Teen girls with ADHD at higher risk of mental illness

Two important things that are missing from this analysis - yes, there is a higher incidence of mental problems in this population. But the fisrt unanswered question is whether people who have mental/emotional problems of another sort are more likely to get diagnosed ADHD, which would account for this discrepancy. My work with abused children suggests that this is in fact the case - 15-20% of the population of foster children has an ADHD diagnosis, vs. 3-6% of the general popluation. In particular, children with a diagnosis of Attachment Disorder or PTSD or Fetal Alcohol Syndrome often have the same kind of symptoms as those diagnosed with ADHD, and an ADHD diagnosis can be confusing and prevent people from looking for the underlying problem in such cases.

More importantly, this article ASSUMES that “treatment” (which the authors don’t define at all) will somehow improve this situation. There is no evidence that I am aware of that this is true at all. In fact, stimulants can make both depression and anxiety worse, and manic and psychotic symptoms are often exacerbated by stimulants as well. Add this to the above regarding the complexities of diagnosis, and it is very speculative that “treatment” (whatever that is supposed to mean) for ADHD will necessarily improve outcomes for people with other mental health diagnoses.

Sorry to be negative, but I had to comment. I think this article is very misleading.

Steve, I’m curious about something you wrote.

My son was diagnosed with ADHD, but there was always some waffling about whether or not this was actually the correct diagnosis as he didn’t really fit all the criteria. A child psychiatrist felt that he showed some signs of FAS but never really made it clear whether it was the FAS that caused his ADHD symptoms or whether FAS is a separate issue. If so, do you know whether FAS is treated any differently than ADHD?

We tried numerous stimulant medications (they helped him focus but caused severe weight loss and irritability), antidepressant medications (they caused giddiness and even more impulisve behavior and didn’t help his focus), and combinations of both for school. Finally, a couple of years ago, we stopped everything, and he’s done no better or worse in school than he did with meds.

At 16, do you think a re-evaluation would be of any benefit in terms of FAS being treated differently than ADHD (if it is…)?

First problem: there is no way to actually determine whether someone “has ADHD” by any objective means. It’s totally a clinical opinion, so depending who you go to, you may get different answers.

To me, the solution for each child depends on what works for them. This is true whether they are diagnosed “ADHD” or “FAS”. A lot of kids diagnosed “FAS” also get the “ADHD” diagnosis, and get treated pretty much the same way. Not that they should, but they do.

Of course, I think how we treat kids with the “ADHD” diagnosis is pretty crappy, too. We used alternative schools and homeschooled to avoid the standard classroom environment, which has been shown through anecdotal and scientific observations to be really unhealthy for ADHD kids. The same is undoubtedly true for a child with an FAS diagnosis.

The person who trained me in FAS issues was very big on environmental modifications, which she feels need to be specialized for the needs of each child. For instance, if an FAS kid has a hard time with noise, you have to get them a quiet place to study. If they have memory deficits, you develop a reminder plan. And so forth. I think this approach should be taken with EVERY child that doesn’t “fit in” to the standard environment.

So I guess my advice would be to inform yourself as much as possible about FAS/FAE, and speak to a BEHAVIORAL specialist who works with this population. They may be able to help you create environmental modifications that will make your child’s life easier. It also helps when HE gets a picture of what his strengths and deficits are, and what he can do about it, rather than getting the picture that he is stupid or handicapped or “disordered” and there is nothing he can do about it. One of the psychological side effects I have noticed about medication for the ADHD diagnosis is that it can tend to make kids feel less responsible for their behavior. We always stressed to our kids that some kids are good at some things and some are good at others, but all have things to work on. We helped them identify the “work ons” without making them feel they were inadequate, and helped them use their strentghs to address the weak spots. I think this works with almost any kid. The trick is properly identifying what those strengths and challenges are, and that’s where the behavioral specialist may be of some assistance.

Hope that is helpful!

Thank you, Steve. We also have tried hard to get the schools our son has attended to shift those square holes around as much as possible to fit his peg. Nonetheless, his learning experience has been fairly dismal, particularly since he entered middle school.

We have also never labeled our son and only point out that, as you said, everyone is different with different strengths and weaknessess.

