Anyone else disturbed by this?
One in 10 North Carolina Kids Given ADHD Status Mon Feb 4, 1:24 PM ET
By Jacqueline Stenson
NEW YORK (Reuters Health) - As many as 10% of North Carolina school children have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and many of those youngsters are taking medication for the condition, researchers report.
This percentage is significantly higher than national estimates of 3% to 5%. Yet the new report, as well as a handful of other regional studies, indicate that ADHD diagnosis and treatment may be much more common than previously thought, the investigators note.
“We found that 10% of elementary school children…had received a diagnosis of ADHD by a doctor or psychologist and 7% of the children were being treated for ADHD with medication,” study author Dr. Andrew Rowland told Reuters Health.
The new findings “make me question whether the 3% to 5% figure could possibly be valid,” said Rowland, an epidemiologist at the University of New Mexico in Albuquerque, who conducted the study while at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina. The results add fuel to ongoing concerns that too many youngsters are being treated for the disorder.
“Medication treatment often is very helpful for children who have ADHD,” Rowland said. “But on the other hand, if it’s not followed up well and the diagnosis is not made according to standardized criteria, that’s when you start to have problems.”
Symptoms of ADHD include inattention, hyperactivity and impulsivity that can lead to academic underachievement and troubled family relationships.
In the study, conducted from 1997 to 1999, parents of 6,099 children in grades 1 through 5 at 17 public elementary schools in Johnston County, North Carolina, completed a survey asking them whether their children had ever been diagnosed with ADHD and whether they were currently taking medication to treat the disorder.
Results published in the February issue of the American Journal of Public Health, journal of the American Public Health Association, showed that 607 children, or 10%, had been diagnosed with ADHD and 434, or 7%, were taking Ritalin or other treatment medication.
Boys were three times more likely to be diagnosed with ADHD than girls, and both sexes were about equally likely to receive medication after diagnosis. However, black and Hispanic children received fewer prescriptions than white youngsters, perhaps because they had less access to healthcare, the researchers suggest.
Johnston County has both rural and urban areas, and its ethnic population is similar to that of most of North Carolina, according to Rowland. As a result, he said, the findings probably apply to the rest of the state and perhaps neighboring states in the South as well.
He said his findings are in line with other regional studies, such as a 1995 Virginia study showing that 8% to 10% of young school children were taking medication for ADHD.
However, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a book widely used by doctors to diagnose mental illnesses, estimates the prevalence of ADHD at 3% to 5%, Rowland noted. The problem, he said, is that solid national data on ADHD do not exist.
“We really need other studies like ours and national monitoring data to know whether the experience we saw is unusual,” Rowland said. “Having that information is important for understanding the dimensions of the impact of ADHD.”
Re: ADHD in NC
Only if the receive any federal or state money. If they are completely independant. they are not required to provide any type of special education services.
Re: ADHD in NC
What I find disturbing is 3-fold:
1) if this report is completely accurate, including all children identified having correct diagnosies, then ADHD is at least twice as prevalant (at least in Johnston County) as is previously thought, based upon the reporting of schools. As ADD/ADHD has defied any efforts to show clustering for any reason aside from certain areas having better services available, whether real or perceived drawing families in. Aside from that ADD/ADHD has been found as frequently across all strata of society in similar prevalance rates. This would mean that there are twice as many children with ADD/ADHD as we now know of, and this mass of children are not receiving any type of services or other inteventions in other areas.
2) if the children identified in this survey are NOT all prorerly classified as ADD/ADHD, then Johnston County has a medical community that is handing out the diagnosis inapproriately. There are other conditions which mask as ADD/ADHD, notably certain forms of dyslexia and very high functioning autism, neither of which are approriately treated with the stimulant medications as are helpful for some children with ADD/ADHD. Assuming the true rate of prevalance of ADD/ADHD in Johnston County is the same as what is currently held to be true (3-5%), we have a rather large group of children medicated (7% according to this study) inaapropriately. Whild Ritalin and other stimulants have shown to be very helpful for some children with ADD/ADHD, they are not without side effects and certain risks. Recently it has come to light that Ritalin physically changes the structure of the brain in the same way as other stimulants (such as cocaine) causing among other things increasing dependancy, even when taken in therapeutic dosages, and this risk is beleived to be greater in younger children than older ones. It has also been found to cause cardiac problems in some children, again like other stimulants, even when taken in therapeutic dosages. So if children who are not ADD/ADHD are being medicated, they are being allowed to face these risks wrongfully, while their true condition (or perhaps none at all) is being left untreated.
