General Articles


Adderall Does Not Teach You Calculus

David Schick, USA TODAY Collegiate Correspondent June 20, 2013

 

In the wake of a prominent senator’s call for a crackdown on “academic doping,” experts confirm that the use of drugs like Adderall and Ritalin by college students is increasingly commonplace.

 

Sonia Tews was overwhelmed. She was paying for her own education while working 30 hours week and, at one point, spent as many as 14 hours on campus six days a week.

Tews, a 2011 graduate of Indiana University-Purdue University Indianapolis who majored in civil engineering, “needed a bump” and that’s when she took Adderall.

Earlier this week, Sen. Charles Schumer, D-N.Y., said he wants colleges to crack down on students’ use of prescription stimulants, such as Adderall or Ritalin, to achieve academic excellence — also known as “academic doping.”

Tews doesn’t fit the profile of most academic dopers as she only used the drug twice throughout her entire college career. Her underlying motivation, however, highlights the main reason for Adderall’s appeal.

“I could get done in two hours what would take four or five without it,” she says.

Two experts who have done extensive research on the topic — David Rabiner, research professor at the Center for Child and Family Policy in the Department of Psychology and Neuroscience at Duke University, and Sean Esteban McCabe, associate professor at the University of Michigan — say that academic doping has becoming increasingly commonplace.

McCabe and Rabiner both point to various research studies that show the majority of students who admitted to using the amphetamine-based prescription did so to enhance their academic performance — to help study and increase alertness or concentration. The prevalence of its use varied from colleges nationwide, ranging from 0% to more than 30%.

“There were just a couple of times where I felt like I was at breaking point where I had no other options,” explains Tews. “And Adderall was a better option than failing and a better option than actually cheating — the traditional type of cheating.”

Based on national data from the 2011 Monitoring the Future study, McCabe says, “One in every 10 college students in the United States has engaged in non-medical use of prescription stimulants in the past year,” and that trend has been increasing over the past few years.

“There’s an assumption that (Adderall) really does help students do better, and in large part that may be based on what students believe, but placebo effects are all over the place,” says Rabiner.

In a recent New York Times op-ed, columnist Roger Cohen writes, “Adderall has become to college what steroids are to baseball: an illicit performance enhancer for a fiercely competitive environment.”

McCabe says the idea of using the drug to increase one’s academic performance is “more of a myth than a reality.” He adds that the efficacy of its non-medical use in a college setting is unproved.

“The reason I didn’t use it regularly is because I take a lot of pride in how well I did in school,” says Tews, who finished top 10 in her class. She adds that her isolated incidents with Adderall were not a contributing factor in her accomplishment.

“I worked all through school, and I paid my way through school, and I know a lot of people who didn’t do that,” Tews says. “And to me, they had more of an advantage than I did because I worked 30 hours a week, and they didn’t. … I think there are different kinds of advantages. Where steroids can actually help you hit the ball farther, Adderall does not teach you calculus.”

Frank Arsics, a senior at Georgia State University — who has been diagnosed with ADHD and prescribed Adderall since age 9 — agrees.

“It doesn’t help you do better; it just helps you focus. It’s not going to give you the answers,” he claims.

Tews argues that her “advantage” was comparable to coffee or to a full night’s sleep — something she often lacked — but, despite her justification, she does feel guilty about it.

“The non-medical use of prescription stimulants among college students has flown under the radar for too long at many colleges and universities, so the recent comments by Sen. Schumer to reduce the non-medical use of prescription stimulants are long overdue,” says McCabe.

He adds that a recent college-based study found more than 50% of students prescribed medications for ADHD were approached to divert — sell, trade or give away — their medication last year. Others have found that almost one-third of undergraduates did divert their prescriptions.

“People try to buy (Adderall) from me all the time,” says Arsics. He says that he’s never sold or given away his medication and takes it only as prescribed.

