ADHD. As for mental health issues like Bi-Polar disorder and others doctors have only recently been using these diagnoses on children as previously the diagnostic criteria only allowed for an adult diagnosis.

    It s an easy ‘throw away’ statement to proclaim children are over medicated. But consider that a child diagnosed with ADD/ADHD who is being treated is much less likely to drop out of school, smoke, have traffic accidents or get involved in illegal drugs. The problem with this is what? And it’s always easy to find an exception or someone who was unfortunately misdiagnosed. However as mentioned by Gabrielbrawley there are new drugs that are much more effective for some folk than the more commonly used stimulants. Sadly some people with ADD/ADHD often have co-occurring issues such has ODD, OCD or depression in varying degrees. Many professionals, people in the entertainment industry and average working folk maintain their careers and employment because of regular medication. I know two ER doctors who are quite ADHD and also quite bright. The other thing to remember is that a medication does not make decisions for someone; medication can often allow the person to make a more appropriate decision that they would not otherwise be able to make.

    Environment certainly can be an issue. More often than not I expect you tend to have parents with similar problems and disorders as their children. ADD/ADHD has been shown to be inherited in around 80 to 90% of children who have been diagnosed. This has significant implications for the types of families children often come from who have been given a mental health diagnosis. Kinda like getting up to bat and already having one strike.

  17. @Stacey:

    Gosh Stacey, you’re going to ruin my prize, but I don’t want you to think I’m really upset about your question. You see, it’s a bit of an ongoing gag, mocking people who keep insisting that every A.I. is a false dichotomy, instead of just relaxing a bit and answering the dang question. At worst, they could ignore it. It was especially annoying to me a couple days ago on the “Good vs Evil” question. So I decided to indignantly predict that the next AI would be a false dichotomy. Then a.real.girl made things difficult by asking a question that wasn’t a false dichotomy at all, but I still had to pretend. That was going to be the end of it, but then Elyse said there was a prize, but I didn’t win it because I was only kidding. So I had to try harder today. Of course, if you have a life and don’t follow my silliness from day-to-day, it just looks like I’m being a jerk about your question. It’s all Elyse’s fault for dangling some undefined prize in front of me. Think of it like Saturday Night Live. It may have been a tiny bit funny, but it just went on way too long.

    It really is a good question.

    Oh look, I’ve upset Kimbo too.@Kimbo Jones Sorry Kimbo.

    I’ll just go hang out in the yard for the rest of the day.

    I am a Hedge

  18. @James Fox: While medicating children who need it is certainly acceptable, medicating children who may not need it is a problem because it’s not like meds affect people in a vacuum, only treating the symptoms they’re supposed to and moving on. They have side effects, they’re expensive, they are a powerful social symbol when having to be taken at school, etc. It’s our job as a society to make medication less of an issue, but we also need to be conscious that it’s not being used as a band-aid.

  19. @Darren
    Never wanted to be “ilk”. Or is it that I have “ilk”. Perhaps my diagnosis is “ilk”. I don’t take medication for “ilk” or feel “ilky”, but for what I got, my medication works really well.

    Good for you taking the necessary steps and finding the information to make an informed decision.

    People are not “chemically coshed” by Ritalin. To say so is ignorant, ill-informed and an opinion that’s likely the result of watching to many “current affairs” shows on TV.

    @Kimbo Jones
    Some frightfully ignorant speculative, pop media informed twaddle. (guess I’m a little crankey meself). Many medications, and most with regard to mental health issues, treat symptoms. It’s the symptoms that suck and cause problems. Being distracted and impulsive and not being able to concentrate is a symptom. The medication treats it! (Band-aids do help injuries) Also there are many ADD medications that are taken once daily and do not involve a school dose.

  20. @Im a Hedge: I appreciated your efforts to get the prize, and it made me smile that you were first up! And now the first to get knocked down. Or would that be a hedge trimming.

  21. @James Fox: For your information I’m not pop media informed. I’m graduate school trained in the health care field and you’ve misunderstood my statement in your haste to assume I’m an idiot.

    Obviously medications treat symptoms. But they also have other physiological effects. It’s naive to think that you can take a medication and feel great because your initial symptoms are relieved. For example, many antipsychotics cause gynecomastia — i.e., men can grow boobs — and tardive dyskinesia. Sure their hallucinations are gone (and maybe not even entirely gone), but they have boobs to deal with and the can’t control sticking out their tongue. Try socializing when you have terrible self-esteem because of your illness and now poor body image on top of everything else.