3) why is this just now coming to light? Where has the State of NC Dept of Ed been in looking into this apparent cluster? How many other communities in NC (or any state) have similar “explosions” of ADD that are also being overlooked? We still do not have all the answers concerning why some children have ADD and others do not. There is a strong indication that genetics plays a role, but there is also some degree of evidence that external factors may also play a role. Any time there is an apparent cluster, the local environment should be looked at very critically, to see if any common threads occur that may lead us to better understand, and hopefully prevent future cases of this problem.
I am reminded of the Brick Study conducted by the CDC. A group of parents in Brick Township NJ got together when they found that there appeared to be an excessively large number of autistic children in their town. After an exhaustive study of the situation, the CDC determined that the rate for prevalance in Brick was 6.7 per 1,000, nearly 1500% of the currently accepted rate of prevalance (then published at 4 per 1,000 for full spectrum). Despite this incredible discrepancy, the CDC concluded that this did not represent a cluster (the parents suspected toxins from local chemical factories), as the State of NJ had school records which showed that over 100 other communities in NJ along had this same rate or higher! Why was this not brought to light sooner by NJ? Why did they not question this incredible difference between what was going on in their state and what the CDC, NIH, et al were saying was the norm? What are these high priced special education administrators at the state level doing to justify their existance, if they are not correlating the information reported to them by the local districts and trying to find answers to what is a meteoric rise in autism, and now apparently in ADD/ADHD?
Re: ADHD in NC
I agree we should never jump into a diagnosis of ADD or ADHD with our kids. However, the fact that an area in NC has a higher rate of ADD or ADHD kids may or maynot be an issue. Studies are finding a higher rate than previously thought. Maybe as high as 30%.
We do need more studies and diagnosis, not by primary care doctors unless they are trained to evaluate ADD.
As for medications, I have not seen anything about Ritalin causing brain structure changes. As far as chemical dependency, they are finding ADD/ADHD kids are more likely to self-medicate if they do not get appropriate treatment.
There is an excellent book out on Whether or not to medicate your ADD/ADHD child. I can’t remember the author, but he is well known in the ADD field.
Re: ADHD in NC
http://www.sciencedaily.com/releases/2001/11/011112073546.htm
Ritalin May Cause Long-Lasting Changes In Brain-Cell Function, University At Buffalo Researchers Find
SAN DIEGO — Scientists at the University at Buffalo have shown that the drug methylphenidate, the generic form of Ritalin, which physicians have considered to have only short-term effects, appears to initiate changes in brain function that remain after the therapeutic effects have dissipated. The changes appear to be similar to those that occur with other stimulant drugs such as amphetamine and cocaine, said Joan Baizer, Ph.D., UB professor of physiology and biophysics and senior author of the study. Results of the research were presented here today (Nov. 11, 2001) at the annual meeting of the Society for Neuroscience.
“Clinicians consider Ritalin to be short-acting,” said Baizer. “When the active dose has worked its way through the system, they consider it ‘all gone.’ Our research with gene expression in an animal model suggests that it has the potential for causing long-lasting changes in brain cell structure and function.” Ritalin is the drug of choice for the treatment of attention deficit disorder in children.
Baizer stated, however, that while the neuronal changes are similar to those seen with cocaine and other psychoactive drugs, it does not seem that methylphenidate in very low doses, as used therapeutically, produces much potential for drug abuse.
“Children have been given Ritalin daily for many years, and it is extremely effective and beneficial, but it’s not quite as simple as a short-acting drug,” Baizer said. “We need to look at it more closely.” Baizer added: “Ritalin does appear to be safe when used properly, but it is still important to ask what it is doing in the brain.”
Previous work in other laboratories has shown that high doses of amphetamine and cocaine switch on certain genes called “immediate early genes” in particular brain cells and that this action causes changes in some aspects of nerve cell function. One of those genes is called “c-fos.” Amphetamine and cocaine both cause c-fos activity in the striatum, a brain structure important for both movement and motivation, and the presence of c-fos activity there has been implicated in the mechanism of addiction, Baizer said. The researchers wanted to see if methylphenidate caused c-fos activation in the same parts of the brain, and at the same levels, as the other drugs.
