http://www.charlotte.com/mld/charlotte/news/7909451.htm
Posted on Mon, Feb. 09, 2004
Experts wonder about long-term effects
Ongoing debate about side effects, drug abuse
MIKE STOBBE
Staff Writer
Opponents of ADHD medication say the use of the drugs surpasses the science
supporting it.
Researchers aren't exactly sure how or why certain drugs work or don't work,
yet millions of children take them anyway.
More than 150 studies have shown short-term benefits from medication for
attention deficit hyperactivity disorder. But the long-term effects are not yet
well understood.
And there's debate about whether drugs like Ritalin and Adderall predispose
children to using illicit drugs later in life.
"That's the million-dollar question: Are we raising a generation of addicts by
giving them stimulants?" said Dr. Wilson Compton, who directs prevention
research at the National Institute on Drug Abuse.
Critics note the chemical similarity between ADHD stimulants and cocaine. They
believe that's a reason some studies have found children diagnosed with ADHD
are more likely to abuse drugs.
But recent studies also suggest that instead of fostering drug abuse, ADHD
medications -- given appropriately -- prevent it. However, the dust hasn't
settled.
There's also worry about side effects: ADHD medications can cause appetite
suppression, weight loss and feelings of moodiness and irritability. If the
dosage isn't correct, patients can become lethargic.
Some Carolinas doctors say they're uncomfortable prescribing ADHD medications.
"Managing (ADHD) without medication is the best approach, long-term," said Dr.
DuBose Ravenel, a High Point pediatrician who prefers behavior management and
other therapies.
Most doctors who treat ADHD prescribe medications and report success. But even
some who see the value of the drugs acknowledge that they don't know everything
about them.
"Some kids respond to one (medication) and not another. We have no idea why
that happens," said Dr. Jeff Epstein, an ADHD expert at Duke University Medical
Center.
Scans have measured biochemical imbalances in the brains of ADHD sufferers, and
found that brains of children and adolescents with ADHD are slightly smaller
than those of children without the disorder.
Studies also suggest ADHD can be inherited, though scientists haven't
identified a specific gene or set of genes responsible.
Researchers haven't come up with a simple blood test, brain scan or other
empirical way of diagnosing ADHD. Instead, most children are diagnosed based
largely on observed behavior -- a highly subjective system.
Doctors are supposed to follow diagnostic guidelines set by the American
Psychiatric Association. But a Duke University study of students in 11 Western
N.C. counties, published in 2000, found that only 43 percent of students taking
ADHD medication met the diagnostic criteria.
A 2002 study of elementary school children in Johnston County, southeast of
Raleigh, found 10 percent of the students in first through fifth grades had
been told they have ADHD by a health professional.
However, it also concluded that some students who were on medications didn't
have ADHD, and many children who did have ADHD weren't being treated.
"The overall conclusion of most researchers in the field is there's probably
both overdiagnosis and underdiagnosis going on," said Dr. Andrew Rowland, the
study's lead author.
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Sadly the *gang* will have a hissy fit that this is posted, along with Mark
Probert, who will deny it.