McCabe advises that colleges and universities should develop “effective policies and programs to discourage the non-medical use of prescription stimulants” because of how often this behavior goes undetected by health services, counseling centers, campus police and campus disciplinary offices.

Similar to Sen. Schumer’s proposed policy changes, McCabe’s ideas include:

Encouraging universities to assess their own schools to find out whether the non-medical use and diversion of prescription stimulants represents a problem on their campuses.
Practicing appropriate diagnosis, treatment and therapeutic monitoring of college students who are receiving prescription psychostimulants.
Educating students that they overestimate the prevalence of non-medical use of prescription stimulants by their peers and that the efficacy of these medications used non-medically to improve academic performance in real-world academic settings is unproved.

“We need to have a balance between reducing non-medical use and still allowing for medications to be provided to the students who need them,” says McCabe.

Tews says academic doping was already “frowned upon” during her time in school and that colleges should take it upon themselves to have an internal program — like an “anti-doping campaign” — if they wanted to reduce its occurrence.

“I did it twice; I graduated; I’m now an engineer; and I’m good at my job,” says Tews. “You could ask my boss that.”

David Schick is a summer 2013 Collegiate Correspondent.


12 Sleep Tips for ADHD Kids

By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH

It’s not your imagination. Kids with ADHD have more sleeping problems than their peers, but setting a sleep schedule can help.

According to the American Academy of Sleep Medicine, even moderate sleep deprivation — losing less than one hour per night of sleep — can affect the academic performance of children withADHD. Yet ADHD and the medication used to treat the condition are known to disrupt sleep patterns, making it difficult to fall and stay asleep — and making bedtime a nightmare for parents of kids with ADHD.

In many cases, creating a consistent sleep schedule and environment can help. “For families who have children with ADHD and sleep problems, it’s often a struggle to create some structure around that hour prior to bedtime,” notes Richard Gilman, PhD, director of psychology in the division of developmental and behavioral pediatrics at the Cincinnati Children’s Hospital Medical Center in Ohio.

“Many of the things that we suggest are minor tweaks to what they already do. We just make it more predictable, more consistent for the child. And the results are well worth it. A lot of the times, parents tell me, ‘If I would have done this years ago, I would have slept better myself.’”

Scheduling Tweaks for Better Sleep

Here’s how to help your child overcome sleeping problems:

Buy an egg timer. Using a tangible instrument like an egg timer helps keep your family on track with bedtime schedules.

Commit to a set schedule. Make sure that your children go to bed at the same time every night and wake up at the same time every morning, including weekends. Allowing children to stay up later on weekend nights and wake up later the next morning just makes their weekdays more difficult, says Gilman. If they are fighting fatigue despite the set schedule, you might need to increase their sleep time. Remember that younger children do need more sleep than older children.

Remove sources of stimulation. During the hour you get your kids ready for bed, turn off the TV, music, computers, and video games. Don’t engage in arguments or initiate any rough play. This is an hour that should be very peaceful, says Gilman. That means that parents also need to be peaceful — no arguing with each other or the children.

Use a reward system. Allow children to earn tokens, stars, or stickers that can be traded in the next morning for a small reward, such as a favorite breakfast food or being allowed to choose the music on the ride to school. These rewards come when expected actions, like brushing teeth, are completed on time. Rewards may also be earned by staying in bed after lights-out.

Keep the house quiet. During the bedtime preparation and once your children are in bed, keep the house quiet and calm. Parents and older children might be up later, says Gilman, but it’s a good idea to keep your voices down and turn down TV and music.

Return children calmly to bed. Even with a reward system and a cozy bed, some children will still get up to find you. Return them to bed without indulging in arguing, threatening, lecturing, or any other energizing activity.

Allow a full hour to get ready for bed. Once you have your egg timer, you can use it to count down the hour your children need to wind down. Here’s how to break down the hour:

First 30 minutes:  Set the egg timer for 30 minutes. This period of time is for hygiene — bathing, brushing teeth, and putting on pajamas.

