The subject of medicating “bad” behavior is sometimes controversial. I’ve met many people in the church who believe that ADD is just an excuse for bad behavior, and that medications prescribed to treat ADD are dangerous, addictive, or damaging, and a poor substitute for good old discipline. I used to think along these lines.
ADD discussions are tied to the ongoing discussion of nature verses nurture, free will, and the dualism of body and spirit.
Let me draw your attention to a remarkable book: Healing ADD by Daniel G. Amen, M.D.
In the introduction to the book, Dr. Amen explains:
This book, I hope, will put to rest the debate over whether or not ADD is real by showing the areas of dysfunction in the brain. New brain-imaging research, conducted at my clinic, has uncovered the ADD brain. Based on our research with thousands of ADD patients using brain SPECT imaging (one of the most sophisticated functional brain-imaging studies in the world), we have been able to see where ADD resides in the brain and why it has such a negative impact on behavior. Right or wrong, humans have an innate distrust of the intangible, but seeing the ADD brain can cause the destructive myths and prejudices to fade away.
…
The first of its kind, this book will give you a completely new perspective on ADD. You’ll see actual ADD brain images (many before and after treatment) and identify the six types of ADD…
Dr. Amen describes these six different kinds of ADD (Classic ADD, Inattentive ADD, Overfocused ADD, Temporal Lobe ADD, Limbic ADD, and “Ring of Fire” ADD) and what is happening in the brain for each type, including what chemicals are deficient or overabundant. Because each type is caused by different chemical problems in different parts of the brain, they have to be treated differently, and treating some types with standard remedies will make things worse, not better.
The remedies recommended by Dr. Amen go way beyond medication. In addition to medication approaches, he recommends school, work, and home strategies, sleep, nutritional and exercise approaches, vitamin and herbal supplement remedies, and more.
Dr. Amen suggests that ADD has a genetic component, but that it can also be induced by head trauma, or even by television, music, or video games, or the Internet.
One of the most interesting parts of the book, for me, was his discussion of how he has employed brain-imaging bio-feedback to teach people with ADD to make their brains work correctly. That is, by watching real time images of what is happening, chemically, in their brains as they try to concentrate, ADD patients are actually able to consciously teach their brains to release chemicals correctly.
This suggests that TV, Video Games, or Blogging might be training our brain to work in certain ways as well.
The book discusses how certain reactions and disciplinary approaches by parents influence the brain chemistry of ADD children or spouses.
As an individual, this book has had an enormous beneficial influence in my own life and for my family, and I recommend it to anyone who is interested in, or struggling with, ADD problems.
From an LDS point of view, I think that the fact that ADD patients were able to observe the bio-feedback of their own brain chemistry and make the decision to change it, a fascinating contribution to the nature vs. nurture debate, and the LDS concept of free will.
Read the book and visit the Amen Clinic website at http://www.amenclinic.com. Take the online ADD self-test here.
UPDATE: And just for some balance, read this critique of Dr. Amen’s approach by Harriet Hall, M.D.
Interesting and extremely pertinent, Jonzenio! Thank you for this information.
Medical progress that makes life more enjoyable is always good news.
On a side note, do some non-ADD students at BYU use black market Ritalin to facilitate study/cramming? It’s pretty common at other schools. Some people even use it recreationally, grinding the pills and snorting a la cocaine.
Sory. Could you repeat the question?
Thank you, Max, for posting a positive, solutions-oriented message on AD/HD. When I first saw the title of this post in my RSS feed list, I cringed — getting ready for the “AD/HD is really just bad parenting” line.
My wife and I used to think AD/HD was just an excuse for not disciplining your kid. That stopped after our first child was diagnosed at age 6. He was difficult from the day of his birth (literally: 18 hours of hard labor). We have always gone overboard in providing love and discipline, so I can assure you, it’s not a parenting issue.
