TIME Parenting

Audra McDonald: Why I Thanked My Parents for Not Putting Me on ADHD Medication

American Theatre Wing's 68th Annual Tony Awards - Press Room
Audra McDonald attends American Theatre Wing's 68th Annual Tony Awards at Radio City Music Hall on June 8, 2014, in New York City. Walter McBride—Getty Images

The decision of whether or not to medicate a child is a personal, difficult and subjective one, the Tony winner writes in response to a TIME article

In response to an open letter to me, titled “Sorry, Audra McDonald — My Kid Needs His ADHD Meds.”

Dear Ms. Luscombe,

I would like first to congratulate you and your son, both on coping with his ADHD diagnosis and on coming to a solution that works for you.

If my speech in any way offended you, I do apologize. However, it was in no way, shape or form intended as a platform for me to denounce the use of medication for ADHD or any other psychological disorder. I myself have benefited from psychotropic drugs to help combat depression in my youth.

The decision of whether or not to medicate a child is a very personal, difficult and subjective one. What works for one child doesn’t necessarily work for another. But in the end, as a parent, all that matters is that you do everything within your power to help your child. You sound like a mother who is fiercely dedicated to your child and his well-being. My mother is also someone who was — and still is — quite fiercely dedicated to her children and their well-being. (In fact, she very much wanted to be the one to respond to your letter.) In the 1970s, when the term ADHD hadn’t even really been coined yet, and Ritalin was still a relatively new drug being prescribed for hyperactive children, my mother and late father were struggling with their very sensitive, overdramatic, hyperactive 8-year-old daughter, who was having serious issues in school. Growing up in my house, “Audra-induced anxiety,” as you put it, had quite a different connotation.

After months of increasingly frustrating, painful moments watching their child struggle, and after talking with psychologists and my teachers — but not yet having the benefit of decades of research, media and social discourse on what was still a relatively new medication — my parents happened to attend a performance at a local dinner theater. Although my family was a very musical one — my dad was a high school music teacher, my grandmothers both taught piano, and, as you yourself were kind enough to bring up in your letter, my aunts used to sing at various black churches in California in the ’50s and ’60s — we were not theatergoers. That night, at that theater in Fresno, Calif., my mother and father saw a troupe of young children performing in a pre-show cabaret. A lightbulb went off in their heads and they decided to encourage me to audition to be a member of this troupe, in hopes that it might be a good outlet for my energy, an oasis for my emotions and possibly a place for me to build some desperately needed confidence. That moment, that decision, that “lightbulb” was what put my feet on the first tiny bricks of the yellow brick road that led me toward the Oz that is my life in the theater. All because they were struggling with the question of how best to help their struggling, unhappy, hyperactive child.

If that moment had not happened — if they had decided to try another tactic (medication or anything else), and I had stayed on what had been my path up until that point — I have no doubt that while my life might have been a fantastic one, it would not have been one in the theater. I have my parents to thank for making what was ultimately a life-changing decision for me.

Last Sunday night, I was overwhelmed with gratitude and love for my parents, who put me on the path that somehow, miraculously led to my standing on that stage, clutching that Tony. I am ashamed to admit that I don’t think I had ever truly thanked them for that before. Unfortunately my father is now deceased, but my mom was there, and I’m so grateful that in the 90 seconds allotted a winner to say thank you — and as the completely addled wreck of an emotional mess that I was at that moment — I was able publicly, from that stage, to look into her tear-filled eyes and acknowledge her struggle and thank her for making that decision. Not for driving me to rehearsals, helping me with my lines or keeping me calm, as you suggest I should have said to her, but for the actual decision she made. That is exactly what I wanted to thank her for, and I did. It was a decision that was very personal, and it ended up being the right one for me. It was a moment for and about my parents and their love for me: nothing else and no one else.

Every parent, when faced with a decision like that, makes it on the basis of real, personal and specific circumstances relating to their child. For some, the right decision is to medicate, for some it is not. For some it is a bit of both, and for some it is any one of a million other variations on the treatment options available. The only common factor that goes into making that decision, which is indisputably true for almost all parents, is the indescribable amount of love they have for their child.