Next 15 minutes:  Set the egg timer for 15 minutes. This period of time is for a relaxing activity, such as reading a book, doing some relaxation exercises, or practicing deep breathing.

Final 15 minutes:  Set the timer for 15 minutes. This is for getting into bed (and staying there). “In bed, there should be some sort of ritual between the parent and the child,” says Gilman. Consider reading a favorite book, snuggling, praying, identifying good things that happened that day, telling a favorite story, or some other soothing and affectionate activity. Lights go out at the last “ding.”
Invest in white noise. A white noise machine is a great way to limit the ability of normal house and family noises to interfere with sleep. As a bonus, turning off the white noise machine in the morning is a helpful way to gently wake up your child.
Wake up gently. You need a good plan for waking up ADHD children, says Gilman. The “bugle call” approach can actually set them up for a day-long spiral of ill temper. Instead, try a gentle action, such as opening the blinds or turning off the white noise machine.

Build in getting-ready time. ADHD children may need a morning schedule that is just as generous in time and structure as their pre-bed ritual. A chaotic rush to get out the door sets the wrong tone for the day.

Monitor naps. Naps can be excellent if they are also structured and time limited, says Gilman, and younger children need them whether or not they have ADHD. Older children, however, can do serious damage to their sleep pattern (and the family schedule) if they are allowed to indulge in a two- or three-hour nap. Opt for a power nap of about 20 to 30 minutes if absolutely necessary.

Consider melatonin. This popular supplement does help children sleep. However, Gilman stresses that you should ask your child’s doctor before using it. Many parents give more than a child needs for sleep improvement. Additionally, a doctor can advise on the best time to give the melatonin. It takes some time to work, so providing it right before bed could still leave a period of frustration for everyone.

When Sleeping Problems Go Beyond Setting a Schedule
If you make all these changes and find that your child still isn’t sleeping well, talk to your child’s doctor.

Researchers are finding physiological commonalities between ADHD and some sleep disorders. For example, in ADHD as well as restless leg syndrome (RLS) and periodic limb movements in sleep, dopamine levels are abnormal. However, even though these conditions share some similarities and even possible genetic links, they have to be treated separately. It is important to take your child’s complaints about going to sleep or staying asleep seriously.

“Children need to be able to describe RLS in their own words for a diagnosis,” says sleep medicine specialist Arthur Walters, MD, associate director of the Vanderbilt Sleep Disorders Center in Nashville, Tenn., and co-author of the first review of the connection between ADHD and sleep disorders. “They might say their legs hurt or that they have an ‘owie’ or the heebie-jeebies.”

He also notes that the catch-all diagnosis of “growing pains,” which may be given when children complain about ongoing leg discomfort, could be a red flag for a sleep disorder. Other disorders that are linked to ADHD include narcolepsy, sleep apnea, delayed sleep phase syndrome, disorders of partial arousal sleepwalking, and night terrors.

Sleep scheduling is excellent for many ADHD children, says Dr. Walters, “but if the kid stops breathing up to 15 times an hour [as can occur with sleep apnea], all the sleep scheduling in the world won’t help.”

By working with your child and your child’s physician, you should be able to create a sound sleep environment to help your child succeed with ADHD.


Pesticides Linked to ADHD, Autism, IQ Scores Reduction

Tuesday, May 28, 2013 – Published in the Sun.Star Davao newspaper on May 29, 2013.

STUDIES have showed that pesticide exposure can increase the risk of neuro-behavioral disorders such as autism, ADHD, hearing loss, and intellectual impairment.

Over the past 30 years, autism rates have dramatically increased by 78 percent and ADHD rates are up three percent every year which have coincided with the rise in the use of pesticides in food.

“Fetuses and children are most vulnerable to pesticide exposure due to their less-developed immune system,” Professor Zwiauer, the head of the Department of Pediatrics at the Central Clinic in St. Polten, Austria warned.