    Considering all that is ignorant now? I’ll have to make a note.

  22. Back in the 60’s our son was one of two children in his class who spent his time (literally) crawling under the teacher’s desk and running around the room. With the help of Ritalin (all that was available in those days) he settled down, went on to college, earned a double-major degree and is now the Executive Director of a foreign language school. He, too, reached a point where he decided he no longer needed chemical help and did just fine without it. BTW, the two kids in his class taking drugs works out to one in fifteen; not too far off from today’s one in ten.

  23. @Kimbo Jones: Amen, sister.

    @braak: Amen, brother.

    @mxracer652: Can you come babysit for me?

    @Stacey: So wouldn’t the choices be:
    (a) Kids have changed; society has not changed.
    (b) Kids have not changed; society has changed.
    (c) Both kids and society have both changed.
    (d) Neither kids nor society have changed …

    Actually, wasn’t the question about whether we have drawn the line in the right place? xoxoxo

  24. @Kimbo Jones: Yes there are often tough decisions to make with regard to the side effects of many medications. A responsible medical provider will discuss these with a patient and some times having to deal with the side effects is the best or only available option. Generally serious side effects like you mentioned are not very common. And I fully agree that socializing with physical, cognitive, mental health and processing impairments can be exceedingly difficult.

    And yes I can get a little impulsive at times when responding, but my apparently misguided assertion that your were misinformed was not meant to imply stupidity.

    Webmed just sent me a medication advert link by e-mail while I was typing this response. Amazing timing.

  25. @James Fox: Side effects being generally uncommon is not an excuse for prescribing drugs to kids who might not need them or are mild enough such that other life adjustments and treatments may be effective for similar symptom-relief. (Incidentally, tardive dyskinesia is relatively common, increases with number of years on the drug, and is permanent.)

    Also, responsible doctors can educate patients all they like, but if the patient can’t or won’t listen, how effective is the explanation? And maybe the parents are listening and understand, but does the child fully understand the potential long-term impact of medication treatment?

    So my answer to the question (are we drawing the line in the right place) was “maybe, but we have to be really careful and here’s why”. I agree with a lot of what you’re saying, but the system just isn’t as clean as “kids has problem, doctors explain it to their parents, kid takes drugs, problem solved”. People don’t necessarily fully comply with drug regimens, understand the medications, or read the educational materials they’re given. Given the vulnerable position that children are in, I think it’s perfectly reasonable to be concerned about the possibility of medicating them unnecessarily (or perhaps necessarily with poorly-understood long-term implications).

  26. I do think that, although some cases are certainly justified, kid’s are being seriously over-medicated these days. I mean, I’ll use myself as an example – I’ve recently been diagnosed with ADD – I think the main reason it was never a huge deal is because I actually like school (shockingly enough), but my doctor did consider prescribing me Adderal (sp?) My mom was all for it – hopeful that it would allieviate my incredible spacy-ness and horrible memory – but I’ve seen how badly medication like that can screw people up, and I opted out. I guess my point is I think that often, people take these medications who don’t really need it, and parents are eager for anything that would make their job as parent a little bit easier, perhaps naive to the possible consequences.

  27. In the 17 years I’ve been a physician ( as both an internist and a pediatrician ) I’ve seen no difference in frequency of making a psychiatric diagnosis between then and now, but I cannot speak for generations past and now. However, there have been changes in treatment.

    Stimulants are the cornerstone ( though this sounds paradoxical, think of people with ADHD as simply dopamine deficient in the ventral tegmental region and frontal cortex region of their brains and it makes more sense because the meds simply increase levels of dopamine there ) but other non stimulants have been tried with varying success rates. The gold standard remain the stimulants. In 1999 a 600 person, landmark study by the National Institute of Mental Health, entitled Multimodal Treatment Study, compared methylphenidate to counseling alone , counseling with meds, and dietary modifications. The bottom line is that stimulants were found to be significantly superior to counseling and dietary modifications have no effect at all. Counseling slightly improved the effectiveness of meds.

    Since then meds have been found to improve ADHD 70% of the time. If one fails, another may still work.

    Depression is a far more complicated issue as recent findings cause the APA to issue a warning about treating adolescents with SSRI ( prozac -like )meds. Suicidide rates were found to be higher in these kids.