Fortunately he has a good psychiatrist, the right meds, supportive teachers and family, and the Gospel. He’s exceptionally bright and doing very well in school now (consistently testing in the high 90th percentile in math and reading). We’re very blessed.
To those who don’t believe there is a such thing as AD/HD, I’ll be happy to take our son off medication and have them come stay at our house for a week. That’s all it will take to change their mind.
Is there an LDS concept of free will? We believe in free will, but it seems like how we think about it varies dramatically.
Clark (#5): That’s an interesting (and important) question. I think there are internal and external forces that can limit your free will. The perfect example is alcoholism — I have no desire to drink alcohol, but my father-in-law can’t go more than a few hours without a drink (and I’m talking distilled spirits, not beer). Is his free will more limited in this area than mine? I think so — partly because his choices have lead him down a path that restricts his freedom, and partly because he (probably) has a genetic predisposition to desire alcohol.
One of the great benefits of the medication my son is on (Concerta 36mg 1x/day) is it helps him control his impulsivity, giving him the option to choose his course of action. In a sense, the meds are enhancing his free will.
I don’t understand Mike. Your father-in-law has no choice but drink?
Eric Russell (#7): Certainly less choice than I do, as he is addicted to alcohol. He is enslaved by it. Hence the Word of Wisdom’s “warn[ing] and forewarn[ing]” about its dangers.
Mike Parker,
Glad things are working out so well w/ your kid. I think I’m like a lot of people who don’t question that AD/HD, ADD, whatever you what to call it, is real, but we do question if it’s appropriate to call something a disorder that seems to effect so many that it seems more like a normal genetic variant in the population. We humans came from hunter-gather stock and weren’t designed to spend hours sitting, studying, etc and the fact that some of us can’t do it w/o meds shouldn’t really surprise any objective observer of human behavior and origins.
All,
Nobody has info if the common phenomenon of “normal†college students using black market ADD meds to facilitate their studies happens at BYU?
Mike,
I see. May I suggest he has the same amount of choice, but making the choice is much, much, much more difficult. Hence the Word of Wisdom’s “warn[ing] and forewarn[ing]” about its dangers.
Not to be nitpicky about words, but it makes a big difference.
Steve,
I just finished four years at BYU, during which time I was in four different wards: meaning, I knew a lot of people. I never knew or even heard of anyone ever using Ritalin or any other meds for studying. Not saying it doesn’t happen. Just that I was never aware of it. So if it does happen, it can’t be too common.
Steve (FSF) (#9): It is not a matter of sitting still vs. hunting and gathering — my children run and play and do outdoor things, in addition to sitting and studying. The issue is one of being able to focus on a single task and stick with it for more than 60 seconds. People with AD/HD have very short attention spans, have difficulty finishing tasks, get easily distracted and (if hyperactivity is present) are constantly “on the go”. The same problem would surface if my son were hunting — he’d take his bow and arrow, head out looking for game, and within a few minutes be standing the middle of a field, staring off into space.
Eric Russell (#10): I’ll accept your argument, though I think the Lord will be more merciful to people whose challenges are greater than others. Since my son is 8 (he was baptized last year), he is on the road to becoming a moral agent. Some of his choices — to finish his homework, to clean his room, to come inside when it’s getting dark — are “much, much, much more difficult” because of the condition he has. So he has free will, but I try to be more understanding and tolerant when he doesn’t immediately do what I ask him to do. Showing mercy, in my own way.
Mike,
Thanks for the additional info. To clarify where I’m coming from, I often hear ~8% of the population has AD/HD. That’s too wide a swath of the population to call it a disorder. We might as well say that shy/introverts have a disorder, or extreme in-your-face extroverts have a disorder, or some white people with skin so fair they can’t tan have a disorder, or men with red hair who have trouble being taken seriously have a disorder, etc. That said, I’m sure there’s a spectrum of AD/HD symptoms and those with more of the symptoms have a more difficult time. Once again, I very happy the modern meds are helping your kid.
