Here are some of the strikes I see against ADHD medication when not absolutely indicated:
-Something like a 50% higher ADHD diagnoses for children in the youngest quartile of their grade.
-A thinner frontal cortex in kids with ADHD compares disturbingly with the thinner frontal cortex of many highly gifted children, and perhaps often with the same symptoms. However the trajectory of the HG+ child is to rapidly gain cortical thickness until it is well above average in thickness around age 11 (if memory serves) then it thins back down some.
-Stunted or delayed average growth for ADHD kids on medication (~1" shorter after three years)
-The strongest outcomes pair cognitive therapies with medication. Taking a kid who has only had medication intervention off of the medication leaves them back at the starting line with no coping skills.
-Often brains grow resistant to psychotropic medications such as reducing the number of receptors for the given medication. Or a brain will cut back on producing its natural alternative. Or when the medication is a receptor blocker, the brain may ramp up production of the chemical for that receptor.
Bingo.
What's worse? Apparently some of those regulatory changes induced by psychotropics within the stimulant classes most commonly used to trial ADD/ADHD treatment cause
permanent regulatory changes in receptors and transporters. They are profoundly addictive. Profoundly. In a small, but very real and very reproducible percentage of those who take them, they
induce psychosis. Really. Rates vary by individual substance, but are well over 1%. It's not always reversible, incidentally.
The thing is, also, that stimulant meds increase focus for
anyone taking them. This is why there is abuse on a positively horrifying scale in collegiate settings with these drugs. There is not really a 'paradoxical' effect that can be used to determine which people are actually in NEED of medication.
It's just like clinical depression-- everyone KNOWS it when they see it. It's just that there isn't a clear diagnostic picture which isn't ambiguous, and the line where medication becomes "the" treatment of choice also isn't clear.
If ADD/ADHD isn't fundamentally an asynchronous development problem for the vast majority of children, then why do so many of them "outgrow" the problem? (And they do, if left unmedicated-- far fewer than half of the children with ADHD retain symptoms into adulthood.)
I strongly suspect that there are multiple populations being lumped together into one classification based on behavioral constructs that probably don't reflect the same underlying mechanistic causes. Some of those people are probably just asynchronous in development, and we're only starting to tease apart who is MOST likely to be misdiagnosed.
Wouldn't it be awesome to get back to a place where people who truly NEED medication can get it without it being assumed that they are selling it for recreational use?