“They have a far greater chance of exposure and absorption in relation to body mass. Pesticide exposure at such an early age can interfere with their development and may even cause lifelong damage,” he said.

This includes developmental delays, behavioral disorders, and even possible motor dysfunction.

In addition, Dr. Zwiauer also shared that pregnant women should also be careful because, along with their unborn child, they are very vulnerable to pesticide exposure.

Pesticides can be transferred from mother to child in the womb. Some exposures can cause delayed effects on the nervous system as the baby’s brain architecture establishes in the womb.

In fact, there are several possible complications and health problems in children that can arise from exposure to pesticides, including childhood obesity and even cancer.

Dr. Zwiauer explained that the best way to reduce the risk of pesticide exposure in infants and young children is to make sure they eat organic food.

Professor and doctor Karl Zwiauer, head of the Department of Pediatrics at the Central Clinic in St. Polten Austria, alongside Dr. Markus Bruengel of the German Society of Nutrition and Nutritional Medicine were guest speakers during a lunch symposium with members of the Philippine Pediatric Society at the Philippine International Convention Center last April 2013 Both pediatric experts from Austria and Germany presented studies on the importance of organic nutrition and why organic foods are a healthier choice, most especially for babies and toddlers when breast feeding is not possible.

Both experts reinforced that breast milk is the gold standard for infant feeding and should be the first choice for feeding infants and toddlers.

Choosing an alternative feeding from breast milk when breastfeeding is not possible should first be consulted with your pediatrician.

Organic milk comes from healthy cows that graze on organic farms, free from harmful pesticides, growth promoting hormones, and antibiotics. There is an increasing number of scientific and clinical evidence on the benefits of organic nutrition for everyone, especially babies and toddlers who absorb much more from their nutritional sources in terms of their body mass. It is important to protect our families from harmful pesticides and chemicals.


10 Tips for Better Sleep With ADHD

By Dennis Thompson Jr.
Medically reviewed by Pat F. Bass III, MD, MPH

Most kids with ADHD have problems sleeping. As a parent, you can create an environment in which sleep may come more easily.

Many children with attention deficit hyperactivity disorder, or ADHD, have problems getting good quality sleep. The disorder makes it difficult for children to fall asleep and then sleep deeply, especially if they are affected by other sleep conditions, such as snoring and sleep apnea.

Studies estimate that between half and three-quarters of children with ADHD experience sleep problems. These problems can include:

Snoring and Sleep Apnea – Habitual snoring is three times more common in people with ADHD than in those with other psychiatric disorders. Snoring can also be a sign of sleep apnea, which is when a person stops breathing for very short periods of time while asleep. Sleep apnea disturbs restful sleep, often without the person being aware of it.

Restless Leg Syndrome – As many as one in four children with ADHD will experience this condition, in which their legs move and jerk to relieve perceived discomfort.

Periodic Limb Movement Syndrome – This is a condition similar to restless leg syndrome, but it involves the arms as well as the legs.

Difficulty Falling Asleep – In one study, between 71 and 84 percent of children with ADHD had a hard time falling asleep.

Difficulty Staying Asleep – In the same study, between 27 and 49 percent of children with ADHD tossed and turned in bed, and between 25 and 36 percent woke frequently during the night.

10 Tips for Better Sleep

Parents can do a lot to help a child with ADHD get a better night’s rest:

1. Create a Bedtime Ritual – Ritualized behavior can send a strong signal to the brain that it is time to go to sleep. Create a simple ritual for your child’s bedtime, so it can be followed even if you’re not around.

2. Make Calming Down Part of that Ritual – Have your child do a relaxing activity prior to bedtime.  “Spend about 20 minutes or half an hour in bed with them, reading to them or listening to music — doing something to soothe the child and help him sleep,” says Constance Wood, PhD, a practicing psychologist in Houston. That old standby, a glass of warm milk, may help.