Steve (#12): I often hear that ~50% of the population “need” corrective lenses. Since so many people have “bad” vision, it can’t be a disorder. Perhaps it’s not something we should bother “fixing.”
I hope that clarifies where I’m coming from. đŸ™‚
Mike,
Please don’t get me wrong. I’m very happy for you, your family and your kid that modern medicine is working so well for you, and never meant to imply that server cases shouldn’t be treated.
As far as the “bad” vision example, most of that is normal aging, a phenomenon that our evolution didn’t have to deal with. In other words, people didn’t live very long as hunter-gatherers, and once you’ve reproduced, evolution doesn’t “care†about you after that. Let’s face it w/o modern dentistry, as an example, most of us would be dead well before 40.
If ~8% of people have AD/HD, there’s an evolutionary reason for it. In other words, there must be some advantage to having some AD/HD symptoms in some situations. Like the way an introvert (which some people view as a disability) can often out communicate an extrovert in one-on-one situations, whereas the extrovert is better with big groups. Or the fact that one in twenty carry the CF gene because if a person has 1 CF gene it makes for a more robust physiology. However, for the unfortunate few who inherit two CF genes, it means a short difficult life.
Once again, I’m very happy for you that things are turning out so well for your kid.
Eric, Ritalin and Aderol (sp?) are definitely abused around BYU – often for late night studying. There is also an other drug specifically designed for certain kind of sleeping diseases that doesn’t have the side effects of Ritalin or other similar methamphitimines. I’ve not heard of it here (the name escapes me at the moment) But apparently there is a booming black market in it at most colleges.
I can see people justifying taking such substances for studying, especially since there is no “buzz” involved. i.e. they aren’t being taken recreationally and there aren’t quite the addiction worries. I suspect most people would see it akin to taking some of their friend’s left over pain killers when they have bad cramps or a bad migraine. I have to agree with them as well. (For the record I have taken Aderol – the similar drug to Ritalin for late night drives a few times)
Steve – you are confusing the benefit for the gene with the benefit for a particular manifestation of the gene. That’s a no – no. The gene may in other circumstances provide an evolutionary benefit, but in some cases become manifest in such a way that it produces a net negative effect. A good example of this is the speculation regarding autism, asperger’s syndrome or similar effects. Those diseases are highly correlated with intelligence – especially the kind manifest in scientists and engineers. Indeed there is some evidence that in areas with many engineers marrying, there is a noticeably higher rate of autism. But we clearly don’t want to say that autism has an evolutionary benefit. Far from it.
I should add as well that most evolutionary psychology is pure ungrounded speculation. So I’d not trust too much when people say what is or isn’t an evolutionary development or benefit in these matters.
My jaw is on the floor. Clark, I absolutely cannot believe that I am reading a Mormon casually defending the illegal use of drugs. It’s funny that you say “there aren’t quite the addiction worries” with pain killers and amphetamines, because there certainly are addiction worries with these drugs–especially when they’re taken without the care of a doctor or for purposes they weren’t intended for. If you think it’s justified for people to self-medicate with amphetamines just to study for a test or make a late night drive, I really hope you join me in my belief that marijuana should be legalized. After all, most of the people I know who smoke pot are just doing so to help themselves with stress–it’s not like they’re doing it “recreationally” or anything.
Steve, I’m with you–I wouldn’t be shocked if ADD and ADHD are shown to have evolutionary advantages. At the very least, it seems that our current society makes these conditions more of a problem than they need to be. I don’t really like the use of the word “disorder” for them (semantics, semantics), but if that’s what it takes for people to get treatment and insurance to pay for it, I support it.
Also, it would be nice if they added a brain scan in to the ADD diagnosis. That would separate kids who are just high-spirited from those who really have ADD and would likely make more people support its treatment.
The worry was the rare use of Ritalin or the occasional pain killers. For instance my wife had some left over pain killers from a dental proceedure. Kept them in the fridge for a few months and then used them for something else where it was appropriate. This sort of thing, while technically illegal, is amazingly common and not the least bit immoral that I can see.
