Over the past couple of decades there has been a huge increase in the diagnosis and prescriptions given out for Attention Deficit Hyperactivity Disorder. According to a news report done by USA Today over the past five years use of ADHD medications have risen 40% totaling 39. 5 million individual prescriptions (“New findings,” 2009). When statistics like this are seen it is only normal for someone to ask questions. People are becoming curious about the legitimacy of the disorder, and whether or not the treatments being given to individuals are appropriate.
The argument seems to be strong on both sides of the fence, but the extensive research done on ADHD leaves it hard for one to believe that it is a made up disorder. Attention Deficit Hyperactivity Disorder or ADHD is a neurobehavioral development disorder diagnosed by a number of symptoms. An article by Ayesha Sajid, Maria C. Poor, and David R. Diaz states that the history of ADHD goes back to 1902 when physician Sir George Frederick Sill came up with what he called “defect of moral control”(58). Dr. Still saw this “defect” to be something beyond the sufferer’s control.
Sajid, Poor, and Diaz go on to talk about the disorders terminology changes up to 1980 when it was officially recognized as Attention Deficit Disorder, with or without hyper activity. “ADHD has been defined by Russel A. Barkley as a disorder of response inhibition and executive dysfunction leading to deficits in self regulation, impairment in the ability to organize behavior toward present and future goals, and difficulty adapting socially and behaviorally to environmental demands”(Sajid, Poor, and Diaz 58). Subsequently it has been proven that neurotransmitter Dopamine plays a big role in ADHD’s symptoms listed above.
It plays a large role in our brains functions including motivation, reward, and punishment. In Sajid, Poor, and Diaz’s article they discuss treating the lack of the neurotransmitter dopamine by using stimulant medications (58). They recognize that stimulants are dopamine agonist which promote the release of stored dopamine(58). Examples of stimulant medications include but aren’t limited to Aderall, Vyvanse, Concerta, and Ritalin. Although stimulants are statistically proven to be the most effective form of treatment it is not the only option.
There are several forms of non stimulant medications that are used for treatment but not as commonly as stimulants. Beyond medications are behavioral therapies which can be effective in treating ADHD. The USA today article “New findings raise questions about use of ADHD drugs” says that at the three year mark behavioral therapies such as parenting and classroom behavioral therapies catch up to stimulant medication treatment. Consequently there was no evident difference in those who received therapies and those who have been taking medications.
Results in studies such as these leave many to think about the appropriateness of stimulant medications. Today many argue about the risk of long term effect from stimulant medication use. Why not go to alternative treatment methods such as behavioral therapy? And those even more opposed often deny the existence of ADHD entirely. To many it is not a disorder, rather a result of bad parenting, too much sugar, or just the result of an energetic child. It is easy to see how these conclusions can easily be jumped to. A lack of personal experience with the disorder is most definitely a cause for lack of understanding.
Those who have ADHD would be able to tell anyone it is not something that is easy to understand. The constant lack of motivation, concentration, and control aren’t symptoms ADHD victims can control. Working in school becomes nearly impossible for some with these symptoms and it is not just from laziness. The lack of the neurotransmitter dopamine effects these parts of the brains functions. These symptoms are something caused by a chemical imbalance rather than by the choice of an individual. Though this is true the disorder won’t get better on its own.
ADHD victims need to help themselves get better, it is a disorder that can be overcome. For many no matter what facts are available ADHD is simply not real. It is easy to understand where people with this point of view are coming from. Starting off with the fact the ADHD doesn’t seem to be present in other countries around the world. Children’s psychologist Angela Southall claims that 90% of the worlds Ritalin is being prescribed in the United States (Southhall). So yes ADHD is more prevalent in the United States than anywhere else in the world.
This leads many to believe that ADHD is something made up by the United States pharmaceutical industry as some sort of hoax. This is certainly an argument that can be credited even by the opposing point of view. It does seem that pharmaceutical companies are marketing their ADHD medications strategically in the United States to get as many people onboard as possible. On the opposing side of this argument it has little to do with stating whether ADHD is real or not. The ideas of the disorder did in fact come up far before pharmaceuticals were involved in the treatment. Another common opposition to ADHD is the medications used to treat it.
