Consider the following scenario. The three most commonly prescribed drugs for attention deficit/hyperactive disorder are all powerful stimulants: ritalin is methylphenidate hydrochloride, dexedrine is dextroamphetamine, and adderall, which is rapidly becoming the most popular, is a time-release mixture of four drugs, dextroamphetamine saccharate, amphetamine aspartate, amphetamine sulfate, and dextroamphetamine sulfate. Occasionally, pure methamphetamine is prescribed, under the trade name desoxyn. All of these drugs have a thriving black market trade associated with their recreational use; of the three commonly prescribed pills, adderall is considered the most desirable and ritalin the least.

Now, the use of stimulants to control a disorder whose main symptoms are hyperactivity seems a bit odd at first glance. The standard medical explanation for this is that the drugs tend to have a paradoxical effect in patients suffering from ADD/ADHD. In other words, they do the exact opposite of what they do to everybody else.

Consider a few more facts. All of these substances take effect a few hours at latest after they are consumed. All of them are quite addictive. In all cases, the medical literature states that full effects from the course of treatment may not be seen for as long as six weeks. Let's break out Occam's Razor.

Now, I could, of course, be totally wrong, but it seems to me that what may be having the "therapeutic" effect are not the actual stimulants, but the body's eventual dependence on the stimulants. Now, I'm not Nancy Reagan (thank God), so I'm not saying that drug dependence is automatically and without qualification morally wrong. But if you consider the fact that many therapists believe that ADD and ADHD are being misdiagnosed far more often than they actually occur (there are currently four million children in America on Ritalin, some as young as 2), the waters get cloudier.

Something awful may be going on. A generation is being raised on medication, for what in many cases may be nothing more than their parents and teachers not wanting to deal with them, simultaneous with a spectacularly ineffective Great Big War on Drugs. The developmental effects of addicting toddlers to stimulants are largely unknown, but it's not exactly a reach to say that they're unlikely to be good.

Historians speculate that one of the reasons that the Roman Empire fell is that the Roman custom of sweetening wine with lead caused collective brain-damage to everybody rich enough to drink wine. It's possible we may be doing the same thing to ourselves.

Note: this is my scholarly, intellectual-style take on this issue. For some good old fashioned fire-breathin' and doom-sayin', see mint-flavored liquid prozac.

Stimulants help people focus, not just people with ADHD. This is a known fact and this is why people with ADHD benefit from stimulant use. There is no "paradoxical" effect at all - stimulants (in small doses) help many people focus and concentrate (note the mighty coder and his one true love: caffeine).

In any case, there is at least one drug for ADHD that doesn't use stimulants (Strattera) though I know little of it (check www.Strattera.com for more information and some creepy looking "normal" kids). Anti-depressants and neuroleptics may also be used (although neuroleptics can cause movement disorders so they are generally the last choice).

Regarding the so-called addictiveness of Ritalin and its ilk, as well as speculation it serves as a gateway drug, I will just quote an article by Michael Fumento:

Further, he says, "There's no evidence anywhere in literature of Ritalin's addictiveness when taken as prescribed." As to the Schedule II listing, again this is because of the potential for it to fall into the hands of abusers, not because of its effects on persons for whom it is prescribed. Ritalin and the other anti-ADHD drugs, says Barkley, "are the safest drugs in all of psychiatry." (And they may be getting even safer: A new medicine just released called Strattera represents the first true non-stimulant ADHD treatment.) Indeed, a study just released in the journal Pediatrics found that children who take Ritalin or other stimulants to control ADHD cut their risk of future substance abuse by 50 percent compared with untreated ADHD children. The lead author speculated that "by treating ADHD you're reducing the demoralization that accompanies this disorder, and you're improving the academic functioning and well-being of adolescents and young adults during the critical times when substance abuse starts."

Some studies have concluded that stimulants may be over-prescribed in some areas but under-prescribed in others (ie/ low income areas). For brevity I won't cite them individually, but feel free to read my sources. It is easy to misdiagnose this condition (for example, a learning disability, petit mal seizures, high intelligence, hearing problems, anxiety, depression, abnormal living conditions such as living with an alcoholic, and other environmental and factors can lead to a misdiagnosis) so diagnosis generally takes a minimum of six months. As in any other condition, misdiagnosis can occur, but it is hardly epidemic, despite what the media may tell you. Unfortunately we get articles and shows such as "Kiddie Cocaine" from CBS (yeah, that sounds even-handed). The NIMH, in contrast, states:

Recent reports (1998 and 1999) found little evidence of overdiagnosis of ADHD or overprescription of stimulant medications.

This relates to the idea that ADHD is a "made up condition" or "bad parenting in action." Unfortunately, it is a very real condition that has little or nothing to do with environment. For example, ADHD children often have siblings that do not have ADHD and the only noted commonality of ADHD home environments is overintrusiveness and overcontrolling of the parents (which is reduced once the child receives treatment) (Carlson et al., 1995 and Barkley et al., 1985).

The physical developmental effects of psychostimulants in children have been the subject of a few studies. They concluded that there are no long term effects to height and weight (Klein & Mannuzza, 1988; Vincent et al., 1990). It is recommended that the height and weight of children on stimulants be monitored as a precautionary measure. Of course, the child's psychosocial development is greatly aided by using psychostimulants. At this time, I am unable to find information regarding any other potential developmental problems associated with stimulants (although stimulant abuse has been shown to cause problems similar to ADHD) but I will update this write-up if I find any (positive or negative).


Sources:
NIMH - Attention Deficit Hyperactivity Disorder. http://www.nimh.nih.gov/publicat/adhd.cfm . National Institute of Mental Health. March 10, 2003
Mental Health: A Report of the Surgeon General - Chapter 3. http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html . US Public Health Service. March 10, 2003
Clinical Practice Guideline Diagnosis and Evaluation of the Child With Attention-Deficit-Hyperactivity Disorder (AC0002). http://www.aap.org/policy/ac0002.html . American Academy of Pediatrics. March 10, 2003
Trick Question: A Liberal Hoax Turns Out to Be True . http://www.fumento.com/adhd/adhdtnr.html . Michael Fumento. March 10, 2003 (I have absolutely no respect for his political views, but his science writing is generally even-handed and he doesn't hide his bias)
Forgot the hardlinks...

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