Wrote A Paper about ADHD Diagnosis in Children...

Preface: Just thought I'd share it because it was an interesting subject. I know there's a lot of passionate folks out there, but this isn't cause for conflict. Simply wanted to share what I found out...

I usually lose points for grammar. Sorry grammar Nazi's...

This is written based on a specific rubric so if it's not as fluid, that's why.

The Current Standards for Diagnosis and Medicinal Treatment of ADHD Must be Reevaluated

"If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away." Henry David Thoreau practically suggests a seemingly unachievable solution to a problem many parents have struggled with for years. How does one approach the needs of a child who has been diagnosed with ADHD? Ensuring that a child is emotionally stable early, is imperative for the welfare of society, but a lack of definitive research on the subject of ADHD should make parents hesitant to accept the first diagnosis, and more specifically, whether or not to give their child medications in response.

 
     Appreciation for the medicinal treatment of ADHD is growing in popularity and for good reason. One can find story after story told by adults who struggled with undiagnosed ADHD I and II as a child. These narratives are filled with frustration, educational failures, disastrous relationships, and often drug abuse (Wanner). A common answer to behavioral problems associated with this disease, and one that has not proven effective, is severe discipline. Juliet Pia, a mother of a young child with ADHD said, “These methods would work temporarily, but nothing had a lasting effect- her brains and body were just moving too fast…. Since I couldn’t sit in the classroom with her all day long, nursery school was just a horror.” Because of this, many researchers are pointing to stimulants such as Adderall and Ritalin. Thanks to new screening programs, and advances in psychiatric research, millions of children and adults are finding relief through these pharmaceutical options and often behavioral therapy. For some, these advances are a relief to a life time of pain. For many, medications are financially, the only treatment option due to health care costs (Marsa). Despite the positive impact, the inability to achieve a clear diagnosis for this disorder has some concerned that instead of lack of acknowledgment, the negative effect of medications due to over diagnosis could now be the bigger issue. 

     The United States uses 80 percent of the world’s Ritalin, a stimulant used to treat hyperactivity. According to Linda Marsa, a teacher and investigative journalist from Los Angeles, prescriptions of the drug “for preschoolers rose 49 percent from 2000 to 2003. This is especially sobering in view of the fact that Ritalin is not even approved for use in children under six [years of age]” (Marsa). Rising national education standards have limited the time that adolescents are allowed to expel their large amounts of inherent energy. This often leads to inattentiveness, hyperactivity and other disciplinary problems. A child’s teacher is usually one of the first to notice these traits. Unfortunately, due to the large numbers of students per classroom, the child is often labeled a nuisance and handed to school administrators and eventually their parents to be dealt with.  Due to these symptoms being difficult to differentiate from lack of exercise, disciplinary needs, and other mental health issues, many specialists suggest mandatory mental health screenings for school age children. Nathaniel S. Lehrmn, clinical director of Kingsboro Psychiatric Center in Brooklyn asks a thought-provoking question, “What is this mental illness for which we are now screening? Years ago, the term ‘mental illness’ referred only to the insane: people with bizarre ideas who were unable to function socially….. The term has been expanded to include increasingly more of the thousand natural ills to which the flesh is heir,” (Lehrman). 

     
     Standards for ADHD diagnosis have been created by the American Academy of Pediatrics but these evaluations can cost exorbitant amounts of money if the individual, or more specifically their parent, does not have adequate insurance. Federal law states that the schools have to provide free evaluations for these individuals as well as classes to facilitate their needs (Marsa). Mental health screenings are often a generic group of questions that allow little to no flexibility for those being evaluated. Schools regularly administer computer based assessments with either yes, or no as optional responses (Lehrman). To effectively diagnose ADHD, several hours of evaluation with a licensed psychologist are needed, but it is common for insurance companies to encourage doctors to restrain from giving referrals to specialists. This makes it cheaper for most primary care physicians to medicate a child instead of encouraging behavior modifications, like therapy (Marsa). Many parents happily agree to continue, noticing an obvious change in their child’s behavior after administering the stimulants but, as many college students can attest, these medications increase the focus and motivation of anyone who takes them. Unfortunately, this does not mean that the root of the problem has been addressed. 

     Multiple issues can present symptoms similar to those of ADHD, including learning disabilities, impaired vision, problems at home, and hyperthyroidism. Parents should consider medications the last resort when treating their child’s ADHD. Prior to administering possibly harmful stimulants, resources such as behavioral therapy, setting goals, teaching the child organizational skills and time management should be attempted. “Children with ADHD need consistent rules. a high degree of daily structure and stern consequences for misbehavior,” explains Marsa.  The need for hesitancy when using medications is due to the side effects often encountered in children. These include sleeplessness, lack of appetite, and sometimes depression.  Many experience what Marsa calls a, “rebound effect”, meaning that when their medication wears off, they become irritable and their symptoms come back. Specialists do not advise allowing children to take the prescriptions without reassessing their need for it regularly. Most encourage parents to occasionally try taking their child off of the drug for a short period of time yearly, under a doctors supervision (Marsa).

     For a child with severe ADHD, medications can have an overwhelmingly positive impact on his or her life. For a child who is misdiagnosed, medicinal dependency and insufficient treatment of the underlying issues can lead to more substantial problems as they age. It is a parent’s responsibility to recognize this need, and go above and beyond, making attempts to find alternatives to legal addictive stimulants. Many are discouraged by his or her child’s march to a different drum, often taking responsibility. For these parents to instead, attempt to find the child’s rhythm, would help to mould an adult who, despite his or her differences, has a well developed sense of self esteem and is capable of functioning without fear of failure. 