Using young rats as an animal model, they gave one group sweetened milk containing a relatively high dose of methylphenidate (20 mg/kg). Considering the differences in metabolism between rats and humans, this is comparable approximately to a dose on the high end of the range that is used therapeutically, Baizer said. They administered the drug at a time during the rat’s 24-hour cycle that would simulate the timing of a child’s dose. Another group received just sweetened milk. After 90 minutes, the optimal time for c-fos development in brain cells, the brains of both groups were analyzed for the presence of c-fos.
Results showed there were many more neurons with c-fos activity in the brains of rats given methylphenidate, particularly in the striatum, Baizer said, than in the brains of control rats. Rats receiving no treatment and sacrificed after a period of rest showed still less c-fos activity, suggesting that some of the c-fos activity is related to moving around in the home cage and not a pure drug effect.
“These data do suggest that there are effects of Ritalin on cell function that outlast the short term and we should sort that out,” Baizer said. “There is no indication of tolerance, but we have no idea if there is adaptation to the effects.”
One next step, she said, is to use microarray technology to see what other genes are turned on in response to short and long-term Ritalin use. Additional researchers on the study were Ashley Acheson, a graduate student in the UB Department of Psychology; Alexis Thompson, Ph.D., a research scientist at the UB Research Institute on Addictions, and Mark B. Kristal, Ph.D., UB professor of psychology.
http://jama.ama-assn.org/issues/v286n8/ffull/jmn0822-1.html
Pay Attention: Ritalin Acts Much Like Cocaine
Brian Vastag
WashingtonAdvanced imaging research has answered a 40-year-old question about methylphenidate (Ritalin), which is taken daily by 4 million to 6 million children in the United States: how does it work? The answer may unsettle many parents, because the drug acts much like cocaine, albeit cocaine dripped through molasses (J Neurosci. 2001;21:RC121).
Taken orally in pill form, methylphenidate rarely produces a high and has not been reported to be addictive. However, injected as a liquid it sends a jolt that “addicts like very much,” said Nora Volkow, MD, psychiatrist and imaging expert at Brookhaven National Laboratory, Upton, NY. “They say it’s like cocaine.”
Acknowledged as leaders in the field of brain imaging of drug effects, Volkow and colleagues have spent several years tracing the effects on the brain of drugs of addiction, using positron emission tomography (PET) and other advanced techniques. Among their long list of findings, they’ve identified the brain’s dopamine system as a major player in compulsive behavior, including drug taking and overeating.
A PRAGMATIC PARADOX
Building on that base, Volkow, associate laboratory director for life sciences at Brookhaven, hit the trail of a legal stimulant. Although they have used it to treat attention-deficit/hyperactivity disorder (ADHD) for 40 years, psychiatrists and pharmacologists have never known how or why it worked. Chemically similar to cocaine and other stimulants, methylphenidate presents a pragmatic paradox: it decreases activity and increases the ability to concentrate in people with ADHD, but in studies, about half of those without ADHD find it unpleasant, like drinking too much coffee.
“I’ve almost been obsessed about trying to understand [methylphenidate] with imaging,” said Volkow at a recent media conference. “As a psychiatrist, sometimes I feel embarrassed [about the lack of knowledge] because this is, by far, the drug we prescribe most frequently to children.”
So the team went to work with PET scans to examine the dopamine system, which stimulates reward and motivation circuits during pleasurable experienceseating, having sex, learning. To pick one of many pleasures, tasting chocolate ice cream will trigger cells in the basal ganglia to release dopamine molecules. These float across the synapse to neurons in a reward circuit. Receptors on these cells sop up the dopamine, activating signals that translate to “this experience is worth paying attention to.” Too much signal and the experience feels unpleasant, overstimulating. Too little, and the experience elicits a yawn; no pleasure, only boredom and distraction.
Volkow wanted to know how methylphenidate affects this signal. But instead of focusing on dopamine receptors, she tracked another part of the system. After the pleasure signal is sent on its way, dopamine molecules recycle back to the neurons that produced them. There, transportersalso called autoreceptorsact as vacuum cleaners, scouring the synapse for another go-around.