I’m positive that your son will someday recognize that he has a mother who is fiercely devoted to him and that every decision she ever made was out of love for the child he is and the adult he will become. My best wishes to you both.

Audra McDonald is a mother, activist and a six-time Tony Award–winning singer and actress.

TIME Parenting

Sorry, Audra McDonald — My Kid Needs His ADHD Meds

Kevin Mazur—2014

Isn't being awesome enough? Do you have to start prescribing as well?

Dear Ms. McDonald,

I love your work. Who doesn’t? Clearly nobody, since you just won a record-obliterating sixth Tony for your performance as Billie Holiday in Lady Day at Emerson’s Bar & Grill. Congratulations. That’s an incredible feat.

And don’t get me wrong, I love that you thanked your parents before anyone, the folks who got you your start in the theater. “I want to thank my mom and dad up in heaven,” you said in that seriously kick-ass red-and-white gown, “for disobeying the doctors’ orders and not medicating the hyperactive girl and finding out what she was into instead and pushing her into the theater.”

I have kids too. Should they happen to ever achieve a modicum of success, I’d like to think they might thank me one day. Not publicly from a podium or anything, but maybe just from their desk, or whatever place of work they happen to land upon. Here’s the thing, though: I really want them to have jobs. Unlike your family, of whom you once joked that if you were “tone-deaf they would have kicked me out,” I’m not musical. Unlike you, my kids do not have five aunts in a professional gospel-singing group. (My brothers did have a band. If memory serves, my mother called them the Unlistenables.)

But here’s the thing: one of my kids doesn’t learn very well without the meds. We’ve tried the theater, sports, music, wearing him out, getting him more sleep, meditation, diet, being super-disciplinarian, being not too disciplinarian, art, bribery and shouting. We even tried chewing gum for a while. Oh, man, that stuff is hard to remove. We tried a lot of techniques, some of them more seriously than others, because we are human and have jobs and other children. But the thing that worked best, that enabled him to learn to read and stopped him from getting into trouble at school, was medicine.

Since completing school and getting a job are pretty tightly linked, our options are limited. Since employment and having a family, or a home or a healthy mental attitude, have also been linked, the parent of a child who has trouble learning can begin to get very anxious. Nobody, as I’ve said before, is thrilled to medicate their child. It’s not what anybody considers a huge parental triumph. We have no trophy cabinet for the expired bottles of methylphenidate. But if you don’t have a child whose talents are as prodigious and obvious as yours, it can be tough to figure out what’s best for them. So you’re left with trying to avoid what’s worst; and clearly not being able to learn is pretty high on that list.

I’m sure that you were not personally judging me and other concerned parents when you thanked your parents for not putting you on Ritalin. I’m sure you weren’t trying to prescribe from the podium. And obviously, you have thrived, against some serious odds. But damn it, you’re not making it any easier to live with our hard decisions. There’s anxiety and then there’s Audra-induced anxiety, which is more dramatic and accomplished than the regular sort. I’m equally sure your parents also drove you to rehearsal a lot, or ran lines with you, or calmed you down if you had stage fright, or told you not to chew your nails. You couldn’t have mentioned that instead?

The chances of anybody winning six Tonys are extremely slender (again, bravo). If by giving my child medication, I have reduced his chances of getting that gong even further, so be it. He may not be Audra-level awesome, but he’s going to get through school. I’m O.K. with that.

TIME mental health

Bad News For Ivy Leaguers: ADHD Drugs Hurt Your Memory

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Smart drugs used to boost performance in the short term have long term damage for the young brain, a new study says

Prescription drug abuse is rampant, and for a third of Americans, the first drug of any kind that they take—including illicit drugs—is an Rx that has not been prescribed to them. That’s not surprising when you consider how many students abuse ADHD drugs for performance. But new research shows that recreational use of smart drugs comes at a cost.