    So what is the present situation? Here is my take , as a clinician, and as a lecturer on ADHD, on meds and kids?

    First of all increasing dopamine will improve executive functions, which are the higher cognitive functions that allow us to organize and prioritize information. These executive functions include but are not limited to attention, focus, emotional stability, effort, decision making, etc. Bottom line is, they allow us to effectively problem solve. ADHD should be cause EXECUTIVE FUNCTION DISORDER as ADHD only trivializes and minimalizes the dysfunction.

    What I know:
    1. Meds work on adhd and they work well , allowing kids not only to problem solve better, but to restore self esteem, which is a huge positive effect.

    2. Not all kids need meds. As with most things in life there is a normal curve which describes severity. Meds are needed for those with moderate to severe ADHD and those who behavioral modifications fail.

    3. There are rigid standardized tests that a clinician must choose from and administer in order to make the diagnosis of ADHD. Criteria must be met before treatment.

    4. Unlike a lab test which is “relatively” black and white , the scoring of ADHD tests are based on completely subjective answers, which can be biased by those filling out the test including the parents, the teachers, and the clinician. Multiple sources minimize bias and , in fact, are required to some degree, in that one cannot diagnose ADHD if it ONLY occurs in school OR at home.

    5. While there is a pharmaceutical presence in offices, it is completely insulting to think that I, or other physicians, cannot read a broad review of literature and go to conferences, to find the most accurate information, no matter how complex the answer or how difficult the subject. I have never met a colleague who solely bases his or her opinion primarily on what one pharmaceutical company presents. This information is highly regulated by the FDA and the penalties are significant if a representative of a pharmaceutical company violates the policy.

    What I don’t know:

    1. Whether or not the present rate of 3-5% of ADHD found in the population represents an increase compared to generations ago – because the definitions have changed and even the name of the entity has changed – and who knows if this “dysfunction” represents a leftover previously productive evolutionary phenomenon or if it’s a consequence of stress or modern life.

  28. @Kimbo Jones: Didn’t say it was and all the reasons you mentioned for not appropriately treating someone with a mental health diagnosis seem based on an isolated example or are emotive and/or anecdotal. Not to mention the insulting presumption that many people ignore their doctors prescribed medication regimes and their is somehow a reason for not prescribing a needed medication. Many working productive people with a ADHD diagnosis would be unemployed substance abusing bums were it not for the benefit of their medication. What having boobs as a result of long term use of an antipsychotic has to do with this is beyond me.

  29. @halincoh: As ineloquent as I have been this evening, I certainly didn’t mean to sound like I was accusing doctors of purposely and irresponsibly doping up kids (for ADHD or any other health issue), so I hope I didn’t come off that way. My experience in imperfect Canadian socialized health care may differ from the American (or other) perspective, but I generally agree with everything you said.

  30. I am the teacher in an Alternative Education Middle School. I have students who have been removed from regular schools. Most of my students are on some type of prescribed medications. We can usually tell after few minutes if student has forgotten to take his medication. Several of our students cannot be maintained, even in my classroom, after missing only one dose.

    I do not know about the past, but in my experience these medications are the only thing keeping the students that I work with out of institutions or jail.

  31. While many medical professionals are quite careful about doing things correctly, many more are under-qualified and over-worked, especially in rural america and when you look at those dealing with the lower income levels. Whereas (in the US at any rate) if you have good insurance you can afford expert opinions, if you don’t you typically get a Physician’s Assistant or Nurse Practitioner who is working basically unsupervised and is doing the best they can. The problem is they are being asked to handle things above their qualifications by the system we have in this country.

    One of the things to consider about medications and their side effects: Side effects are simply unwanted reactions to a medication – if that side effect helps another condition, you now have an “off label” use. In other words whether something is a side effect or not solely depends on if you want the result.

    As to getting bent because it was suggested people don’t follow directions with medication – get over it – they don’t in a statistically significant percentage of the US population. If a little helps some more will help better right? That is all too often the way abuse starts. If people always followed directions there would be a lot less abuse of medications in this country. It isn’t insulting anybodies intelligence to suggest so when it is a provable fact.

    And what medications are abused? Stimulants. Analgesics. Depressants. Psychotropics. How many of those are prescribed to children for behavioual issues? The stimulants and Psychotropics for sure.