Earlier research had shown that cocaine blocks about 50% of these transporters, leading to a surfeit of dopamine in the synapse and a hit of pleasure. Because of methylphenidate’s chemical similarities to cocaine, pharmacologists thought that it might work in the same way, only less potently, blocking fewer transporters. Animal studies with high doses of methylphenidate indicated that this could be the case.
STARTLING RESULTS
Using a radiotracer, [11C]raclopride, that labels dopamine transporters, the team scanned 11 healthy men who took various doses of oral methylphenidate. The results were shocking.
“We were surprised as hell,” said Volkow. “We didn’t expect this.” Instead of being a less potent transport inhibitor than cocaine, methylphenidate was more potent. A typical dose given to children, 0.5 mg/kg, blocked 70% of dopamine transporters. “The data clearly show that the notion that Ritalin is a weak stimulant is completely incorrect,” Volkow said.
More pondering led the team to consider two theories. Methylphenidate could be blocking the recycling of dopamine exactly as cocaine does, leading to strong signals that would yield a high and lead to addiction. But this did not jibe with four decades of clinical experience.
So they considered another possibility. Perhaps methylphenidate seeps into the brain slowly, and as one by one the drug molecules block the transporters, dopamine cells shift gears. Like a union foreman yelling to an assembly line to slow down, the cell interprets the transporter congestion as a signal that too much dopamine is being produced. The neuron cranks down production, sending less dopamine into the synapse, suppressing the reward signal.
The two theories opposed each other. But Volkow was unfazed. “We had to let the data speak for itself,” she said.
That meant measuring the amount of dopamine floating in the synapses. Fortunately, the investigators had at hand another radioactive label that binds only to open dopamine receptors. A weak PET signal would mean low numbers of open receptors, which in turn would mean that large amounts of dopamine occupied the synapse.
After combining data from the volunteers, the team got its second surprise. Those who took methylphenidate displayed high levels of extracellular dopaminejust like people using cocaine. But if methylphenidate works like cocaine, why aren’t millions of US children getting high and becoming addicted?
CAPTURING THE ANSWER
The answer came after Volkow combined her results with those from another research team. In 1999, Darin Dougherty, MD, and colleagues at Massachusetts General Hospital and Harvard University Medical School reported that people with ADHD have many more dopamine transporters than those without the condition (Lancet. 1999;354:2132-2133). This surplus increases the collective cleaning power of each cell; as dopamine fires into the synapse it is quickly sucked back, before it can home in on reward circuit receptors. “There isn’t enough time for it to produce a signal,” said Volkow.
It finally started to make sense. Children with ADHD produce weak dopamine signals, meaning that usually interesting activities provide fewer rewards. In effect, their attention circuitry is underfed. At the same time, they experience a related effect: random, distracting neuron firing. Or, as Volkow put it, more noise and less signal. This background hum interferes with concentration, making the child more distractible.
Methylphenidate flips the relationship, upping the signal and reducing the noise. After someone swallows methylphenidate, it enters the bloodstream and eventually finds the brain, where it blocks dopamine transporters and increases attention signaling. Again, cocaine acts the same way. But the two drugs differ in a significant way: methylphenidate takes about an hour to raise dopamine levels, whereas inhaled or injected cocaine hits the brain in seconds. “It is the speed at which you increase dopamine that appears to be a key element of the addiction process,” said Volkow.
While the team is unclear on why this speed factor is so important, future research will focus on it. They also plan to map dopamine levels in volunteers who have ADHD when they are at rest or while concentrating. Other research will search for molecular tools to screen children for dopamine transporter levels; those with high levels could be identified early and encouraged with behavioral solutions before methylphenidate is prescribed. “We know that social interactions can increase dopamine receptors,” said Volkow, but whether better interplay also affects transporter levels is unknown.
The long-term dopamine effects of taking methylphenidate for years, as many do, are another unknown. The only two large epidemiological studies conflict. One reports more drug addiction in children with ADHD who took methylphenidate compared with children with ADHD who took no drug (J Learn Disabil. 1998;31:533-544); the other shows the opposite result (Pediatrics. 1999;104:e20).
