About My Generation and Me

ADD/ADHD is a puzzling disorder, being difficult to diagnose, frustrating to experience, and controversial to treat. I chose to blog about this topic because I have ADD. Words flow into my brain, but my frontal cortex fails to process them into any meaning. Words go in one ear and out the other. Although I have tried Adderall and Ritalin, done all different types of cognitive therapy exercises, and been tested by many caring consultants, I have not figured out any easy solution to my dilemma – school is a difficult task for me. My own experience is being repeated in pediatricians’ offices across the country with many anxious parents and confused children who move through the offices, receive adjusted prescriptions, and return to school medicated and expected to behave and achieve within a certain range. I believe that many children in our generation can relate to this problem. I also believe that many healthy or “normal” individuals are taking medications to simply enhance their academic performance. In today’s society, our generation is a generation to watch in terms of the neurological enhancements more and more people are ingesting. It is important for all individuals to consider this new lifestyle because it is relevant to all modern consumers. Elanor Williams and Mary Steffel’s address this trend perfectly in the Journal of Consumer Research article stating that “some of these products are intended to ‘enable’ people who are functioning at a disadvantage due to illness or disability to perform up to their full potential, and some products are meant to work to ‘embellish’ otherwise healthy, well-functioning people to advance beyond that level.”[1]

                                

Diagnosis

Scientists have not yet identified a particular area of the brain which corresponds to a deficit such as ADD and school psychologists have not agreed on a clear cut set of symptoms which require treatment. So how can ADD be accurately diagnosed? This trend is disconcerting because it is extremely difficult to diagnose true ADHD/ADD accurately. Now, it appears that many people are trying to figure out ways to obtain these enhancement pharmaceuticals to be used as “neuro-enhancement” as opposed to treating a true mental disorder. According to Nancy Shute of NPR, these pharmaceuticals are used as “smart drugs” or “study drugs” that give students a competitive mental edge on studying. [2] This trend of high school and college students obtaining these drugs on the black market to enhance their academic performance is actually being mainstreamed into the practices of some pediatricians. In fact, it might even be embedded in our culture as standard procedure. For example, it is much cheaper and easier to prescribe stimulants than it is to afford non-pharmaceutical interventions such as cognitive behavioral therapy, extra tutoring, and hands on teachers. Alan Schwarz quotes pediatrician, Dr. Michael Anderson, in his New York Times article as saying that “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”[3]  What is interesting to note here is that Dr. Anderson is prescribing medications for his low-income elementary school patients who have poor grades in much the same way that wealthy students use stimulants off label to improve what could be considered satisfactory grades. Clearly, the drugs are being used increasingly, but whether they are self-prescribed, doctor prescribed for ADHD or learning enhancement, diagnosis is problematic. The standard procedure for diagnosing ADHD is described by Ryan D’Agostino in Esquire magazine as lasting twelve minutes being based upon a short questionnaire, checking some boxes, and listening to a short report from frustrated parents.[4] Diagnosis is tricky enough when it is being done in a pediatrician’s office for real behavioral problems, but how can one safely take that and apply it to people who only want to get an advantage in school?

Side-Effects/Addiction

Because diagnosing ADD is such an inexact science, it seems questionable that using amphetamines would be the proper and only solution for treatment especially because of the extreme side effects and addictive nature of the prescriptions. These medications affect appetite, sleep and mood. According to Alan Schwarz, the effects of long-term usage are not well known and it is possible that children may develop dependencies on the drugs that last well into adulthood.[5] Nancy Shute points to the fact that Adderall and Vyvanse can be addictive and, in fact, are in the same category as Schedule II Controlled Substances, Oxycontin and morphine. She lists a wide range of side effects for the most prescribed ADHD drugs including aggression, mood and behavior changes, twitching, shaking, insomnia, sudden high blood pressure, irregular heartbeat, and seizures. [6] Ryan D’Angostino writes ADHD stimulants have been linked to incidents of sudden death related to patents with heart problems. Users may develop bipolar conditions as a result of taking the medicines. Some of these stimulants can cause paranoia, facial tics, and even suicidal thoughts. [7] Given all of these potential negative health consequences, the trend towards using these drugs purely for education enhancement very troubling.

Effectiveness

While the side effects are frightening, do they outweigh the benefits of these medications to treat under-achieving students with real behavioral problems? Do the side effects limit the mass appeal of these drugs and their emerging performance enhancing possibilities? The drugs are effective. Ryan D’Angostino is adamant that “Yes, the drugs these children consume may work. They help them focus for longer periods of time. They help them do better in school… And Everyone’s happy because the kid is now under control.”[8] Simon Outram, in the Journal of Medical Ethics, states “that the slow-release action of methylphenidate works to improve the concentration abilities of people diagnosed with ADHD, by controlling excessive production of dopamine.” And, in healthy adults there is improvement in spatial working memory and executive function. [9]  So although there are many negative side effects, the benefits may go beyond simply treating ADHD symptoms and actually do point to positive behavioral results in healthy adults who want to improve their performance. 