People wonder why hyperactive children are being treated with stimulants. The side effects of stimulant medications seem to not be so positive and don’t seem to be acceptable for a child with ADHD. Side effects such as motor tics, insomnia, and loss of appetite are all commonly seen among stimulant medications. Stimulant medications are also known to be highly addictive. Their is a dangerous possibility of substance abuse with the medications. People wonder if something causes side effects such as these, there must be some sort of possibility of long term effects from medication use.
It is certain that stimulant medications are not something to be messed with. They need to be used appropriately by the right people in order for the treatment to be safe. Probably the most common argument to ADHD’s legitimacy is that it is just the way that child behaves. Many are against putting a labeled disorder on a child or adults particular behavior. To many a child’s behavior is a result of the way they are parented. Kids that are not performing well in school must have not been parented properly at home. This is probably the case for some of the children in school but certainly not all.
Many parents go above and beyond to fix their child’s behavior before even thinking about putting a medical diagnosis on their child. For many parents this is the last thing they would want to do. It is important to understand that ADHD is a complex disorder that involves a lengthy and broad diagnosis process. Understanding ADHD is not easy and requires an extensive amount of research to gain an understanding. There are three important features when it comes to the ADHD diagnosis process. Impulsiveness, inattention, and hyperactivity levels are all tested by a checklist of symptoms.
An article on ADHD states that their are five parts of the diagnosis process. It needs to be understood that all symptoms must be more severe than another individual at a comparable level of development. The five parts of the diagnosis process are labeled parts A through E (Goldstein and Naglieri 860). Part A contains the often cited 18 diagnostic symptoms; Part B requires that symptoms must cause impairment before age 7; C that impairment must be present in two or more settings; D that there is clear evidence “of clinically signi? cant impairment in social, academic or occupational function” (p. 3); and ? nally, E requires that symptoms should not occur exclusively during the course of other conditions or be better accounted for by other mental disorders. As you can see a process such as this makes it difficult when trying to clearly identify whether an individual has ADHD or not (Goldstein and Naglieri 860). Taking a look at ADHD’s 18 diagnostic symptoms is a good way to understand they way ADHD effects a certain individual. The American Psychiatric Association lists the following symptoms to be part of the inattention category of ADHD.
Failing to pay close attention to detail or make careless mistakes in schoolwork, difficulty sustaining attention in tasks or play activities, not listening when spoken to directly, often does not follow through on instructions and fails to finish multiply types of work, difficulty organizing tasks and activities, often avoids or is reluctant to engage in tasks that require sustained mental effort, often loses things necessary for tasks or activities, often easily distracted by extraneous stimuli, and is often forgetful in daily activities (124).
These symptoms are used to classify what is considered inattentive ADHD commonly known as ADD. The American Psychiatric Association refers to two more categories of symptoms regarding ADHD. The Hyperactivity category includes symptoms such as often fidgeting with hands or feet, Often leaves seat in classroom or in other situations in which remaining seated is expected, Often runs about or climbs excessively in inappropriate situations, often talks excessively, often has difficulty playing or engaging in leisure activities quietly (124).
The next category of symptoms developed by the APA regard impulsiveness. These symptoms include often blurting out answers before questions have been completed, often has difficulty awaiting turn, and often interrupts or intrudes on others (124). These two categories are used to classify two different types of ADHD. One being combined ADHD which requires that symptoms from the inattention and hyperactivity categories be present. The other type is hyperactive-impulsive ADHD which requires that symptoms from hyperactivity and impulsiveness are present.
For an individual to be diagnosed with ADHD they must not only suffer from a range of symptoms but also fulfill parts B through E of the diagnosis process. The second four parts of the diagnosis are what separates those with ADHD and an individual that would be labeled as lazy. ADHD is developed in adolescence. This is a big factor in separating those with ADHD, and say college students who trying to receive an Aderall or Ritialin prescription to help get their work done. When being diagnosed it would be hard for a doctor to really tell if the individual had suffered from the symptoms at an early age or not.