Researchers from the University of Delaware and Drexel University College of Medicine reviewed the latest research on the effects of medications like Ritalin and Proviigil on the juvenile brain and discovered smart drug use is certainly not benign. The new research published in the journal Frontiers in Systems Neuroscience shows that while a drug like Ritalin may offer a boost in mental performance, it’s a short-term crutch that can actually adversely impact the brain’s plasticity, interfering with people’s ability to plan ahead, switch between tasks and be overall flexible in their behaviors.

For instance, the researchers looked at one of the most popular smart drugs on the market: Methylphenidate (otherwise known as Ritalin and Concerta). The drug is meant to treat ADHD, and about 1.3 million U.S. teens have reportedly used the drug without a prescription in the last month. Rat studies have shown that young brains are very sensitive to methylphenidate and that even low doses can harm nerve activity in the brain as well as memory and complex learning abilities. For a drug that’s supposed to offer better mental performance, the long term effects appear to do the opposite.

The study also took a look at the drug modafinil, also known as Proviigil which is used for sleep disorders like narcolepsy. The drug can help boost memory and is abused for various mental tasks, especially tasks related to numbers. But once again, the drug has very similar long-term effects on the young brain.

Finally, the researchers looked at a lesser-used class of drugs called ampakines, which are being studied by the military to increase alertness. They are known to improve memory and cognition, but for young people, unsupervised use can result in an overstimulated nervous system which could actually kill nerve cells.

“The desire for development of cognitive enhancing substances is unlikely to diminish with time; it may represent the next stage in evolution—man’s desire for self-improvement driving artificial enhancement of innate abilities,” the authors write.

And there’s no arguing with that. Other recent research looking at the use of smart drugs among Ivy League students found that many use ADHD drugs for academic performance, and they don’t think it constitutes as cheating. The study found that a third of the students in the study said using ADHD drugs for performance enhancement did not count as cheating, 41% said it was cheating, and 25% said they were not sure. People who used ADHD meds were also more likely to think it was a commonplace on campus.

The use of ADHD and other smart drugs has long been an ethical issue, and a growing one at that. Increasingly more people are being diagnosed with ADHD, even adults. The amount of adults taking ADHD drugs rose by over 50% between 2008 and 2012, according to a recent report. But now, emerging research shows the issue is also a biological one, and the early findings are not pretty.

The researchers of the latest study conclude that scientists and the medical community have a responsibility to very carefully evaluate and research each no drug to gain a greater understanding of drugs’ impact on the brain.

 

TIME

Many Ivy League Kids Don’t Think Taking ADHD Drugs is Cheating

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Many students use ADHD drugs for academic performance, and they don't think it's cheating

About one in five students at an Ivy League college said they’ve used a prescription ADHD drug while studying, and a third of the college students did not think that qualified as cheating, according to new research.

ADHD medications, like adderall or ritalin, are commonly misused among people without a diagnosis as a way to perform and concentrate better. A 2011 paper from the College Board reported that though available numbers are small, students do obtain and use ADHD drugs and learning disorder diagnoses to gain an academic advantage, the New York Times reports. Of course, there are people with legitimate disorders, but the new study focused on students without ADHD.

The researchers, who will present their findings at the Pediatric Academic Societies (PAS) annual meeting this weekend, interviewed 616 students at a “highly selective college” (the researchers did not say which), and found that 18% used the drugs for academic reasons, and 24% had done so eight or more times. College juniors were the most likely to abuse the medication, and students who played sports or were involved in Greek life were also the most common abusers. Since the researchers excluded anyone with an ADHD diagnosis, all the students were therefore using the drugs illegally. The researchers did not ask about the source of the medications, but told TIME in an email that they are almost always from other students.

When asked whether this type of behavior classified as cheating, a third of the students said it did not, 41% said it was cheating, and 25% said they were not sure. People who used ADHD meds were also more likely to think it was a common phenomenon on campus.