3. Unplug Before Bedtime – Television and video games can rev up a kid who should be calming down. Turn off all the electronics well before bedtime.

4. Create an Environment Conducive to Sleep – Make sure the bedroom is cool, dark, quiet, and free of any distractions that might impede or disturb sleep. Put away toys and dim the lights.

5. Reserve the Bedroom and the Bed Mainly for Sleeping – Remove most toys, games, and other distractions from your child’s bedroom, and make sure playtime occurs in common areas of your home. Don’t let your child play in bed or spend a lot of time in the bedroom — this reinforces that both are reserved for sleeping.

6. Encourage Self-Soothing – Providing a special blanket or stuffed toy for your child to hold while going to sleep can be soothing. The less a child needs your presence, the more easily she will be able to get back to sleep on her own if she wakes up in the middle of the night.

7. Enforce a Consistent Sleeping and Waking Schedule – Make sure your child stays awake during the day, so he’ll be sleepy at bedtime. Regular bedtimes and waking times can help a young body establish a rhythm.

8. Cut Out Caffeine and Sugar – Caffeine and sugar are in a lot of foods, and both are stimulating and can keep your child up late. Read labels and make sure foods and drinks your child has in the evening are caffeine-free and contain very little sugar.

9. Treat Medical Issues – Consult your doctor regarding medical problems like allergies or asthma that could be contributing to snoring, sleep apnea, or other sleep disorders.

10. Praise Successful Sleep – Give your child praise when she makes it through the night with few or no sleep disturbances. This will help reinforce the importance of sleeping quietly through the night.

Sleeplessness is a common problem for children with ADHD, but not an insurmountable one. Parents involved in their children’s lives should be able to help teach how to successfully nod off night after night.


Medication Affects Reward / Punishment Processing in Children with ADHD

www.GoodTherapy.org (April 11th, 2013)

Primary among children with attention deficit hyperactivity (ADHD) is the impaired ability to respond to rewarding and punishing stimuli. Parents and teachers of children with ADHD often report that these children are not motivated by the promise of a reward for good behavior. Likewise, they are often undeterred from engaging in negative behaviors even when threatened with punishment. This has been the case with some children with ADHD, but not all. In fact, the use of stimulant medication has been shown to have some effect on this process. But the direct influence on reward/punishment processing and on positive/negative feedback in children with ADHD is unclear. Yvonne Groen of the Department of Clinical and Developmental Neuropsychology at the University of Groningen in the Netherlands wanted to explore this deficit in children with ADHD more thoroughly.

Groen recently conducted a study involving 17 typically developing children (TD), 15 children with ADHD who were taking Methylphenidate (Mph) and 15 with ADHD who were not on medication (Mph-free). She assessed their evaluations of immediate and delayed rewards and punishments. She also measured how well they responded to feedback as persistent and intense positive feedback has been shown to improve behavior and emotional regulation in children with ADHD. Groen discovered that when compared to receiving no feedback whatsoever, children who received positive feedback outperformed children who did not, regardless of whether they had ADHD or took Mph. Additionally, all the positively reinforced children responded more accurately and reacted more cautiously to prompts than the children who received no feedback.

When she compared the groups of children, Groen found that the TD and Mph-free children had the most accurate responses to the prompts when they were provided with rewards versus punishments. However, all the ADHD children with and without Mph did show improvement in accuracy with promise of reward or punishment. But continuous positive reinforcement and promise of positive reward was more motivating for the ADHD children and led to more focus on accuracy than with Mph. In sum, the findings from this study show that ADHD children with and without Mph are able to identify positive and negative feedback immediately, but have difficulty evaluating delayed feedback. This was especially evident in the ADHD children with comorbid psychological conditions. Groen added, “This may explain the often observed positive effects of continuous reinforcement on performance and behavior in children with ADHD.”

