ADHD: On the rise or over-diagnosed?

MOBILE, Ala. (WALA) - When an Adderall drug shortage struck in the spring of 2011, millions of patients with Attention Deficit Hyperactivity Disorder were sent scrambling from pharmacy to pharmacy looking for their meds. Many of them had no luck and were forced to go without for quite some time.

In terms of who is to blame or what caused the shortage, the answer depends on who you ask.

Many faulted the government which controls the main ingredient used in the drug. Some pointed to the drug companies and claimed they were diverting patients to more costly treatments. Then others questioned whether ADHD was being over-diagnosed in people mimicking the symptoms.

"I think it's being over-diagnosed, and I think that there's less tolerance of children and less ability to deal with their fluctuations," said Dr. Elias Chalhub of Mobile Neurology Child & Adult.

Critics argue that the steep increase in prescriptions for Adderall and similar drugs over the last decade indicates a troubling trend to medicate children having difficulty in school, as well as reflects the abuse by people faking the disorder to get their hands on psychostimulants.

The Substance Abuse and Mental Health Services Administration reports that an estimated 6 percent of college students misused drugs like Adderall, Ritalin, and Vyvanse just this past year. The students were abusing ADHD drugs to stay awake and cram for tests, or to stay out later and party longer.

Dr. James Wiley, founder of FOCUS in Mobile, tells FOX10News that he believes ADHD abuse is a dangerous habit that is on the rise.

"There are people potentially on college campuses in which the short-acting medications are used to get high or even to enhance performance," explained Wiley.

ADHD: Signs & Symptoms
A child with ADHD might: have a hard time paying attention daydream a lot not seem to listen be easily distracted from schoolwork or play forget things be in constant motion or unable to stay seated squirm or fidget talk too much not be able to play quietly act and speak without thinking have trouble taking turns interrupt others
ADHD Links & Resources
Frustration to Focus Center in Mobile	frustrationtofocus.com
Fact Sheet from the CDC	ADHD Fact Sheet (pdf)
Data & Statistics from the CDC	Map, Data & Statistics on ADHD Prevalence
ADHD Families support group	CHADD Chapters
National Institutes of Health (NIH) Full ADHD Info	ADHD from NIH

The active pharmaceutical ingredient (or API) in Adderall is a psychostimulant called amphetamine salts. Amphetamines have a high potential for abuse because they can produce a high similar to cocaine when taken by people without ADHD.

So that it doesn't fall into the wrong hands, the Drug Enforcement Administration (DEA) controls the supply of amphetamine salts with a manufacturing quota system. They also authorize distribution of the key ingredient based on what the agency determines to be the actual medical need.

"We have to walk a fine line between guaranteeing the availability of the medication but also not allowing so much to be made that it could be diverted for misuse," said DEA spokeswoman Barbara Carreno.

Industry, however, says it's the DEA's quota system, not the manufacturers, that is the root cause of the shortage issues plaguing legitimate people in need of the drug.

"Our production facilities are currently running at maximum capacity for Adderall utilizing all available API," stated Denise Bradley, Teva Pharmaceutical Industries' communications director. "The catalyst for the problem is the quota system, not the business."

For the sake of people like Lizzetta McConnell and her son, diagnosed with ADHD, that's little comfort. They feel stuck in the middle of a tense battle.

"Medicine doesn't fix everything, but it does help the struggle. Because it is a struggle; it's something that you have to live with every day," she said.

McConnell's son was in the second grade when he was diagnosed. He is now 19-years-old. It took a while to find the right treatment approach.

She describes the difference like this:

"It was just like walking into a dark room and the lights came on," McConnell said.

McConnell is not alone. According to the Centers for Disease Control and Prevention, it is the most common childhood disorder, affecting an average of 9 percent of children between the ages of five and 17. It's a problem with inattentiveness, hyperactivity, impulsivity or a combination - the symptoms fall into those three categories.

Symptoms

Inattentive symptoms

• Fails to give close attention to details or makes careless mistakes in schoolwork
• Has difficulty keeping attention during tasks or play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
• Has difficulty organizing tasks and activities
• Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
• Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
• Is easily distracted
• Is often forgetful in daily activities

Hyperactivity symptoms

• Fidgets with hands or feet or squirms in seat
• Leaves seat when remaining seated is expected
• Runs about or climbs in inappropriate situations
• Has difficulty playing quietly
• Is often "on the go," acts as if "driven by a motor," talks excessively

Impulsivity symptoms

• Blurts out answers before questions have been completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others (butts into conversations or games)

Signs and tests

There's no specific test for ADHD. Gathering as much information as possible about your child is the best way to get an accurate diagnosis.

To bring more clarity to the issue, the American Academy of Pediatrics has issued the following guidelines:

• Children should have at least six attention symptoms or six hyperactivity/impulsivity symptoms, with some symptoms present before age 7.
• The symptoms must be present for at least 6 months, seen in two or more settings, and not caused by another problem.
• The symptoms must be severe enough to cause significant difficulties in many settings, including home, school, and in relationships with peers.

In older children, ADHD is in partial remission when they still have symptoms but no longer meet the full definition of the disorder.

The child should have an evaluation by a doctor if ADHD is suspected.

Evaluation may include:

• Parent and teacher questionnaires
• Psychological evaluation of the child AND family, including IQ testing and psychological testing
• Complete developmental, mental, nutritional, physical, and psychosocial examination

As mentioned, treatment is usually a combination of medication, various types of psychotherapy, education or training.

There are several different types of ADHD medications that may be used alone or in combination.

Psychostimulants are the most commonly used ADHD drugs. Although these drugs are called stimulants, they actually have a calming effect on people with ADHD.

These drugs include:

• Adderall and Adderall XR
• Concerta
• Dexedrine
• Focalin and Focalin XR
• Metadate CD and Metadate ER
• Methylin
• Ritalin, Reitalin LA
• Vyvanse
• Desoxyn

Manufactures of the drug say they are doing their best to fix the shortage. But by all accounts, experts expect that the shortage seen in 2011 will continue into 2012.

In the meantime, McConnell feels demand has exceeded supply. She says whatever the reason for the shortage, it has left her family with the extreme inconvenience of having to go to multiple pharmacies to fill her son's prescription.