More and more people are being diagnosed with ADHD, including adults. The number of adults taking ADHD drugs rose by over 50% between 2008 and 2012, according to a report. One of the hard parts about screening for the disorder is that doctors need to determine who has a legitimate disorder and who is looking for a performance fix. The researchers say their study raises those serious questions for providers: “To the extent that some high school and college students have reported feigning ADHD symptoms to obtain stimulant medication, should physicians become more cautious or conservative when newly diagnosing ADHD in teens?” study author Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven & Alexandra Cohen Children’s Medical Center of New York, said in a statement.

The findings will be presented Saturday, May 3, at the Pediatric Academic Societies (PAS) annual meeting in Vancouver.

 

TIME ADHD

It Doesn’t Matter if ADHD Doesn’t Exist, My Son Still Needs Drugs

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Here's what would induce a parent to start messing with the chemistry of their growing kid's brain

No mother wants to drug her kids. Nobody lies around pensively stroking her pregnant belly and thinks, “Just can’t wait to medicate this little sucker.” But here’s the thing: unless we are going to radically alter the way we teach kids, there’s not much else parents can do to get some kids through school.

We swung wildly from feeling stricken about drugging our son to feeling guilty we had waited so long.In his recent book ADHD Does Not Exist and his essay for TIME, Dr. Richard Saul suggests that attention-deficit disorders are massively overdiagnosed and a bunch of the symptoms occur in any busy human being. He warns that we are looking for a chemical solution to a problem that needs a therapeutic one. But this is a bit like saying that we already know how to prevent AIDS (simply stop having sex or sharing needles!), so we don’t need a vaccine or a cure. It’s not as easy as it sounds.

Everyone who defends giving kids stimulants has a story and here’s mine: I have a charming but mischievous son who skipped the part of elementary school where kids learn to read. Was read to as a child, bookish home, did first grade twice, had tutors, the whole nine yards. Still, when shown a picture of a hen with the word hen underneath, he’d read chicken. Maddening. He was diagnosed as dyslexic (another condition that “doesn’t exist,” according to some), and we sent him to a school that specializes in reading difficulties.

The school was great, but we got a lot of calls. There was a certain amount of our son being sent out of the room. This is in class sizes of no more than 12. Therapy, sleep, “finding a passion,” various flavors of carrot and stick were tried. No stone was left unturned. The subject of meds came up — nobody ever says it’s mandatory, it just comes up in conversation — but we held firm. We are not a pill-popping family. We don’t even take headache medication unless our vision gets blurry. We would push through, with discipline and love and grit. The teachers would just have to manage him better. After all, what would induce a parent to mess with the chemical balance of a growing child’s brain?

We may have stood our ground forever, except for the aforementioned “charming” part. Turns out our son was something of a pied piper. If he decided to wander off task, he took half the class with him. The nice folks at the nice school pointed out it wasn’t very fair to the other parents. It’s like that whole other childhood medication controversy, vaccination. Sometimes you don’t just do it for you. Maybe you can stomach your kid not learning, but it’s not cool if he takes the more vulnerable — and sometimes less able — kids with him.

But, in any case, what modern parent can approach the specter of a child who doesn’t learn with any equanimity? Even a not-very-attentive adult can see that the knowledge sector of the economy is the safest haven in downturns. The gap between those with college degrees and those without is ever widening. Not just in income, but also in life areas like successful marriages and health. The option for a kid who can’t sit and learn is not a slightly less lucrative career, it’s a much more miserable existence.

So here’s what would induce a parent to start messing with the chemistry of their growing kid’s brain: fear. As we saw our child fall behind, and we looked at what lay ahead, the cold hand of impending doom got us by the neck and squeezed. The older a person is, the harder it is to learn to read, we’re told. If a child can’t read, he can’t learn any other subject, including math. So the kid needs to be able to concentrate; he needs to be able to take tests; he needs to be able to hear what his teachers are saying. Either he needs a class size of about six, with an incredibly adept and captivating teacher, or he needs a little help.