People of this age being diagnosed results in people questioning the legitimacy of ADHD. It needs to be understood that ADHD symptoms are something that an individual must have dealt with nearly their whole lives. Part C of the diagnosis process states that the symptoms must be present in two or more settings. When a child isn’t performing well in school, and matches ADHD symptoms there is not enough evidence to diagnose that child with the disorder. Symptoms must be seen in other aspects of the individuals life such as on a little league sports team or at home.
This makes it clear that the person actually has problems with the control of their actions. Similar symptoms in multiple environments make it clear that someone is actually having problems with ADHD, rather than just school itself. One of the most key parts of the diagnosis process would probably be part D. For and Individual to actually have ADHD the symptoms must be significant. Symptoms are usually declared significant by being compared to by another individual at the same level of development. For example some children’s hyperactive behavioral actions could be explained by simply being a child.
Children have a lot of energy and enjoy to play. A child who actually has ADHD would have energy levels much higher than those in the rest of the class. They would appear to be much more restless and inattentive than almost all of the individuals in their class. This is the part of the diagnosis process that really separates the real cases from the fakes. People often over exaggerate symptoms in order to be diagnosed with ADHD. The final part of the diagnosis process part E is what declares that a child officially has ADHD.
This part of the diagnosis process is what makes sure that a child isn’t being misdiagnosed with ADHD. It is necessary to make sure an individuals ADHD is not being mistaken for another mental disorder. This is where it is important that a full background check of the individual is taken into account. It is important that every little detail of the individuals history is taken in order to avoid a false diagnosis. Usually the patients genetic background will be looked at to see if any other mental disorders are seen in that patients genetic history.
The patients background check is also an important part selecting the proper treatment. As discussed briefly earlier ADHD stimulants play a big role in the ADHD controversy. It is known that stimulant medications are the most common approach to treating ADHD. An article “Overview of ADHD” make this claim about the effectiveness of Stimulant medications, “With reported 65% to 75% clinical improvement in double-blinded placebo controlled trials in both children and adults, they are considered as first-line therapy” (Sajid, Poor, Diaz 58).
With statistics like this the effectiveness of stimulants cannot be questioned. Sajid, Poor, and Diaz claim that stimulants are the best researched form of treatment (58). They continue to talk about the options of either long acting or short acting stimulate formulations that contain methlyphenidate (58). Methylphenidate is what promotes the release of stored dopamine into the brain and selectively promotes the release of newly synthesized dopamine into the brain. By understanding this it is easy for one to see that dopamine certainly plays a role in ADHD.
If sufferers of ADHD didn’t have some sort of imbalance of dopamine levels why would the medication be so efficient. This certainly rules out certain aspects of the opposing sides argument on ADHD. For one this shows that ADHD is not simply a disorder of laziness, bad parenting, or lack of control. The severity and uncontrollableness of the individuals behavior can be further explained by something other than reason. The symptoms are for certain a result of an individuals dopamine levels present in their brain. Through this information one can see that the use of stimulant medications to treat ADHD are appropriate.
Unfortunately there is a lot more to the argument for this conclusion to be made. A series of questions are brought up by the opposing view even after seeing information similar to what has been presented. Opposers commonly like to question the increase in the prescription of stimulant medications since their origin. Research done by the Commission for Scientific Medicine and Mental health shows a 700% increase in the use of stimulant medications since the 1990’s (Lefever, Arcona, and Antonuccio). There is a lot to be said about this increase, as it explains a lot of ADHD’s history.
A book titled Minimal Brain Dysfunction in Children helps us trace the use of stimulant medications to treat ADHD like disorders back to 1960 (Wender et al. 10). The period of 30 years from 1960 to 1990 was more than enough time for people to start actually hearing about ADHD. We can assume that since 1960 the general public in america has gained a much better understanding of the disorder. For people to be skeptics of the disorder and its treatment methods upon their initial discovery is something easy to understand.
Once research of the disorder and its medications were made available to the public showing proper information about the disorder it would likely become more acceptable. Although the timing of an increase in the disorders popularity can be explained, the tremendous increase and constantly growing numbers may still seem a mystery to many. These growing numbers can be explained by a few different things. To start the growing popularity of the disorder has made it seem more acceptable to have. Parents of children and adults themselves aren’t hesitating to be diagnosed and treated for ADHD.
