Wednesday, July 31, 2013

ADHD Symptoms and Why Drugs Don't Work

For many years, Ritalin and Adderall have been the most common treatment for ADHD symptoms. Many people, including physicians who ought to know better, still believe that children who suffer from attention deficit disorder have an "inborn defect" which makes them different from supposedly "normal" children; as a result, central nervous system stimulants such as Ritalin have a "paradoxical effect" (the theory goes) upon them, calming them down and helping them to focus rather than exciting them. In a recent article from the New York Times, Dr. Alan Sroufe of Minnesota's Institute for Child Development disputes this theory and shows that these drugs had exactly the same effect on radar operators during World War II; he also found that "all children, whether they had attention problems or not, responded to stimulant drugs the same way."

In other words, children who suffer from ADHD symptoms don't have an inborn defect, and there's no evidence for the supposed "paradoxical effect" of the most common ADHD medications. Ritalin and Adderall are stimulants -- "uppers", as we used to call them during my youth -- and anyone who has relied upon them to get through exams week understands their short-term benefits. Like other amphetamines, these drugs help you to focus your attention and to engage in "boring" tasks (like studying for your biology final) for an extended period of time -- say, that all-nighter while you're cramming.

As the body adapts to these drugs, the short-term benefits often fade (just as the short-term benefits of taking anti-depressants fade after 6-8 weeks). They also have unpleasant side effects such as sleeplessness and loss of appetite, feelings of dullness and changes in personality; they've also been linked to intermittent psychotic episodes. Anyone familiar with the side effects of other drugs that affect neurotransmitters in the neural synapse (the SSRIs, for example) has to wonder if nerve damage may also result from using Ritalin and Adderall long-term.

As with adults who stop taking SSRIs for depression, children who discontinue stimulants for ADHD symptoms also demonstrate the "rebound effect"; their behavior worsens, which then convinces parents that the drugs were actually "working", when in fact their children's bodies have adapted to the drug in their system and strongly react to its withdrawal. Adults may have a similar response if they suddenly stop drinking coffee or quit smoking. For similar reasons, the worsening of depression symptoms after stopping the use of SSRIs often convinces patients that the drugs were actually "working".

Due to aggressive marketing by the APA and the pharmaceutical industry, along with the nearly universal wish to believe that psychiatric problems and societal ills can be solved by taking a pill, physicians and parents have come to rely on medication as the preferred mode of treatment, especially when they hear of studies showing brain anomalies in children who suffer from ADHD symptoms. If you're familiar with the work of Allan Schore, you know that brain anomalies also result from failures in early attachment, during the first year of life. It's quite likely that ADHD symptoms and the brain scan anomalies found in children who suffer from those symptoms result from experience.

Since 1995, Dr. Sroufe and his colleagues at the Minnesota Institute for Child Development have been following 200 children born into poverty, thus more vulnerable to behavioral problems. His and other epidemiological studies have found that the environment of the child is a better predictor for the development of ADD problems than IQ or infant temperament, including activity level. These studies tell us that what happens to you during infancy and early childhood will shape you (and your brain) for life.

I have close friends whose son, born prematurely, suffers from ADHD symptoms. His premature birth and the experience of those early months of life color his family, peer and academic relationships to this day. I've known others who suffer from attention deficit disorder, with family backgrounds full of chaos and instability which likely influenced the development of their ADHD symptoms. Helping someone recover from such early deficits is a highly complex and difficult challenge; it's so much easier and deceptively comforting to believe that you can prescribe your way out of the problem, rather than trying to do something about the complex interaction between societal woes, family fragmentation and neurological development. In a similar vein, it's much simpler to buy into the widespread belief that SSRIs will cure your depression than face the facts: making a meaningful difference in your state of mind means engaging in the difficult and long-term work of psychotherapy.

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