We started giving him meds at age 11. Within two weeks, there was a marked change. That year, he learned to read — and write. I got my first comprehensible Mother’s Day card. (“Yeah, the teacher warned me that you would cry,” he said.) We swung wildly from feeling stricken about drugging him to feeling guilty we had waited so long.

Could we get our kid through school another way? Maybe. Perhaps spend half the day in P.E. Or get him a governess instead of a classroom. Or find a teaching style that is different, somehow, more kinesthetic or less visual or uses blocks or therapy monkeys. But they’re all just maybes and he’s not our only kid and he’s not our only life challenge and his useful school years are slipping away. The meds work, are almost free of side effects and, far from being handed out willy-nilly, are a huge pain to get every month.

When I asked our now 16-year-old son if he liked taking his meds, he said “Sure. They help me concentrate.” And when I followed up with, “Would you rather be able to concentrate without them?” he gave me one of those specially-reserved-for-moronic-parents-looks and replied, nice and slow, so I’d get it. “Wouldn’t anybody?”

Right. Wouldn’t any parent prefer to get their kids through school drug-free? Yep. (Well, mostly. As Dr. Saul suggests, it’s hard to believe the growth in ADHD prescriptions is completely organic. I’d love to hear from some parents on how their kid’s ADHD went unnoticed until they had to take the SATs.) But if we want to eradicate a chemical solution to what might be a behavioral disorder, we’ve got a whole economy and education system to reorganize. While you guys get on that, I’ve got to get my kid through school.

TIME

Taking ADHD Drugs as a Child Linked to Later Obesity

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New research out of the Johns Hopkins University Bloomberg School of Public Health shows that the body mass index of children diagnosed with ADHD and put on medication to treat it can increase months or even years after they've stopped taking their treatment

As recent data continues to show higher rates of attention-deficit/hyperactivity disorder (ADHD) among children, parents, doctors and researchers have been eager to better understand what the rising numbers will mean for a generation of kids. With the latest figures suggesting that as many as 11% of youngsters ages 4 to 17 are living with a diagnosis of ADHD in the U.S., some studies have linked the disorder to higher rates of substance abuse and smoking, and now obesity.

The latter is particularly puzzling to scientists for two reasons: First, hyperactivity doesn’t seem like it should lead to gaining weight. Second, the most common medications for treating ADHD are stimulants, which help to balance out excitatory chemicals in the brain and even out nerve firings so they’re less chaotic. Stimulants include amphetamines, which have been used for decades as a metabolism booster to help the body burn calories faster.

(MORE: Medicating Young Minds)

But we may have to rethink the way we think of stimulants, and how we’re medicating our kids. Dr. Brian Schwartz, professor of environmental-health sciences, epidemiology and medicine at the Johns Hopkins University Bloomberg School of Public Health, and his colleagues compared how body mass index (BMI) — a measure of height and weight — changed depending on whether kids were diagnosed with ADHD, and whether they were treated with the most commonly prescribed stimulant medications.

The researchers studied the same group of 163,000 children ages 3 to 18 over a period of up to 13 years, tracking their diagnoses, drug treatments and weight. For the children diagnosed with ADHD and put on medications, their BMIs remained slightly below that of their peers who either were not affected by ADHD or had the disorder but were not treated, or treated with nonpharmaceutical therapies. That wasn’t a surprise, since years of studies have shown that stimulants, or amphetamines, can inhibit growth.

(MORE: Reading the Brain: FDA Approves First Scan for Diagnosing ADHD)

What stunned the scientists was what happened after the kids came off the drugs. About half of the children in the study remained on the medications for about six months or less, while the other half took the pills for about a year. On average, by age 13, those who had taken the medications started to put on weight, while those who hadn’t did not. “That BMI growth curve was curving dramatically upward,” says Schwartz, who reported his findings in the journal Pediatrics. “This is the first time to my knowledge that the idea of a BMI rebound after discontinuation of stimulants has been reported.” The BMI of ADHD children who used other types of treatments actually converged with those of children who were not diagnosed with ADHD.

