A misdiagnosed generation

When the New York Times reported that the use of prescription sleeping pills by under-19s in America had apparently risen 85 per cent from 2000 to 2004, it fired a new round in the debate on behavioural drugs for children (1). Medco Health Solutions, which manages healthcare plans for more than 55million Americans, made these estimates based on data from its own customers.

Of the 181,000 estimated 10- to 19-year-olds who are taking sleeping pills, 15 per cent are also on stimulant medication to control their attention deficit hyperactivity disorder (ADHD). Indeed, Dr Robert Epstein, Medco’s chief medical officer, said: ‘It leads you to wonder whether these children are being treated for insomnia caused by hyperactivity or whether the medication itself causes the insomnia.’ (2)

As Slate’s William Saletan put it pithily: ‘1) Kids need sleeping pills because their ADHD keeps them awake. 2) They need sleeping pills because their ADHD pills keep them awake. 3) Stop drugging your kids.’ (3)

It’s not just the ADHD medication keeping children awake. Paediatricians say that children’s schedules and lifestyles – watching television and playing videogames until late at night – are interfering with their sleep. They recommend regular schedules, cutting down on soft drinks containing caffeine, and more warm baths and quiet bedrooms.

Other reports that claim the rate of medication for ADHD has increased three to seven times in the past decade. About 2.5 to 3 per cent of all school-age children in the US are taking medication for the disorder – that’s about half the 5 to 7 per cent of children diagnosed with it (4).

So is the disorder overdiagnosed? If medication like Ritalin or Adderall helps a child calm down and concentrate, does that mean he’s really hyperactive? Not necessarily – stimulants will help any child or even any adult calm down and concentrate, the way caffeine helps office workers stay on track until 5pm.

Ritalin may work on a hyperactive child, but it will also work on any normal child – which suggests that the line between what is ‘normal’ and what we perceive as ‘hyperactive’ is actually very fuzzy.

We may be medicalising ordinary childhood behaviour, attempting to mould children into cherubs who sit quietly in class and go to bed by 9 each night without a fuss. While we may sometimes want to smack the five-year-old monkeying around on train handles, such behaviour is fairly natural for a curious, active child.

In addition, we need to distinguish between overdiagnosis and overmedication. Even if a child or teenager genuinely has a hyperactivity condition, medication isn’t necessarily the best option. Nathan, a 22-year-old university student in the USA, was diagnosed with ADHD and given medication in high school, after years of struggling with boredom and dismal grades.

‘Ritalin was an interesting drug, because it would make me feel very good and productive for a few hours and then I would become depressed and frantic afterward’, he says. ‘It was really a short-term solution which I only liked to use when necessary – before an exam, for instance. [Later] I found that exercise had very much the same effect on my thinking as Ritalin except it didn’t have the downer at the end.’

Nathan was lucky enough to have supportive parents, who ended up home-schooling him and teaching him to deal with the condition.

Even if behavioural medication makes life easier for some children and their parents, it could have long-term physical and psychological impacts. Nearly 20 years ago, the sociologist Christopher Lasch wrote in his 1979 book The Culture of Narcissism about the tendency to seek medical explanations for life and family problems.

Today, this tendency is more prevalent than ever. College students put on Ritalin or Adderall early in life are still using it, not because they need it, but as a study aid. Some are even selling their pills for five dollars a pop. Girls as young as 16 are demanding cosmetic surgery for imagined body issues.

The result of an over-medicalised society is people who grow up thinking there’s a pill for every ill and who seek quick fixes for life’s troubles. But quick fixes sometimes have side effects – like insomnia in ADHD children on stimulants. And they excuse bad behaviour and absolve people of the responsibility to change.

Grace Chua is studying in America, and is currently working as an intern at spiked.

(1) See report in the New York Times

(2) See report in the New York Times

(3) Equal-Opportunity Sodomy, Slate, 24 October 2005

(4) Defining and diagnosing ADHD on the Medicating Kids website