Because people with low levels of dopamine receptors are at risk for drug addiction, Volkow said that researchers need to understand if methylphenidate can alter the whole dynamic of the dopamine pathway. “Could chronic use of Ritalin make you more vulnerable to decreased dopamine brain activity as cocaine does? It’s a key question nobody has answered.”
Re: ADHD in NC
Thanks Dad,
That was a very interesting article. It makes sense to me that the Ritalin acts like cocaine in the brain, but the key part is the effect it has on those with ADHD vs those without. It is suppose to stimulate a part of the brain. The fact a study says it increasing drug addiction who took Ritalin the key word being took, does not surprise me either. There was a long standing belief that kids outgrew ADD or ADHD. The reality is many did not and ended up self-medicating ie cocaine or PCP. I think the danger in addiction would happen whether or not they took Ritalin. Also, the degree of ADHD varies dramatically. Those not medicated may not have the higher need for focus and attention function as intensely as those who use drugs.
You are correct the jury is still out. It will be interesting and intriguing to watch and understand the results. A key concern will still be the need to take care in diagnosis.
Thanks for all of the great information.
Re: ADHD in NC
Thanks Dad! I couldnt said it better, and it sounds as if you have really done your homework. The fact is….it is a lot easier and comforting to believe the words that come from our doctors. Especially the pediatricians that we have used since we were kids. I would like to add- PARENTS! wake up! Get ALL the information on the non drug therapies and the drug therapies before you make a chioce to do something that could damage your childs life 7-10 years from now. It is really too easy to get these kids diagnosed. My son got a diagnosis from a questionaire and 1 office visit that lasted about 20 minutes. His dad was diagnosed before ADD/AdhD was so popular in the 70s. He was on Ritalin for years and is now 38 years old. He has a horror story, just ask me and all of his other ex wives! These are our kids! We need to start making EDUCATED decisions on what they need. Get all the facts. There is a lot of information out there that will blow your mind. Book of choice ” No more Ritalin” by Mary Block. She was an ordinary house wife and once doctors almost killed her child she decided to go to med school. She is the founder of the Block Foundation in Texas. I guarantee you will not only read this book twice, but you will be out getting all the books you can get your hands on to find out more. By the way, my son is on treatment that has NO side effects. He has even told me how much better he feels. So do the teachers. It has been an unbelievable difference. Signed Happy in Georgia!
Re: ADHD in NC
I personally know several adults who took Ritalin in the 70s and 80s. They all are dependant on “Recreational Drugs” and/or alcohol as well as still taking the prescriptions for the ADD. I think enough time has past to hear about studies that confirm how beneficial medication did, and how much better or worse a persons life is now after going thru drug treatment. From reading all the problems that parents face on this web site and have thier kids on medication is no support to me that medication corrects half the problems. I want hard cold evidence, proof that medication is the answer. Anyone know of recent studies done to confirm the difference in non medicated and medicated individuals? I would be interested in the findings.
Dad,
How does the article disturb you? That there is no information or that more kids are diagnosed. 75 experts in the ADHD field have recently signed a petition called the International Consensus Statement on ADHD. You can find it in full at
www.additudemag.com/additude.asp?DEPT_NO=101&SUB_NO=55
Here are the first few paragraphs.
Note from Bob: Mainstream media coverage about attention deficit hyperactivity disorder has historically been biased, full of misinformation and heavily influenced by anti-psychiatry groups.
In response to this unfortunate trend, Dr. Russell Barkley and 74 other prominent medicaldoctors and researchers in AD/HD issued the following statement, which was forwarded to additudemag.com for publication on Feb 1, 2002. ADDitude Magazine applauds these professionals for taking a stand and helping to set the record straight.
Here is the International Consensus Statement:
January 2002
We, the undersigned consortium of 75 international scientists, are deeply concerned about the periodic inaccurate portrayal of attention deficit hyperactivity disorder (ADHD) in media
reports. This is a disorder with which we are all very familiar and toward which many of us have dedicated scientific studies if not entire careers. We fear that inaccurate stories rendering ADHD as myth, fraud, or benign condition may cause thousands of sufferers not to seek treatment for their disorder. It also leaves the public with a general sense that this disorder is not valid or real or consists of a rather trivial affliction.
Hope this helps.