That means that long after children have stopped taking medications such as Ritalin, Adderall and Concerta, their bodies may still be feeling the effects of the drugs. Moreover, the younger the children were when they were prescribed the medications, the more they gained weight as teens. The same held true for those who took the drugs for longer periods of time. “Whatever the stuff does to you for that relatively short period of time — months to a year — it seems to alter your BMI trajectory for a long period of time after,” he says.

(MORE: ADHD Kids Can Get Better)

It’s not clear how that may be occurring — but children’s brains are still developing, and it’s possible that the changes in brain chemicals caused by the ADHD medications could reset and prime young bodies for obesity by disrupting normal appetite signals and the calorie-burning processes.

If that’s the case — and more studies will be needed to confirm that theory — the results are particularly concerning, since the latest surveys also show that many pediatricians are turning to medications more quickly than they should to treat their youngest patients. While the American Academy of Pediatrics recommends behavior therapy as the first line of treatment offered to preschoolers diagnosed with the disorder, a study released earlier this year showed that 1 in 5 specialists prescribed medications for preschoolers, either alone or in combination with behavior therapy, at the time of diagnosis.

(MORE: Doctors’ New ADHD Frontier: Diagnosing Adults)

“We certainly need to be more cautious about use of these medications in children,” says Schwartz. “Obesity has lifelong risks. If this is a consequence of stimulant use, and since there is evidence that we might be overprescribing stimulants, we might be contributing to the childhood- and adult-obesity epidemics.”

TIME ADHD

Doctor: ADHD Does Not Exist

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Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children — and now adults — who can't live without stimulants is no solution

This Wednesday, an article in the New York Times reported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.

And why shouldn’t they?

If someone finds it difficult to pay attention or feels somewhat hyperactive, attention-deficit/hyperactivity disorder has those symptoms right there in its name. It’s an easy catchall phrase that saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. What I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.

Allow me to explain what I mean.

Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the DSM changed the label numerous times, from hyperkinetic reaction of childhood (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition) to the current label, ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.

Today, the fifth edition of the DSM only requires one to exhibit five of 18 possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list, look it up. It will probably bother you. How many of us can claim that we have difficulty with organization or a tendency to lose things; that we are frequently forgetful or distracted or fail to pay close attention to details? Under these subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts they’re a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive-compulsive disorder and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

What’s so bad about stimulants? you might wonder. They seem to help a lot of people, don’t they? The article in the Times mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.

First, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; Big Pharma is understandably not as concerned.

Second, there are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are also consequences that are even less well known. For example, many patients on stimulants report having erectile dysfunction when they are on the medication.

Third, stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living over the long term.

For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.

It’s time to rethink our understanding of this condition, offer more thorough diagnostic work and help people get the right treatment for attention deficit and hyperactivity.

Dr. Richard Saul is a behavioral neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is published by HarperCollins.

TIME ADHD

Doctors’ New ADHD Frontier: Diagnosing Adults

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Figuring out the difference between stress overload and legitimate attention disorder is a fine line

When Peter Coyne’s 6-year-old son was diagnosed with ADHD 12 years ago, Coyne, 53, hardly knew what the disorder was. So he decided to read up on it.

“Suddenly I thought, ‘oh my God,’ this is what I’ve had my entire life,” says Coyne, a designer at a public relations firm. He flashed back to his younger years in school. He never thought he was stupid, but as classes progressively required more reading and attention, he suffered.

“It was frustrating. I used to think, maybe I don’t try hard enough. Maybe I don’t care. Maybe I’m lazy,” says Coyne. He scheduled an appointment with a psychiatrist, and Coyne got his own ADHD diagnosis the same year as his son. He finally had an answer for why he was the way he was. It was a relief.

The number of adults taking ADHD drugs rose by more 50% between 2008 and 2012, according to a report out this week from pharmacy management company Express Scripts. In 2001, 0.5% of adults ages 20 to 44 were on ADHD drugs, says Dr. David Muzina, vice president of specialist practice at Express Scripts. It crossed the 1% mark for men in 2004, and for women in 2005, and has been steadily rising ever since.

