There are many issues
regarding volitional use of cognition enhancing drugs but perhaps the most
troubling is the epidemic of prescription drug abuse in ADHD. The treatment of
ADHD has become a very controversial topic. Over the last few years there has
been a rapid increase the number of ADHD diagnoses, particularly among young
boys. Historically 3-7% of children have been diagnosed with ADHD, but recently
over 20% of young males have received this diagnosis. It is hard to credit that
there have been physiological changes in the population that would result in a
trebling of the incidence of this disease. Rather it is likely that social and
economic factors are impacting the situation. First, this is a very lucrative
market and thus pharmaceutical firms have actively pushed their various drugs.
Second, in a time of increasing economic stress it is natural for parents to
want their children to do well in school, but at the same time parents may have
less and less time to spend with their children. Thus a stimulant becomes a
substitute for parental involvement in a child’s education. Third, the
diagnosis of ADHD, which is diffuse and subjective to begin with, has been
loosened in recent years, thus allowing physicians and parents more latitude in
placing their children on medication. Finally, one wonders if the changing
roles of males and females in our society may have something to do with the
fact that boys receive the preponderance of ADHD diagnoses. What historically
would be considered normal behavior for a young male, including a great deal of
motor activity, restlessness, and some degree of aggressiveness, is now
interpreted as pathological in a society increasingly influenced by female
norms of behavior. This may be particularly relevant in the context of
diagnosis of ADHD in elementary school children, where women continue to be the
great majority of teachers. While some physicians have characterized ADHD drugs
a ‘safer than aspirin’ there clearly are hazards in chronic use of powerful
brain stimulants such as Ritalin®. Thus, as a society, we seem to be conducting
an experiment of questionable value on our children.
Something similar may be
happening with diagnosis of autism. A recent report (1) suggests a 30% increase
in the frequency of autism in young males. While children with clear autistic
characteristics obviously need to be identified and helped promptly, there
seems to have been a loosening of diagnostic criteria so that more and more
children are being caught in the net of
‘autism spectrum disorder’. Once again it is unlikely that there is a
physiological basis for the apparent increased frequency. More likely,
behavioral characteristics that a generation ago would have been deemed just
slightly unusual are now being defined as a disease. The driving forces for this
are less clear since pharmaceutical companies are not making money from autism.
The long-term consequences of
over-diagnosis (and in the case of ADHD over-medication) are very unclear. Some
children may be helped by medication or treatment. However, what is the impact
of being labeled abnormal to a child’s self-esteem? What are the consequences
of chronic use of stimulants such as methylphenidate (Ritalin ®) or atomoxetine
(Strattera ®). As a scientist I know that all drugs have side effects but in
some cases those effects do not show up for many years. This is a difficult quandary
for parents of affected children.