We’ve always been very reluctant to use meds as they seemed to do more harm than good— for OUR son— And, at almost 16, he’s totally against taking meds. However, and this is what prompted my question, he’s perfectly okay with using marijuana on occasion, and I’m wondering if what he’s told us and we’ve heard from his ped neuro might have some truth— that he may be using the marijuana to calm his very busy mind. Obviously, if he’s trying to medicate himself with marijuana, we’d MUCH rather he did so with something that’s actually legal.

He may be doing just that. You might want to direct him to coffee! Still, at his age, he has to make his own mind up about what works. It might be time to have a serious discussion with him about what he is trying to accomplish with the marijuana and see if there is another way to do it. He is probably in a better place to answer your question than anyone else. Again, I think it’s about trying to find the right environment and addressing his needs in that way, rather than trying to make him different to fit in. Maybe he can tell you what need he is meeting by smoking the marijuana.

I know quite a few young guys who are self-medicating with marijuana. I wish they could get proper care and treatment, but some of them have at least reached a state of equilibrium.

[quote:d9c2ce3a1a=”victoria”]I know quite a few young guys who are self-medicating with marijuana. I wish they could get proper care and treatment, but some of them have at least reached a state of equilibrium.[/quote]

I am not completely comfortable with the term self-medicating. Although I think it happens I don’t think it happens usually for the indentified “disorder”. Some people just want to escape all the crap life gives them. In the case of clinical deprssion I think self medicating happens frequently but often the substances used are actually the main cause of the depression in the first place.

Steve, as usual your advice and observations are right on target.

I agree - I wince whenever I hear the word “self-medicating”. They are not self-medicating, they are taking drugs to alter their consciousness. Psychotropic medications do the same thing, hopefully in a more controlled fashion. Frankly, I think the “treatments” that we have to offer people who have difficulty adjusting to the demands of our high-tech society are pretty lame. And I say that as a mental health professional who has seen thousands of adults and children enter the mental health system.

Every person is different, and we each come up with our own coping methods. Some are sanctioned by our society, and some are not, but I can’t tell anyone what will work best for them. I think each of us has to figure that out on our own. The term “self-medicating” seems to imply that medication is the right answer, and that the person just hasn’t realized it yet. I wish I could say there were medications that can make people’s lives unerringly better, but there aren’t. It’s all pretty much a crapshoot, and the “professionals” can’t even agree with each other what to do. So there’s not much left for us except to rely on our personal integrity, and do what we believe is right. Sometimes no one agrees with us, but we still have to do what works for us. The best treatment I know of is to provide as many options as possible in as neutral a framework as possible, and encourage people to select the ones that work best for them.

It’s a tough world out there!

Unlike the designer lables like ADHD and ODD clinical depression is a real thing that may actually be underdiagnosed. Many of the anti-depression drugs are effective and comparitivly safe. Unfortunately popping a Welbutrin every morning is probably not the best way to deal with clinical depression. I also think that in some circles depression may be being over diagnosed and anti-depressanta are being doled out like candy to everybody who has the blues.

I have seen people around me come back to normal after taking Paxil. It is interesting how hormonal abnormalities are ignored as a cause for many so called psychiatric disorders. Look at post partum depression, PMS, and peri-menepause and their relationship clinical depression. I often wonder if that snake oil salesman Kevin Trudeau may be corrrect when he says our food supply is contaminated with hormones that cause many health problems in our children

I do think the drug companies are now targeting girls for the bogus ADHD dx. I mean they already say 12% of boys have ADHD. They could double their market by zeroing in on chatty girls.

Oh, how I agree with you, Jerry and victoria… #1, even middle-aged adults “self-medicate” themselves, whether they realize they are doing it or not, and also they do it with alcohol. I believe most of them know they have a serious problem/disorder, but are afraid to be diagnosed by an MD (who can balme them?), and/or find it is so much easier to “self-medicate” themselves. Why do you have a problem with the term “self-medicate”? It is what it is.

And #2, I am a firm believer that clinical depression is the real underlying culprit in a plethora of problems (panic disorder, all the vast ranges of anxiety disorders), but the current trend is to label a person with one of the “designer” diagnoses, ADHD, etc., etc., etc…

The reason I don’t like “self-medicate” is that, to me, it implies that somehow, if the person were taking the “correct” medication, their situation would be taken care of. Medications of every type (legal and illegal) only deal with the symptoms of the problem. I have helped hundreds and hundreds of depressed people over time to improve their lives through discussion and creative action. While for some people, taking medication can create a temporary space where they are more able to understand what is happening and take appropriate action, and I certainly think that is a valuable and appropriate use for such medicaitons, I can’t say that I have seen much evidence that people’s lives dramatically improve in the long run through taking any kind of medication. The improvements I see come from people getting a handle on what they are doing with their lives and getting into a position where they can make conscious choices how they want to deal with the conflicts their life presents. If the medication helps with that, I’m all for it, but medication without these other changes doesn’t generally have the desired effect.