Parents educating themselves for the past decade about a problem that afflicts more and more children has led to greater awareness about the disorder. “What commonly brings someone in is they see their child being evaluated and recognize symptoms in themselves,” says Dr. Len Adler, the director of adult ADHD at New York University’s School of Medicine.

But diagnosing adults isn’t the same as diagnosing children—it’s harder. Since adults in general deal with a greater cognitive load than kids, there’s a fine line when it comes to distinguishing stress overload from legitimate ADHD symptoms. According to the DSM V, adults and children are assessed based on long list of symptoms for both inattentiveness and hyperactivity. Kids must meet six symptoms in each category for a period of at least six months, while adults need only meet five in each for the same time period—since adults tend to learn to cope and lose some of the more obvious symptoms with age. Some of the symptoms sound like your average overworked adult: difficulty with organization, easily distracted, unable to sustain attention, fidgeting, talking too much, interrupts often.

Most importantly, though, adults need to show that the roots of their disease took hold in childhood. “The consensus is that you cannot develop ADHD as an adult. You must have had symptoms in childhood,” says Dr. Joseph Austerman, a children’s psychiatry and psychology clinician at Cleveland Clinic. But ascertaining that is inherently problematic, since reporting often comes from the distracted adult in question. Significant others or parents are sometimes consulted, but the amount of information physicians can assess for adult patients is limited compared to that for children. Research has found that, among adults with ADHD, only 11% are diagnosed and treated.

The alarming rise in medication among children and adults has skeptics questioning the accuracy of so many diagnoses. Many also point to the successful marketing push from big pharma, which in 2012 saw profits nearing $9 billion for stimulant medications, compared to $1.7 billion just a decade ago, according to a report from The New York Times. And that’s from what has been predominantly a kids market. Online quizzes from ADHD advocacy groups can also prompt adults to seek help. “There’s no denying there’s a strong possibility that these numbers speak to clinicians’ proclivity to easily prescribe these medications to adults who are asking for them,” says Dr. Muzina.

While there may be growing cases of questionable ADHD diagnoses, for those who do have the disorder, it’s a relieving answer to a confusing and frustrating childhood. Men, who are more commonly diagnosed with ADHD, struggle more with holding down jobs and relationships.

“People at my age, we learn to adapt,” says Coyne. “It’s not like I can’t sit in my chair anymore. Now, I am just distracted.”

Dr. Muzina estimates that ADHD drug use in adults will grow by 25% over the next five years. But the chicken or egg question prevails. “The part that we are concerned about is how much of this drug use is related to over-diagnosis and over-treatment of symptoms that aren’t really a condition,” Dr. Muzina says.

TIME ADHD

Number of Adults Using ADHD Drugs Reaches New High

The number of adults using the pills rose by more 50 percent between 2008 and 2012, according to a new report, leading to concerns that the trend of over-diagnosing in children is now occurring in adults

The number of adults taking ADHD drugs rose by more 50% between 2008 and 2012, according to a new report from pharmacy management organization Express Scripts.

The report shows that adults taking medications like Adderall, Concerta, and Strattera rose from an estimated 1.7 million in 2008 to 2.6 million in 2012. For young adults, the increase in ADHD-related drug use was even greater, especially among women ages 26 to 34, who experienced an 85% increase in use. Some medical experts believe that ADHD is over-diagnosed in kids, and that trend is now bleeding over to adults.

The authors of the report note that the increased rate of ADHD medication among adult women could be due to the fact that females tend not to display the disruptive behavior symptoms of disorder, but are more inattentive and therefore may be overlooked when they are kids. It could also be attributed to inappropriate use of the drugs, for example, as an appetite suppressants.

The new findings come from an analysis of about 15 million privately insured people under age 65 and a closer look at pharmacy claims of 400,000 people who filled a minimum of one prescription for ADHD treatment during the study period.

You can read the full report here.