Annotated Bibliography

Briggs, Rahil. "Mental Health Screening for Kids: Column". USA Today. Gannett Company. 31 January, 2013. Web. 6 November 2013

Rahil Briggs is an assistant professor of Pediatrics who teaches at Albert Einstein College of Medicine. USA Today is a nationally published magazine so he is writing a public interest piece prompted by his work with children at the Children’s Hospital at Montefiore. He discusses the idea that although mental health screenings aren’t necessarily refined enough, he feels it is it important nonetheless, because of issues like the Newtown massacre. His opinion is based on his experience as a doctor.
Brigg’s main argument is that gun control is not enough to rid our country of severely violent acts like what happened at Newtown and Columbine. He feels that mental health screenings for each child are imperative and should be part of the enrollment process for school. I think that this article provides one explanation as to why so many children are given tests for things like ADHD. Societal focus on mental health has increased due to education but also because so many negative things have happened recently due to lack of attentiveness towards those struggling with mental health issues.

“Eleven Percent of U.S. Children Ages 4-17 diagnosed with ADHD.” United Press International. UPI, 24 Nov 2013. Web. 24 Nov 2013.

United Press International is a 106 year old company that licenses content directly media outlets, and businesses as well as governments and researchers around the world. As a news publication, their focus group would be a broad as possible.  It points out the alarming number of children currently taking medications for ADHD and explains the nature of ADHD and the effects of treatment.

Lehrman, Nathaniel S. "Mental Health Screenings in Schools Can Harm Children." Mental Illness. Ed. Roman Espejo. Detroit: Greenhaven Press, 2012. Opposing Viewpoints. Rpt. from "The Dangers of Mental Health Screening." Journal of American Physicians and Surgeons (Fall 2006). Opposing Viewpoints in Context. Web. 10 Nov. 2013.

Nathaniel Lehrman is the the clinical director of Kingsboro Psychiatric Center in Brooklyn, New York and an assistant clinical professor of psychiatry at the State University of New York. This article was written for the Journal of American Physicians and Surgeons, so he is writing to fellow academics and colleagues. His opinion is based on his experience in the field of psychiatry. He feels that mental health screenings can misdiagnose children who are suffering from unfortunate life circumstances, not struggling with mental illness.
Lehrman states several cases where children and teenagers were misdiagnosed and whose situations actually declined due to their being medicated. He points out that not every person is mental ill, it has been “expanded to include increasingly more of the thousand naturals ills to which the flesh is heir.” or it has been used as an excuse for every persons flaws. Schools make more money when kids have disabilities and for a while ADHD was classified as a disability so people could get disability benefits for it! This article provides a lot of useful facts that outline a majority of my opinion. It takes more than a simple screening to diagnose someone with a life changing disease.

Marsa, Linda. "ADHD Drugs Are Overprescribed for Children." Are Americans Overmedicated? Ed. Tamara Thompson. Detroit: Greenhaven Press, 2011. At Issue. Rpt. from "Is ADHD Getting Out of Control?" Ladies Home Journal(Apr. 2005). Opposing Viewpoints in Context. Web. 10 Nov. 2013. 

Linda Marsa is a journalist from Los Angeles who teaches medicine, science and health. She is writing for the readers of Ladies Home Journal. She feels that ADHD symptoms can be indicative of other issues and that simply handing a child stimulants and other powerful medications used to treat ADHD is “Bad medicine”.  I assume that her writing is based on experiences that she has had while teaching.
She states a large amount of statistics about Ritalin prescriptions for preschoolers and 2-4 year olds, assuming that the majority of audience members will be shocked because Ritalin is not approved for use in children under the age of 6. No one knows exactly what ADHD or how it should be treated. She feels that because “diagnosis is a judgement call” many doctors aren’t taking enough time to establish a relationship with a child before handing them medication. She discusses alternative methods to treat hyperactivity, the difficulty involved in diagnosing ADHD and the guidelines for the American Academy of Pediatrics.  Marsa sheds light on how ADHD diagnosis has gotten out of control and needs to be studied further. She also talks about the negative affects of misdiagnosis in children which is a logical reason to reconsider over diagnosis.

Wanner, John. "Adults with Attention-Deficit/Hyperactivity Disorder Face Serious Challenges." Behavioral Disorders. Ed. Louise I. Gerdes. Detroit: Greenhaven Press, 2010. Opposing Viewpoints. Rpt. from "Addressing Attention Deficit Disorder in Adults." The Journal of Employee Assistance 37 (Oct. 2007): 27-28. Opposing Viewpoints in Context. Web. 17 Nov. 2013

John Wanner is an Employee Assistance Program consultant who suffers from ADD. In this article he tells about his personal struggle with ADD and not realizing he had it until he was an adult. He believes that it effected many parts of his life, specifically the education and professional aspects. He talks about how many people with ADD have suffered through bad relationships, and used drugs, as well as dealt with a lot of emotional issues because of self esteem. His “angle of vision” is based on the fact that he, himself has been diagnosed with ADD (ADHD inactive).

His main idea is that it takes some adults many years to realize that there could be a reason behind the majority of their life’s issues. He is passionate about changing the lives of others suffering with ADD/ADHD. This is a personal experience that provides some insight into those actually suffering with the disease. This will be part of my argument that although ADHD IS over diagnosed, completely disregarding mental health screenings would be counter productive. The key is to provide more detailed one-on-one screenings that last longer .