    @ halincoh: Drug Detail Men have been gaming the system for YEARS. And they still do, especially to low income clinics. (They call it charity support strangely enough – give free meds to a clinic and the Rx rate of those meds skyrockets at said clinics).

    And let us not forget the items the Detail men give to remind you of their products: Pens, Stationary, luggage tags, magazine subscriptions (with advertisements for their meds in said magazines), etc. No it isn’t the golf clubs and trips of the 60’s 70’s and 80’s, and the cash kickbacks have always been illegal (though you read about those schemes being uncovered still to this day), but it still happens. Tell me – if you are writing a script for a person with depression, and your using a pen and a Rx paid provided (and advertising for) the makers of Paxil, how much more likely are you going to be to write Paxil? Good old subliminal advertising still works.


    Now before I get off of my soapbox understand this: I’ve worked in the medical profession. My grandfather was a DO, his wife designed the laboratory at more than one hospital, as well as running his office. My mother has worked in hospital billing and admitting departments. I was diagnosed with Epilepsy at 4, had one school suggest Ritalin for me, had so called “experts” claim I would never learn to read or write. Been There, Done that, worn out that T Shirt.

  32. @James Fox: A couple of things, I feel someone should bring up possibly.
    1. Where did you get the impression that Kimbo was stating that a person should not be treated properly for a mental illness because of the potential side effects? From my understanding she seemed to be stating that if the drug’s side effects out weigh the benefits in a particular situation of a particular case, they probably should be avoided. I never found any reason to assume that she was stating that these drugs should not be used ever in any case.
    2. Many would be unemployed, drug-addicted bums? Really? I have a real hard time believing that and I am one of those for whom Ritalin and later Adderall did in fact help. While this is purely anecdotal, I have known people who were diagnosed much later in life (in one case a lady in her mid to late sixties, she was an executive at the company my dad works at by the way) and most were pretty productive before they were diagnosed. Sure the meds actually improved their mental concentration and social interactions etc., but they were far from being drug-addicted bums. This isn’t to say that a few might end up that way, and maybe that’s what you meant by “many” but to imply that any large, significant portion would be without providing the relevant references to back up your claims is pushing it.
    3. The boobs thing Kimbo mentioned was in relation to her point about side effects and unnecessary use of medications. By unnecessary I mean to say, any instance where a person, child or otherwise, is being medicated despite not having a sever enough case to warrant it. She could have just as readily used Ritalin or Adderall as examples as they are amphetamines and they do have fairly significant side effects (appetite suppression, insomnia, eye twitching, and a couple of others I can’t readily recall). Though they are rare in most cases, they aren’t non-existent and if a child is not ADHD, or only mildly ADHD, this could result in some major issues. She, however, chose the drug(s), I presume, she happens to be most familiar with as examples of drugs that have a very positive effect in some cases but in others the side effects of which may not be worth the benefits.

  33. Argond – if you think a PEN … a friggin’ PEN is going to influence me, that is not only an insult … it’s absurd.

    Furthermore, in the right hands, samples save poor patients from going without.

    And finally , if we docs are in our right minds, the writing on our pens or pads mean nothing in terms of our decision making.

    There are good and bad craftsman in every profession. There are men and women of honor and dishonor in all walks of life. And yes, we humans, we docs, are all influenced by many variables. So bad stuff happens for many reasons and quite honestly, most of what does happen is minor. Overwhelmingly though, good care, honorable care, and well thought out care is what is delivered. Mistakes will always happen in all walks of life. Practicing intentionally deceptive medicine, however, is RARE.

  34. I’m glad the detail men’s little ploys don’t work with you – that is a wonderful thing. Unfortunately I HAVE seen little stuff like that get people’s business. And your kidding yourself if you think it doesn’t happen.

    Yes the free samples help a lot of people, including people I know personally. But the fact remains that it also steers business to those products.

    Intentionally Deceptive medicine is rare I am sure. Sloppy medicine is not, unfortunately.

    And to any health care professional who tries to not be influenced by the things the detail men can give them – THANK YOU.

  35. I think we are beginning to understand how some mental illnesses we see in adults–bipolar, in particular–play out in children.

    I would have greatly benefited from some medication as a kid. I tried to commit suicide while I was in 5th grade. And again in high school.

    Yeah, my family life wasn’t great–but that is not normal, and had there been medication available when I was a kid, it sure would have saved me from a lot of trauma.