Trends

The barrier between enhancement and treatment is breaking down.  The line between enhancement and treatment is becoming less black and white and becoming more ambiguous. This is because more and more children are being diagnosed with ADHD and are being prescribed with cost effective stimulants to alleviate their symptoms. And, more and more people are using the stimulants simply to enhance already satisfactory performance. But, as a permanent trend, are consumers going to be fully accepting of the use of this medication as fair? Here is what we know: Diagnosis of ADHD has increased from 3% of American children to 11% in 2013 and between 2008 and 2012 sales of ADHD drugs have grown by 89%. [10] 

The statistics show that the trend is here to stay. What are some of these reasons? It is possible that more kids genuinely have attention problems. Reasons for this lack of attention are as follows: too many electronic devices, too much refined sugar, pharmaceutical companies promoting ADHD medications, lack of exercise in school.[11] Specific research has even shown that public policy like the “No Child Left Behind” Act has actually fueled this trend by requiring students to make certain cut offs on standardized tests.  Steven Hinshaw, a professor of psychology at UC Berkeley, suggests that because of this policy more under-achieving low-income children are being diagnosed with ADHD and prescribed drugs as a result the pressure of these federal requirements. [12]

Looming Questions

The stage is set. It is clear that drugs such as Methylphenidate are being administered in order to achieve educational success with or without an official ADHD diagnosis. What is happening in our culture is that there is a changing way of looking at the use of these drugs. This new framework is “the product of a changed social context in which the barriers between enhancement and treatment are already breaking down.” [13] People are becoming more accepting of these drugs as fixes to alleviate school pressure. Although there may be people that argue that unless there is a really accurate diagnosis for a specific medical issue, children should not be drugged because of the unknown long-term developmental effects. It appears that our consumer culture is trending away from that. These drugs are now being used just as steroids are used in the sports industry to improve performance of professional athletes. There are uses for steroids that are for certain illnesses, but there are illegal uses for these drugs for athletes to get ahead of the competition. There are laws and policies to address this issue in sports of unfair advantage. So the question now for these emerging trend in today’s society is how will we as a society manage the distribution of the neurological enhancement drugs and to make sure the playing field is fair for people who have been officially been diagnosed with Attention Deficit Disorder?

References

D’Angostino, Ryan. “The Drugging of the American Boy,” Esquire Magazine, Esquire.com, April 2014. Retrieved December 10, 2014. Print.

Outram, Simon M. “The Use of Methylphenidate Among Students: the Future of Enhancement?” BMJ, Vol. 36. No. 4 (April 2010), 198-202. Print.

Schwawrz, Alan. “Attention Disorder or Not, Pills to Help in Schools,” New York Times, nytimes.com, October 9, 2012. Retrieved December 10, 2014. Web.

Shute, Nancy. “Neurologists Warn Against ADHD Drugs to Help Kids Study,” National Public Radio, npr.org. March 14, 2013. Retrieved December 10, 2014. Web.

Williams, Elanor; Steffel, Mary. “Double Standards in the Use of Enhancing Products by Self and Others,” The University of Chicago Press, Vol. 41 No. 2 (August 2014), 506-525. Print.

Photos Sources

1.    Source: oneradionetwork.com

2.    Source: specialedpost.org

3.    Source: cchrint.org

4.    Source: IMS Health

5.    Source: coachingforadhd.com

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[1] Elanor Williams and Mary Steffel. “Double Standards in the Use of Enhancing Products by Self and Others,” The University of Chicago Press, 506.

[2] Nancy Shute. “Neurologists Warn Against ADHD Drugs to Help Kids Study,” National Public Radio, 1.

[3] Alan Schwarz. “Attention Disorder or Not, Pills to Help in Schools,” New York Times, 1.

[4] Ryan D’Agostino. “The Drugging of the American Boy,” Esquire Magazine, 3.

[5] Schwarz, 3.

[6] Shute, 2.

[7] D’Agostino, 2.

[8] D’Agostino, 27.

[9] Simon M. Outram. “The Use of Methylphenidate Among Students: the Future of Enhancement?” BMJ, 199

[10] D’Agostino, 3.

[11] D’Agostino, 5.

[12] D’Agostino, 8.

[13] Outram, 201.