This factor by itself can explain an increase in diagnosis since 1990, although something as simple as this doesn’t fully explain the 700% increase statistic we have seen (Lefever, Arcona, and Antonuccio). A major part of the problem linking to ADHD’s overwhelming increase in acceptance is misdiagnosis and even an entirely false diagnosis. Due to the competitive nature of humans, parents are looking to have their child diagnosed to receive advantages in school. Students who have disabilities are allowed extra time on tests and given other advantages to make up for their disorder.
This has parents headed to the doctor to give false accusations about the severity of their child’s ADHD symptoms. A statistic given in a Medical News Today article states that 46. 7% of the children diagnosed with ADHD only displayed mild symptoms, compared to the 13. 8% that actually suffered from severe symptoms. This statistic provides evidence that a majority of the ADHD diagnosis’ are made on children who don’t display significant problems with their symptoms. As a result of this we can conclude that due to the significance level of symptoms being 46. % of the ADHD diagnosed population, that a majority of this population doesn’t actually have ADHD according to the diagnosis process. The problem of ADHD over diagnosis can be solved through its definition. Author David Antonuccio claims in an article that part of the ADHD definition is statistical rarity limiting only a certain amount of the population to have the disorder. He goes on to say that the ADHD prevalence estimate was set at 3% to 5% (Antonuccio). Having this statistic in the definition certainly verifies that increasing false diagnosis of ADHD is certainly becoming more common in The United States.
Another article from The Washington Post written by Steven Weinberg shares a statistic that claims 9% of children in America have ADHD. This goes 4% above the prevalence estimate of 3% to 5% when describing ADHD’s statistical rarity. This helps us realize that the leniency, broadness, and lack of control over the diagnosis process is what is causing the tremendous diagnosis increase seen in the disorder. Having this information displayed makes it clear how misconceptions about the legitimacy of ADHD are created. People having seen this huge increase in diagnosis and treatment is what makes them question the disorder.
Now having seen how ADHD diagnosis has become increasingly popular we can conclude that it has nothing to do with the validity of the disorder. This problem belongs to the people of The United States rather than the ADHD community. It is important when looking at the truthfulness of ADHD to look at the definition of the term rather than the cultural problems it has aroused. The problem of false and misdiagnosis are not the only things that raise questions about ADHD. People seem to think there is only a presence of ADHD in The United States.
While it is true that ADHD rates are much higher in The United States, it is certainly not the only country in the world who is involved with the disorder. A newspaper article put out by The Times in the United Kingdom shows that they are dealing with problems similar to those in The United States. The article goes over statistics that display tremendous increases in stimulant medication prescriptions in several different parts of the UK. In a similar article it is stated that in the country Scotland prescriptions increased from 4,000 in 1996 to 72,000 in 2009 (Smith 8).
Followed by this he says “The Scottish Government yesterday said the rise was down to better detection of ADHD, a result of wider knowledge of the condition among health workers”(Smith 8). After taking a look at what is going on in the UK, it’s safe to say they are undergoing the same process The United States did years ago. The lack of knowledge about ADHD in previous years is what kept ADHD diagnosis so low in certain countries until more recent years. This helps us clear up the misconception that ADHD is something that only exists in The United States.
Countries all over the world are continuously seeing large increases in diagnosis rates of ADHD. The reason the rates aren’t as high as The United States is simply because the disorder is something new to these countries. Now it should be safe to say that ADHD is in fact a real disorder. With today’s technologies resulting in new discoveries on the brains functions and the disorder’s acceptance present in the worlds developed countries make it difficult for any individual to deny this fact. Although the controversy of ADHD’s legitimacy has been made clear, the argument does not end here.
In close relation to the over diagnosis controversy, a similar controversy is aroused by ADHD’s stimulant medications. Stimulant medications have aroused a whole new controversy of their own in the medical world today. It is common to see an individual reject the use of stimulant medications because of the various negative side effects that come with their use. The question of long term effects being caused by stimulant medications is being seen more often among users themselves, and anyone else involved in the argument over ADHD.