    Our entire family has a long history of depression, bipolar, and suicide. I see it in my aunts, uncles, and cousins. We need the drugs. It’s appropriate.

    Is that true of everyone? Probably not, but I see a huge amount of clinical depression in the students I work with at the college level.

  36. also–I happen to know about dyskinesia, since I worked on antipsychotic drug research for a while.

    That is a side effect for schizophrenia drugs. It is NOT common for other behavioral medication. There is really no other treatment for schizo other than drugs–and it truly is life changing.

    It is not a good choice–but for the most part, man boobs are still better than permanent involuntary hospitalization for severe cases.

    A lot of what we work with now are blunt chemical instruments. Hopefully as we understand brain chemistry better, we will refine our tools.

  37. @killyosaur42: Yes, you’re on the right track with my comments.

    Having gone back and read the thread, I think part of the apparent confusion surrounding my comments is that I was answering the question in general (as it was a general question) and somehow my comments got roped around ADHD only.

    My initial comment was about all child pathologies — which could include ADHD, but mainly ODD, conduct disorder, depression, etc.

    My next comment (my only comment about ADHD) came from something I read in an ADHD book called “An ADHD Primer”. So that may be inaccurate and I’ll certainly change my mind if someone gives better evidence, but I didn’t just pull that out of my ass.

    My next 3 comments were to illustrate that medication isn’t as simple as “take the pill, feel better, no consequences”. That is based on my academic studies. I was *not* saying that *no* children should be on medication. That’s ridiculous.

    All of this was in answer to the question “But are we drawing the line in the right place, so that we are medicating only those that truly need it?” and not “please give a personal example of where ADHD medication worked for someone who obviously needed it” (no offense).

  38. @bug_girl: I did not bring up dyskinesia in relation to behavioural medication, but as an example of side effects to drugs. I’m familiar with antipsychotics, so that’s what I used. Perhaps I should have used something else, but my point was: drugs have side effects.

  39. @Kimbo Jones:

    All of this was in answer to the question “But are we drawing the line in the right place, so that we are medicating only those that truly need it?” and not “please give a personal example of where ADHD medication worked for someone who obviously needed it” (no offense).

    My personal example was more directed at James Fox as a showing that I am not against the use of medications when they are necessary, and was not really in response your point. I was trying to be perfectly clear, and show that I do not in any way oppose the use of medication where it is in fact useful and necessary.

  40. @darren: If you think things have changed about being on meds for a mental illness, let someone, especially someone with power over you (like your employer) know about it. Then sit back and watch. The prejudice will enlighten you greatly. I keep my mouth shut except for very close friends about all medications.

    @all: One major problem is that psychiatry has continually medicalized things that aren’t medical problems. The DSM-4 has been continually revised by psychiatrists in thrall (via payoffs and goodies) to drug companies. This is why we have so many ridiculous “diseases” – they make drug companies lots of cash.

    Note: Drug companies regularly sponsor “tests” of their products and suppress results that they don’t like. This is a matter of public record and has been revealed in numerous lawsuits.

    @halincoh, it is true that most doctors aren’t swayed by giveaways. It is equally true that doctors, like anyone, can be swayed by misleading or incomplete data about their tools and methods. This has become a major issue for the AMA Journal among others – The drug company-sponsored trials are sneaking into print under the guise of “scientific studies” that are really marketing-based and skewed in favor of the drug producer.

    This is also why, although there are many cases of health problems like ADHD and ADD, they are ridiculously overdiagnosed. I say that both from a patient and from my wife’s experience as an RN/BSN.

    Given a mental health issue, I would much rather see a clinical psychologist, which is a psychologist with an MD that has as few drug company goodies on display as possible.

  41. Rather late to the party here…

    I recently picked up a book entitled My Lobotomy. It’s by a man who, in an time before ADHD and ritalin were acknowledged, was given an “ice-pick lobotomy” by parents desperate to control their child’s behavior.

    While I think both are cases of misdiagnosing “undersupervised childhoods” as a problem of the kid, the ability to give kids drugs to control them probably encourages the trend; parents who would never dream of lobotomizing their offspring will be happy to drug them because there’s no physical harm done.

  42. Any discussion like this about the pros and cons of a medicated society, whether for children or adults, must include a duscussion of pharmaceutical corporations and their various ways and means to profit.