Reference:
Groen Y, Tucha O, Wijers AA, Althaus M. (2013). Processing of continuously provided punishment and reward in children with ADHD and the modulating effects of stimulant medication: An ERP study. PLoS ONE 8(3): e59240. doi:10.1371/journal.pone.0059240


The Drug War on Boys

By DANIEL J. FLYNN

Beware of drug pushers in white coats.

The Centers for Disease Control and Prevention reported this week that nearly one-fifth of high school-age boys have been diagnosed with attention deficit hyperactivity disorder (ADHD). Doctors eventually medicate two-thirds of them. The diagnoses represent a 41 percent increase over the last decade.

The primary gateway drug for teenagers isn’t marijuana or beer. It’s prescription medication. As the New York Times piece breaking this story points out, feeding a child a daily diet of Ritalin increases the chances of dependency, anxiety, and psychosis. Sports once channeled the energy of testosterone-fueled teens. Now our overprotective culture complains of the dangers of sports as it fills children with chemicals.

“First, do no harm,” a med school lesson so basic that even high school dropouts know it, gets tossed down the memory hole by script-happy doctors. As any street pusher will tell you, it’s all about the Benjamins.

It’s easy to wage a war on drugs when the enemy combatants wear tie-dye and long hair, or gold chains, track suits, and beepers, or, in their current incarnation, saggy drawers and designer t-shirts. When the drug pusher dons a white coat, the lab garb provides a cloak of invisibility. Despite ubiquitous evidence of their malfeasance in overmedicated America, dope dispensing doctors remain largely immune from criticism. Indeed, the indecency resides in the suggestion that writing prescriptions can be habit forming, not in the writing of prescriptions that form habits.

The collective cognitive dissonance on drugs doesn’t withstand an honest look at the history of the science. In most instances, today’s dirty “street” drugs were introduced as yesterday’s clean cure-alls by pharmaceutical companies.

Bayer bequeathed both aspirin and heroin to the world. Marketed more than a century ago as “the sedative for coughs,” heroin witnessed unlicensed, unscrupulous open-air pharmacists infringe on the patent of their Bayer parent. One of the German pharmaceutical giant’s old advertisements shows a loving mom spoon feeding heroin to her daughter above the caption “the cough disappears.” It didn’t say what took its place.

Ecstasy, the dance-party drug also known under its alphabetizednom de narcotique “X,” “E,” or “MDMA,” first came into existence not at warehouse raves but in a Merck laboratory.

Sandoz Laboratories created LSD, which the company marketed under the name Delysid. As they withdrew from the hallucinogen market in the mid-1960s, a Harvard professor — not a cult crazy or a deranged hippie — emerged as acid’s pied-piper.

Before Tony Montana served as an evangelist for cocaine in Miami, Sigmund Freud did in Vienna. Freud used his considerable intellectual powers to write “a song of praise to this magical substance.” Therein he boasted that cocaine “wards off hunger, sleep, and fatigue and steels one to intellectual effort.” Moderate cocaine use, he maintained, neither proved “detrimental to the body” nor induced a “compulsive desire to use the stimulant further.” But Freud’s life contradicted his claims. He remained addicted to the drug, with disastrous and debilitating consequences, for more than a decade.

Cocaine is a helluva drug. So are Ritalin, Desoxyn, and Adderall — members of the methamphetamine family whose names have been changed for respectability purposes. Surely posterity will look upon our age’s penchant for dispensing Ritalin or OxyContin under medical auspices the way we look upon Bayer’s creation of heroin or Freud’s proselytizing for cocaine.

If a highbrain the likes of Sigmund Freud could so misconstrue the destructive power of narcotics, isn’t it possible that doctors with lesser intellects might also err in judgment today? Alas, their affliction isn’t a lack of intelligence but a surfeit of arrogance.

Boyhood isn’t a medical condition to be cured. The God-complex of doctors, on the other hand, could use an injection of humility. Physician, heal thyself.