A study shown in the Journal of Psychosocial Nursing and Mental Health Services holds the answers to these questions. In order to gain an understanding of stimulant medications it is necessary that a brief summary of this study is given. A table titled Effects of Long-Term Stimulant Therapy on Safety Outcomes in Children With ADHD states the following information regarding side effects of stimulants; Treatment was well tolerated, 7. 6% of patients discontinued treatment. Minimal effects on weight and heigh were seen. Small if any changes in blood pressure or heart rate. Headaches were seen in 3% of patients, insomnia in 19. % of patients, decreased appetite in 18. 7%, abdominal pain in 11. 1%, and tics in 9. 4% of the patients (Wilens, Donner, Michaels, Ambrosini, Biederman, and Lerner). As you can see questionable side effects are seen with the use of stimulant medications. There is a possibility to have trouble sleeping, have problems with abdominal pain, a decreased appetite, and suffer from tics. This study was done over a two year period so it insures that most side effects caused by stimulants were seen in this study. In the two years of this study nothing was discovered that wasn’t know before.
With the long term use if stimulants you will most likely suffer from a few negative side effects. ADHD patients involved in stimulant treatment would be able to tell you the side effects may not seem pleasant, but can be overcome by proper use of the stimulant. To begin stimulant medications must be taken early in the morning to avoid possible insomnia. For extended release stimulants the effects last anywhere from 12-18 hours. Taking your medication early in the morning gives time for the medications effects to wear off. It is also important that an individual under treatment makes the effort to eat.
Stimulant medications decrease appetite not allowing an individual to realize their hunger. Although one may not feel hungry, it is important to eat healthy foods for every meal of the day. Not eating due to stimulant treatment can become a problem and result in serious weight loss. It is important that a few more things are taken into account when being treated with stimulant medications. Before treatment even starts it is important that the proper prescription be given. The article “Overview of ADHD” gives this information on stimulant treatment, “Before prescribing any medication, a full history should be taken.
In the case of stimulants, it is especially important to check for a personal or family history of heart conditions and arrhythmias. Of Course, a complete physical examination is also required with referral to a cardiologist if indicated from information in the history” (Sajid, Poor, Diaz 58). Once heart Conditions are ruled out it is safe to say that with a proper ADHD diagnosis stimulant treatment is appropriate. Parents may want to monitor their children carefully once treatment begins. It is important to watch the way one reacts to the medications to make sure none of the side effects cause serious harm.
Weight and height should be monitored carefully. In the instance of significant weight or height change treatment should be discontinued. Stimulant medications hold another attribute that give users one more reason to take caution. Stimulant medications are proven to be addictive when the user disregards their prescribed amount. It needs to be understood that in no case should an individual exceed their recommended dose. This is considered abuse of stimulant medications and can result in serious problems. An article regarding the misuse and abuse of stimulant medications gives a list of symptoms that help detect misuse or abuse.
Users themselves and parents of adolescent users should look for behavioral changes, problems in school or work, change in activities and friends, heightened attention, long periods of sleeplessness, not eating, secrecy and isolation, fatigue, depression, racing heart, confusion and delusion, aggressiveness, irritability, mood swings, weight loss, and dilated pupils (McCarthy). These symptoms will all become apparent when dealing with one that abuses their prescription. The possibility of addiction among stimulant users does in fact exist.
This addictive attribute can be disregarded given that the prescription is used as directed by his or her physician. Through the series of information given on the effects of stimulants it can be said that they’re appropriate as long as the individual being treated takes the necessary precautions. They are effective in treating those with ADHD, and are the answer to the problem for many. For some individuals stimulant medications may not be the right treatment. In this case there are many other options of treatments and therapies that are appropriate for treating those with ADHD.
In fact the effectiveness of behavioral therapies among those with ADHD has aroused another controversy regarding stimulant medications. This relatively new controversy is brought up in the USA Today article “New findings raise questions about use of ADHD drugs”. A quote from the article regarding studies on behavioral therapies says, “It now reports the advantage is gone by the three-year mark. By the six and eight-year mark, across 30 measures of behavior and academics, the children still being given medication by their parents fared no better than their non-medicated counterparts… ” (2009).