TIME mental health

More Bad News for Older Dads: Higher Risk of Kids With Mental Illness

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The effect of paternal age on autism, schizophrenia, and ADHD may be greater than previously thought

For so long, mothers – particularly older moms — bore the brunt of responsibility for genetic disorders in their children. And for good reason. Eggs are stockpiled from birth, not made anew with each monthly reproductive cycle, so eggs stored for decades until childbearing can develop genetic mutations. The older the mother, the greater the chance of abnormalities that can contribute to conditions such as Down syndrome, especially after age 35. Fathers, on the other hand, constantly make sperm, so their reproductive contribution was supposed to be fresher and free of accumulated DNA damage.

That may not actually be the case, however, according to the latest study in JAMA Psychiatry investigating how advanced paternal age can affect rates of mental illness and school performance in children. After a groundbreaking genetic analysis in 2012 highlighted the surprising number of spontaneous mutations that can occur in the sperm of older men, scientists have been delving into the relationship to better quantify and describe the risk. While some studies confirmed the connection, others failed to find a link.

MORE: Older Fathers Linked to Kids’ Autism and Schizophrenia Risk

In the latest research, Brian D’Onofrio, associate professor of psychological and brain sciences at Indiana University, and his colleagues attempted to address one of the biggest problems with studying the trend. Most of the previous investigations compared younger fathers and their children to different older fathers and their offspring. “That’s comparing apples and oranges,” says D’Onofrio. “We know young fathers and old fathers vary on many things.”

So his team turned to birth registry data from Sweden and compared children born to the same fathers, evaluating the siblings on various mental health and academic measures. The study included 2.6 million children born to 1.4 million fathers.

What they found surprised them – so much so that they spent about two months re-evaluating the data to make sure their numbers were correct. While the previous genetic study found that an older father’s DNA may account for about 15% of autism cases, D’Onofrio’s group found that the increased risk for children of fathers older than 45 years soared to 3.5 times compared to that of younger fathers. Children of older fathers also showed a 13 fold higher risk of developing attention deficit-hyperactivity disorder (ADHD), a 25 times greater chance of getting bipolar disorder, and twice the risk of developing a psychosis. These kids also had doubled risk of having a substance abuse problem and a 60% higher likelihood of getting failing grades in school compared with those with younger fathers.

MORE: Too Old to Be a Dad?

“What this study suggests is that the specific effect of older paternal age may actually be worse than we originally thought,” says D’Onofrio.

The scientists controlled for some of the well-known factors that can account for poor grades and psychoses and mental illnesses, such as the child’s birth order, the mother’s age, the mother’s and father’s education level, their history of psychiatric problems, and their history of criminality. Even after adjusting for these possible effects, they still found a strong correlation between higher rates of mental illness among younger siblings compared with their older ones.

The 2012 genetic study pointed to a possible reason for the higher rates of mental illnesses – because genetic mutations tend to accumulate each time a cell divides, older men may build up more spontaneous, or de novo, changes each time the sperm’s DNA is copied. While a 25-year-old father may pass on an average of 25 mutations to his child, a 40-year-old dad may bequeath each offspring as many as 65; the researchers calculated that the de novo mutation rate doubled with every 16.5 years of the father’s age. In contrast, regardless of her age, a mother tends to pass on about 15 mutations via her eggs.

The findings still need to be repeated by other groups, but the large sample size and the careful way that the researchers designed the study – to analyze the same fathers over time – suggest that the association is significant and worth considering for those who put off having a family. “This study suggests that paternal age does need to be considered as one of many risk factors associated with children’s mental health,” says D’Onofrio.

MORE: Fewer Drugs Being Prescribed to Treat Mental Illness Among Kids

Whether it gains the same amount of weight that maternal age does in family planning decisions isn’t clear yet, but even if it is confirmed, he notes that the correlation doesn’t predict that every child born to an older father will develop a mental illness. Older parents also have protective factors against these disorders, including more maturity and financial and social stability, that can offset some of the effect.

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