    While drug companies do indeed provide some good stuff that helps improve our lives, they are nowhere within even a distant moonshot of being white knights on shining chargers. Like any major corporation they are mandated to make a profit at any cost: make a profit, or die.

    There is a great deal of legitimate research (proper scientific studies and research papers not usually available online except for a fee), available in your local library on the profoundly deleterious, harmful, anti-society practices of all the major phrmacorps form the distant past right up to the present. It just takes some time and effort to dig it up.

  43. @SicPreFix:
    It sounds like you may have looked into this a bit. With the stipulation that things could be improved, do you think on balance the pharma industry has been a plus or a minus?

    I am a Hedge

  44. My son has been diagnosed with dyslexia and Aspeger’s. I hope saying that latter bit doesn’t invoke skeptical wrath. He’s not on any kind of medication/diet, for the record.

    He’s in sixth grade. With the exception of this year and kindergarten, his teachers have insisted he be tested/medicated for ADD or ADHD. Every year.

    This year, however, he’s in a program designed for Asperger’s kids. It’s going reasonably well.

    One year, the school insisted we have him tested. We did. The doctor was, of course, immediately convinced that he wasn’t ADHD. He’s not! He has other conditions that the schools were not equipped/trained to deal with. In fact, New Mexico public schools do not recognize dyslexia, period.

    …I can’t tell you if kids are statistically over-diagnosed. I can’t tell you where “the line is drawn” in our society. My kid was labeled ADHD, repeatedly. But not by experts. And I think that’s the most important point: deciding your kid needs medication without expert opinion to back it up is wrong. Wherever “the line” currently is, where it should be is a discussion for experts. Not laypeople like me.

  45. @Im a Hedge:

    That’s a really good question. I don’t know. Sorry, but I just can’t come to a decision.

    Some of the plus-side stuff is so big, so powerful, like vaccines, and some of the negative-side stuff is also so big, like selling thalidomide (as recently as 1998) to third world countries as a headache and morning sickness rememdy that I just don’t know.

    Frankly, I would need to do a great deal more research before I could make up my mind, and perhaps that can’t even be done.

    Pharmacorps represent one of the most powerful lobbying agencies in the Western world. It’s a very tough call.

    In the last decade there have been several high-profile instances of doctors, both practising and research, who have lost their jobs and their tenure because they gave a drug company’s latest whiz-bang a cautionary, or worse, report.

    Hospitals, universities, colleges have all lost research funding because someone on the staff published negative reports on phramcorps drugs and/or practices.

    It’s a very big issue, and I don’t know exactly where to sit on that fence.

  46. @SicPreFix:

    That’s a really good question. I don’t know.

    I like meeting people who are comfortable saying that, but uncomfortable knowing it.

    I am a Hedge

  47. Agreed, SicPreFix, Hedge.

    That is a very underused phrase in today’s world. I’d look up to any politician that had the guts to say that on the stump.

  48. SicPreFix has a good point when he says that many of the documents are out there if you look for them. I also think that many people are convinced that if they DID look them up, they wouldn’t be able to understand them.

    I have found that, given the appropriate references, education, brainpower and time, most of us can understand enough to make a good decision on most topics that we care about.

    Unfortunately, people tend to defer to authorities too much in our culture. If one of my kids had been diagnosed with something life-changing like ADHD, I would be doing lots of reading, lots of questioning and seeing many other authorities before I made any decisions about treatment and/or medication. I do not say this to disparage anyone on the list who has had to deal with this in their own lives or to criticize anyone’s decisions. It is just that I live by my avatar’s name: “Question Authority.” I neither completely believe nor trust authority figures without sufficient independent corraboration. My stance would be “Show me the evidence that led you to this conclusion.”

  49. I’m literally alive because of Pharma, so I’m biased. If you took my drug away, I might live another 12 months, if I was lucky. And I would be in pain for 6 of them, and possibly in a coma for the last few weeks.

    I’m also a registered Green, though, so I absolutely abhor the corporatism that they employ. It should be a (more-heavily) regulated industry.

    On the whole, though, I like living more than I hate corporation.

  50. @killyosaur42: I was more referring to the general tone of this thread than you specifically. But, understood. Thank you. :)

    @JRice: This is similar to what I’ve experienced. I used to work at a children’s hospital and I’d commonly see kids who were on medications from their family doctor to treat illnesses that weren’t yet formally assessed or diagnosed due to wait lists with psychiatrists. They had to go by parent and teacher reports.

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