This quote is referring to behavioral therapy’s ability to catch up to the effectiveness of stimulant medications after a three year period. This causes many to question the use of stimulant medications. It wouldn’t make sense to pump your child full of amphetamines when you can gain the same results by behavioral therapy. Refuting the previous argument three years is a long time. As Stimulants are instantly effective many individuals are looking for instant results. Although reaching a conclusion on this argument isn’t possible, combined treatment methods completely erase the idea of the argument.
If both forms of treatment are seen to be equally effective, why not use them both. With the instant effectiveness of stimulants and the long term effectiveness of behavioral therapies, a whole new therapy can be created that is twice as effective. ADHD patients on stimulants would be more susceptible to participating in behavioral therapies. Thus the therapies process would go much quicker producing positive results in half the time. Combined therapy is the ultimate way for any ADHD victim to overcome their problem.
Through all of the information that has been given in this argument two final conclusions have been reached. The first conclusion was that ADHD is in fact a real disorder. The second conclusion would be that among individuals that qualify for their use, stimulant medications are an appropriate method of treatment. After seeing long term studies on the safety of their use and studies on their overall effectiveness it is safe to make this conclusion. As ADHD is one of the most researched disorders in medicine it is only normal for a large portion of information to be left out this argument.
The large amount of information that has been left out of this argument makes it natural for objections to be made. For some the evidence presented isn’t enough to acknowledge the truth of the conclusions that have been reached. This is completely understandable among those who are heavily apposed to the argument. It is possible that there is information available that opposes the view that was presented. Chances are that information would be much less credible than what was presented, but it is important to recognize possible objections before the argument is complete.
It is only normal for any individual to hold personal beliefs. Individuals opposed to the argument may have their own beliefs that disregard the facts that have been presented. For example an individual that is heavily opposed stimulant medication use would object to the conclusion reached on behavioral therapies. To certain individuals behavioral therapy is better option than the combination of stimulants with therapy. Their personal belief being stimulants are an inappropriate method of treatment leaves the effective option of behavioral therapy to be the better choice of treatment.
In this situation credit can be given to this objection, but the facts available don’t give it as much support as the original conclusion. There are certainly objections to the argument that can be based on fact. The position stated on the presence of ADHD in other countries will be objected by many opposers of the argument. Even after seeing the factual evidence that ADHD popularity is on the rise in other countries, many would argue that the presence in other countries is only a fraction of what is seen in The United States.
This statement may seem to be the basis of a strong argument but is counteracted by other factors. When the numbers are measured in individuals the countries population needs to be taken into account. The US has a much larger population than most countries causing individuals as a unit of measure to be much higher. When a percentage is created by dividing the amount of individuals by the countries population much more accurate results becomes available. When looking at ADHD rates in units of percentage similar rates are seen among the worlds developed countries.
The most expected objection to the given position would be regarding stimulant medications. Although the results of the two year study regarding the safety of stimulant medication use displayed no significant danger in use, opposers remain pessimistic. To many the evidence provided by a two year study isn’t enough. It is strongly believed by many that the long term use of stimulants will eventually negatively impact health. This objection is hard to argue due to the fact that we are not able to look into the future. Negative health effects from long term use of stimulant medications is certainly a possibility.
Looking back on the fact that ADHD and its treatments are among the best researched ideas in medicine gives hope that any long term health effects would have by now been recognized. Now that all of the possible flaws on the presented position have been reviewed it can now be said that the conclusions reached are justified. ADHD is in fact a real disorder, and the use of stimulant medications for treatment are appropriate. ADHD is a disorder that should be accepted and understood by society. It is a mental disorder that results in significant behavioral and social problems in an individual’s life. The disorder is omplex and causes changes in the brains functions causing a series of symptoms to occur. Society needs to realize that disregarding ADHD’s legitimacy is offensive to those who suffer from it. It is crucial for members of society to regard that use of medications for treatment is the only way for some individuals to overcome these symptoms. Passing on knowledge of ADHD is important to the future of the disorder on those who suffer from it. Regardless of any personal beliefs it is important to respect the beliefs of other. The controversy over the disorder needs to come to an end, and the fact that ADHD is real needs to be recognized.
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