We all get a genetic inheritance, and we have to deal with that, but in my experience, focusing on the things we DO control (such as our own thoughts, beliefs and behaviors) can create long-term and dramatic changes that no drug is capable of doing. I hate to see people lose sight of this possibility by believing that a medical solution to their problem exists, when in actuality, medicine is only able to achieve temporary symptom relief, and sometimes at a cost that is fairly substantial, in terms of money or side effects or both. I’d rather have people looking at their motivation for taking the drugs - “I am trying to escape from my anxiety” - rather than medicalizing their problem - “I am self-medicating.” A semantic distinction that many people might find hair-splitting, but in my experience, the perspective that you choose to take on a problem dictates a lot about how you approach the problem. I prefer to challenge people to take a look at all the possible options rather than conclude that because they chose to use illegal drugs, a legal drug would necessarily be the appropriate solution. When medications are used, I believe they need to be considered a secondary intervention undertaken in order to empower the recipient to better make some of those other, structural life changes that lead to long-term relief from the thoughts or feelings they are trying to escape through street drugs.

[quote=”Steve”] I hate to see people lose sight of this possibility by believing that a medical solution to their problem exists, when in actuality, medicine is only able to achieve temporary symptom relief, and sometimes at a cost that is fairly substantial, in terms of money or side effects or both. I’d rather have people looking at their motivation for taking the drugs - “I am trying to escape from my anxiety” - rather than medicalizing their problem - “I am self-medicating.” A semantic distinction that many people might find hair-splitting, but in my experience, the perspective that you choose to take on a problem dictates a lot about how you approach the problem. I prefer to challenge people to take a look at all the possible options rather than conclude that because they chose to use illegal drugs, a legal drug would necessarily be the appropriate solution. When medications are used, I believe they need to be considered a secondary intervention undertaken in order to empower the recipient to better make some of those other, structural life changes that lead to long-term relief from the thoughts or feelings they are trying to escape through street drugs.[/quote]

I do agree with you, Steve, on an intellectual level. And I would like to state my position on the taking of illegals — I’m completely against it. And the cost of legal meds sure is substantial, to say the very least.

But sometimes the symptoms of MD diagnosed problems, such as clinical depression, and the myriad of anxiety disorders can be so debillitating, the patient cannot helps him/herself unless he/she is first treated with medication. The stigma, which is still there by the way, against meds of any kind is a scary thing indeed for those who *truly* need them to have a somewhat “normal” life — whatever that is.

Hi, Catherine!

I am not disagreeing with what you are saying - if people find a medical approach helpful or necessary to get them through what they need to get through, more power to them for doing what is working for them. What I don’t like is the implication that a person is using illegal drugs BECAUSE they should be using legal medications and just haven’t realized it yet. It suggests that a failure to recognize the appropriate legal medication is the cause for using the illegal ones, which I think is a gross oversimplification of both addiction and effective mental health treatment.

There are far too many messages today that suggest that any negative behavior or emotion can be eliminated by application of the correct medical intervention. In my experience, this is absolute nonsense. Mental and emotional problems are the result of enormously complex interactions between inherited traits, biological variables (sleep, food, toxins, allergies), emotional vulnerablilty/strength (upbringing, trauma history, temperment, coping skills, current abuse or victimization by parents or partner) and social variables (poverty, unemployment, racism, lack of community, sexism, school or work expectations, and the generally depressing coldness of Western social institutions) that to try and reduce “mental illness” to a biochemical problem is utterly ludicrous and counterproductive. This is not to say that medicine doesn’t play a part, but if we look, for example, at how schools are uniformly discouraging to kids with certain preferred learning styles or personalities, and we consider that these kids are required to attend these dysfunctional schools year after year in a seeminly endless tunnel of torture with no way to change or escape this (from their viewpoint) enormously oppressive system, is it any wonder that they reach for drugs as a way of soothing their sense of hopelessness and despair? Isn’t it pretty understandable that they are depressed and hopeless about their situation? Are we implying that no one should EVER feel a sense of hopelessness or despair regardless of the adverse circumstances they are exosed to? And are we really doing such a child any favor by saying they are “self-medicating” their depression, and providing them with a legal alternative way to dampen their depressed mood, while still compelling them to attend this institution that is so utterly inflexible and ill-suited to meet their particular needs? This makes as much sense as telling the domestic abuse victim that she is drinking to “self-medicate” the effects of being periodically beaten up and systematically threatened with violence on a daily basis. She may benefit from antidepressants as a way to overcome her lack of hope and start to organize an escape plan, but her problems are not caused by a lack of antidepressants, nor will they be solved by a prescription.