As for marijuana, I don’t think it should be legalized for casual use anymore than I think the prescription structure of drugs in the US should be eliminated, no matter how silly it is at times. (i.e. why does allegra require a $200 doctor visit to get in the US while I can pick it up over the counter for $10 in Canada?) I do think that medical marijuana should be allowed. It seems amazingly hypocritical and nonsensical that most hospitals have cocaine on location for certain medical procedures but can’t do the same with marijuana.
Steve (#14):
As far as the “bad” vision example, most of that is normal aging, a phenomenon that our evolution didn’t have to deal with. In other words, people didn’t live very long as hunter-gatherers, and once you’ve reproduced, evolution doesn’t “care” about you after that.
I’ve been wearing glasses since I was 11 years old to correct my myopia caused by astigmatism. I guess according to your theory I’m an evolutionary reject that should have been put out of my misery years ago.
Your postulating is contrary to the mercies of the Atonement, and has the added benefit of being highly offensive.
Mike,
Sorry to have offended. Certainly didn’t mean to. But please don’t put words in my mouth that I hadn’t even fathomed. I am really glad things are turning out so well for you and your family. May G-d bless you and your family in your journey.
Clark,
I kind of expected to hear that use of black market ADD meds to facilitate studying happens at BYU, but much less so than most universities. And the recreational use (grinding the pills and snorting a la cocaine for an instant high) doesn’t happen at BYU. And I think that’s what you’re saying.
I do think there’s a disturbing similarity between an athlete using black market steroids and HGH and a scholar using black market ADD meds.
I don’t deny recreational use at BYU. I’ve had friends here who’ve unfortunately made some poor choices and succumbed to drug addiction. There certainly is more around than you might think and I know of some major well know BYU figures who were troubled with such problems. (No – that’s all I’ll say)
The difference between steroids and the occasional use of a drug for staying awake seems to be the consequences. Weight lifters who consistently use steroids (and you have to use them fairly consistently) are risking a lot of health problems. No offense, but the occasional use of some ADHD medicine really isn’t much of a risk. The danger (and this is why we have prescription laws even if they are silly at times) is that you’ll have an adverse reaction or that you’ll take too much or so forth. With a doctor supervising you that is less of a danger. Although to be frank, the way most doctors prescribe anti-depressants and ADHD medicine that’s really not much of a check. I know of a few people around BYU who simply gave all the symptoms for ADHD and had no trouble getting a prescription for Adderall. And in those cases they aren’t even doing anything illegal!
I think the problem is that people don’t realize exactly how strict the prescription laws are. You are breaking the law in exactly the same way if you take the left over medicine of a spouse. Even if it is just some allergy pills, some pain killers, or anything else. Yet, as I said, I am very confident that most people do this all the time.
Further I’d be quite prepared to defend the claim that a student occasionally taking Adderall for studying/driving is no worse than half the people taking prozac, zoloft, or so forth for what is most likely not bad clinical depression. I’d go even further towards those who get antibiotics they don’t really need since that has a major effect on society as a whole in a way those other drugs don’t.
BTW – I don’t think all of it is publicly readable. But this story from New Scientist is rather interesting about cognitive enhancing drugs. The drug I was thinking of that is widely available on the black market is modafinil which is used to treat narcolepsy. (I’ve never seen it and wouldn’t have clue in the least for how to get it either – but I’m sure there are plenty of people using it here, as with anything else)
The big issue, of course, is whether taking cognitive enhancing drugs is wrong. I don’t think it is wrong the way that an athelete taking steroids is. Academics and atheletics are run on fundamentally different principles.
Clark,
You’re making me feel better. I started post mission social drinking at BYU, that in turn contributed to my pre-marriage major LofC problems, but I always viewed myself as one of a few renegade fringe clique freaks in those days. When I went on to Michigan, I fit right in. But at BYU, my self image was that of one sick pup.
