Over the last ten years, the number of school-aged children diagnosed with Attention-Deficit/Hyperactive Disorder (ADHD) has jumped from 7.8 to 11 percent.
While partly attributable to changes to diagnostic criteria laid out by the American Psychiatric Association as well as greater awareness of the disorder, the rise in diagnoses is a hot topic among physicians and parents alike.
Parents in particular must wrestle with the kinds of questions that would keep anyone up at night. Does our child really have ADHD or something else? Do we give them Ritalin or another drug that might have harmful side effects? Are we bad parents for giving our child medication?
Marissa and Tom suspected from an early age that their son Reed was not simply acting out.
“I knew it wasn’t terrible twos,” Marissa recalls.
Marissa and Tom took their son to see a neuropsychologist as he was finishing up kindergarten. Reed was put through a battery of tests during four separate appointments to determine whether or not he had ADHD.
“I wanted this test because I wanted certainty,” Marissa points out.
Reed’s physician prescribed Ritalin to treat his symptoms. Marissa and Tom feared that starting medication at such a young age could harm Reed’s development.
“He was too young,” Marissa states with some emotion.
“You’re afraid you’re gonna lose your child’s personality,” Tom adds.
Marissa and Tom started Reed on Ritalin one weekend while he was in first grade. Marissa remembers watching her son staring out of the rear car window rather than kicking her seat and pinching his older sister.
“I got freaked out,” Marissa admits.
After consulting their therapist, Tom and Marissa realized the dramatic changes in their son’s behavior meant that Ritalin was having a positive impact.
Tom and Marissa first tried restricting Reed’s diet and other alternatives before deciding on medication. None of these changes seemed to work.
“I even tried helping him learn how to meditate,” Marissa says with a chuckle.
Medication has also helped Reed with his school work. Prior to starting Ritalin, a one or two page homework assignment would take Reed three hours to complete.
“Now he’s better than his older sister at getting his homework done,” Tom observes.
Ultimately, Marissa and Tom feel that medicating Reed’s ADHD was the right decision. Marissa talks about asking her son how he felt about being on medication. Reed had told his Mom that it made him feel like everybody else.
“Right there I stopped feeling guilty about giving him medicine,” Marissa recounts. “I said alright, this is what we’re supposed to do.”
While Ritalin frequently has been prescribed for how quickly it acts upon patients—results can be observed in as little as twenty minutes—the drug can cause unwanted, sometimes severe side effects.
Ritalin commonly causes loss of appetite, weight loss, and insomnia, as well as redoubled hyperactivity after the medicine wears off. Doses of more than 20 mg can result in nervousness, heart palpitations, and shakiness. Though Ritalin has not been linked to addiction, persons with addictive personalities may abuse it.
Jerry and his wife Kim learned the hard way that taking Ritalin caused their son Seth to shed weight excessively.
“He was emaciated,” Jerry confides.
“He was a bag of bones,” Kim agrees.
The deleterious effects Ritalin had on Seth may have been prolonged by tension that arose between his father and mother, Jerry’s first wife, over whether or not their son had ADHD.
Seth was diagnosed with ADHD and prescribed Ritalin by the time he had entered first grade. His mother took him to see a number of doctors during his formative years. Not all of them agreed with the original diagnosis, and they recommended that he be taken off Ritalin.
“A couple of doctors said he doesn’t need this,” Jerry says with some emotion.
Kim and Jerry feel that Seth was misdiagnosed with ADHD in part because parents fill out paperwork on their child’s behalf during examinations. Seth’s mother, a registered nurse, completed his forms for him.
“If they’re answering the form in a certain way, the doctor gives his or her diagnosis based on what the parent is filling out,” Kim surmises.
Jerry and Kim say that Seth, though not always a model child, rarely caused any serious difficulties when spending time with them. They add that he seemed better when he wasn’t taking his medication.
Seth was not taking Ritalin during a two-week camping trip he took with Jerry, Kim, his sister, and half-sister.
“I remember especially Heather and Elaina commented that Seth was less on their nerves,” Kim says with a laugh.
Seth recently graduated from High School and plans to enlist in the Navy. He has long since ceased taking Ritalin.
Jerry and Kim worry that ADHD has been over diagnosed and that some parents medicate their children as a way to raise them.
In their son’s case, they fear the damage his diagnosis and treatment inflicted upon his health may be permanent.
“I’m don’t see him recovering fully,” Jerry confesses.
Even when a child has been correctly diagnosed with ADHD, Ritalin may not be the best solution. Parents may need to try a variety of drugs to help curb their child’s impulses.
Children may also exhibit symptoms of multiple conditions in tandem with ADHD, including Asperger’s Syndrome and other autism spectrum disorders. A full diagnosis of a child’s specific disorders sometimes takes years to complete.
Russ and Katie began taking their youngest son Joey to a speech therapist at one and a half years old. Then at three years old, they took him to a developmental pediatrician to rule out autism. The possibility occurred to Joey’s therapist that he might have ADHD.
Joey’s physicians spent the better part of three years determining the extent of his disorder. Russ and Katie have tried a multitude of medications to help control his hyperactivity.
“That was the one thing we really hated. It was almost like he was a kind of guinea pig,” Katie admits.
Some of the medicines Katie and Russ gave Joey had positive results but produced worrying side effects. Focalin, a mild stimulant similar to Ritalin, made Joey sleepy. Adderall made Joey angry. Deytrana, a once-daily skin patch, seemed to be working but ultimately gave Joey social anxiety.
“We were told don’t be satisfied. If there’s something that doesn’t seem right, then keep trying,” Katie comments.
“But ultimately it’s helped him a lot,” Russ points out.
Russ and Katie stress that medication is a small part of Joey’s treatment.
“We also have to work on the behavioral side too,” Katie says.
Behavioral experts regularly meet with Joey to work with him. A therapeutic support staff specialist accompanies him to a summer camp he is attending to help him further develop his social skills.
Despite the complications they encountered, Russ and Katie are confident that Joey was diagnosed correctly.
“His diagnosis was not just our input but also the doctor’s input and also a teacher’s input. It had to be across the board,” Katie expounds.
While Katie and Russ see ADHD can be misdiagnosed, for them it is a legitimate diagnosis and cause for concern.
“I always hate when people say that it’s not real,” Russ says. “I don’t think they are in our shoes.”
Likewise, they find the idea of not availing themselves of medication and therapy to help their child adjust to life with ADHD unthinkable.
To me it’s like saying should you not treat depression or cancer,” Katie says pointedly.
Whether or not ADHD has been over diagnosed remains open for debate. What is clear is that parents of children who have been diagnosed with the disorder must make difficult choices that will impact their children’s lives. Support and understanding is important for those on all sides of the issue.
Some of the names of those interviewed have been changed to protect their privacy.