I hope I am being clear here that I am not criticizing the use of such legal prescriptions if they are part of a plan to ameliorate the circumstances that are creating the emotional distress that a person is experiencing. I am saying that telling a drug abuser that they are “self-medicating” suggests a very simplistic view of addiction and of the causes and cures of human suffering in general. I strongly oppose the current efforts to define every sort of human suffering as a medical problem that should be treated by a drug. We are spiritual beings with intentions, needs, desires, frustrations, fears, and disappointments. These are all a part of a normal life, and our “negative” emotions often are excellent guides to correcting the course of our lives, just as physical pain tells us to get our hand off a hot burner. The addict is generally trying to rid themselves of some of these unwanted emotions through the use of illegal drugs, rather than listening to and responding to what their body/mind is trying to tell them. Suggesting a legal drug alternative as a comprehensive solution is simply not sufficient to address all the complex needs and barriers that create situations where a person might turn to drugs as a coping response.

Hi right back at ya, Steve:

Geez, what a great, complete answer. I realize that so many over-simplify this issue, but you certainly have not, you are being very clear here.

On a very personal level, I know someone who is just as you have described, and it is so tragic to watch this person disintegrate from what he once was. His “drug” (and yes, we all here know it is a drug) of choice to - I’m sorry to use the terminology if it’s offensive or inaccurate in a lot of cases, but cannot come up with a better way to describe what it is that he does - “medicate” himself, is and has always been alcohol, since he was about 13 years of age, when his older siblings introduced him to it. He is absolutely aware that he suffers from some pretty serious form of social phobia, has a library of books and self-help tapes and CDs on the subject, and perhaps has some other phobias or possibly OCDs as well, but since I’m no MD, I cannot diagnose him, nor will I presume to do so.

It is very sad, what abuse of alcohol, and I’m assuming at least some of the illegals can do to a person’s brain and personality, over a long period of time. (I’m referring to at least half a lifetime in this man’s particular case.) He is only 41 years old. But I understand you can’t help one who does not wish to be helped, he must want to help himself. But “medicating” himself with all that alcohol is clearly not the answer, for his life is only worse for it now.

It is always a shame to see people avoiding their lives, by whatever means. Alcohol is probably the most destructive drug that there is, at least in terms of total harm done. I recognize that people are suffering all over our world, and it saddens me, especially when so much of it seems needless. That’s why I tend to focus my energies on changing the institutions of our society rather than trying to “fix” individuals so they will “fit in” better to the existing structure. I think the existing structures are largely very damaging, and schools are a huge contributor to people’s misery and self-hatred. That’s why I kept our kids at home or in alternative schools that respected their need to be themselves. And they seem to have turned out all right after all. Sometimes the most empowering thing I have been able to do for my clients is to allow them to see that they have damned good reasons for being depressed. It’s not just them. This is a difficult society to live in for many people. When they recognize that they are not necessarily at fault for not “fitting in”, it is easier for them to cope with their differences than if they are stigmatized by a label and told it is all a matter of brain chemistry. That’s my experience anyway. I don’t begrudge people trying to feel better, but you see from your friend that just feeling better temporarily doesn’t really do you much good. I think the focus should be on living better, rather than feeling better. It is harder in some ways, but in the end, it is far more satisfying to struggle through some difficulties and discover a new way to deal with the reality that confronts you. Maybe not everyone is up to it, but I am not one to give up on people. I like to believe we all have it in us. Makes me a good therapist, even if I do have my occasional bouts of dispair!

Thanks for your warm response. You are a special person!