What Medication?

Dr. Roger McIntire

Editor's note: This is second in a three-part on what causes the terrible twos and the terrible teens.

As a treatment for Attention Deficit Hyperactivity Disorder (ADHD), Ritalin increases nervous system alertness and thereby increases focus and ability to concentrate. Over 11 million prescriptions for Ritalin are written each year to treat ADHD. The use of Adderall and Dexedrine is not far behind Ritalin in the totals for ADHD treatment, up 2,000 percent in the last 9 years.

Yet a study by Drs. Adrian Angold and E. Jane Costello found that the majority of children and adolescents who receive these medications do not fully meet the criteria for ADHD—even with the expanded criteria for ADHD approved in 1994 by the American Psychiatric Association.

Dr. Lawrence H. Diller, pediatrician and author of Running on Ritalin: A Physician Reflects on Children, Society and Performance in a Pill, concludes: "How we deal with our kids' problems reflects our thinking and a much larger problem in our culture."

Many parents have made medications their permanent treatments. An editorial in the Journal of the American Medical Association reported that drugs have tripled for children under 5, increased 170 percent for 5- to 14-year-olds and 300 percent for the 15- to 19-year-olds.

Seasonal Affective Syndrome (SAD) turned out to be eight-year-old Dean's problem discovered when Mom kept records over the weeks of a fall semester. As the winter days grew shorter, Dean's depression grew deeper. When a set of bright fluorescent lights were added to his first morning hours, Dean's behavior improved.

Still about 3.4 million U.S. children under 18 are said to be seriously depressed. Doctors write over 800,000 prescriptions for antidepressants such as Zoloft, Paxil, and Prozac each year for this young age group. Medications can be lifesavers for parents suffering with a severely disturbed child. Drug companies have a right to be proud of the help they provide. But it is not right to belittle environmental effects just because medications can reduce the symptoms.

Every parent has been amazed by a healthy child finding 200 ways to lie in front of a TV, 100 ways to wear out shoes and even socks, and 50 ways to wear good clothes in an outrageous way. Activity, even hyperactivity, seems to be just part of growing up.

Many parents want a solution that concerns no more work and attention than making sure the troublesome one gets his medication. Physicians hope prescriptions will do the job. The business world may hope to sell caffeine, sugar and additives, regardless of the behavioral effects. And children may be tempted to use medication as an excuse to escape responsibility.

Parents will need to keep a close eye on the possible sources of problems to be sure medications continue only when, and only as long as, needed.

Next time: Daily family strategies for the terrible twos and terrible teens.

Dr. McIntire is the author of Teenagers and Parents: 10 Steps to a Better Relationship and Raising Good Kids in Tough Times. Write him through CCBS or go to www.ParentSuccess.com.

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