Well, I’m not sure it is something to be proud of. And, as I mentioned, I saw the terribly consequences on some friends. (One friend started just playing around with pain killers, due to health problems. It became more. Then when he had trouble getting black market pain killers he turned to cheaper solutions which ended up being heroine which then in turn destroyed his life.
I know “with every fiber of my being” that ADD is genetic, although I don’t dispute it could be caused by other things as well. My husband’s whole family is ADD and OCD in varying degrees and I tell you, it is a cheap thrill to live with.
We treated each of our children differently. My stepson was quite severe and without Ritalin, I, or his mother, would have killed him before he became an adult. When I married my husband, I was appalled at the idea of medicating a child and refused to do it. By the time we’d been married three weeks, I’d done a 180 and never forgot that pill.
His sister only took Ritalin for a few years, only on school days, it helped her concentrate at school.
The child we have together reacted badly to Ritalin, she became very zombie-like and we chose to use behavior modification. I poured myself into her. She struggles with relationships and learning and comprehension issues, but she is basically okay and her self esteem is good.
Before I experienced this first hand, I thought parents were just lazy and didn’t know how to discipline. Now I know it is a very difficult, complicated, and often emotionally painful issue for everyone it touches. There are times I just want to strangle my mother-in-law. Think Monk. I know, different issue, but in my experience, some level of OCD goes along with ADD, perhaps they develop it to cope, I don’t know.
Hence, my love of valium.
Do any women go the sperm bank route when hubby has ADD, or other issues?
annegb (#25): Thank you for sharing your story. I’m glad to know there are others out there who have struggled with this too.
If you’d like to read a little my family’s experience, Jeff Lindsay just shared it on his blog:
http://mormanity.blogspot.com/2005/06/mental-health-and-prejudice-against.html
Steve (#26): Are you a troll, or just completely lacking in tact? It seems evolution gave you a pass on the sensitivity gene.
Mike,
It was a question, not a statement. Lighten up. A man never knows.
Yes, and an extremely offensive question. There are more important things to life and family than perfect genetics.
You know, Mike, when my stepson was in first grade, his teacher was convinced he didn’t need medication and asked us to take him off it, said she’d deal with him. She came crawling back after two weeks and begged us to put him back on it.
You really have to experience it to understand it. Forgive them, they have no clue.
I’m really glad so much research has been done on ADD, sounds like a really interesting book.
My husband was diagnosed with ADHD as an adult, back when it was a very new discovery. The shrink he saw put him on Ritalin–didn’t work. Tried Dexadrine–didn’t work. Tried Imiprimine (not sure how you spell these meds) and it seemed to help him concentrate. It also turned him into a complete zombie, changed his personality completely, and ruined a year or more of our lives. It was a nightmare. It took us forever to realize that it was the drug making him violently angry and then suicidally depressed, if he missed a single dose. I called the shrink and he wanted to UP THE DOSAGE. I couldn’t believe it. My husband tried to go off it cold turkey. For two weeks he was on an emotional rollercoaster that was just horrible. So he went back on the meds, and we slowly weaned him off. It took him a year or more to really recover from that.
So we’re understandably pretty anti-medication. (I’m also diabetic, and the experiences I’ve had over the years with physicians has also made me rather anti-doctor, as well.) I don’t object to other people using medication, I just know it was the wrong choice for my husband. But I do think there are way too many kids on meds (I’m thinking specifically of kids I’ve known who really didn’t need it).
My husband ended up going back to school to get a mechanical engineering degree, graduated a couple years ago. He did it without telling anyone he had ADHD. He refused to let anyone know purely out of spite. He was going to do it just like anyone else would, and he did. Maybe he managed to retrain his brain like this book describes, I don’t know. He’s definitely figured out some coping techniques over the years.
Thanks for sharing your story, Susan. The hardest part of starting any psychiatric medication is finding the right med (or combination of meds) and the right dosage.
My wife and I struggled for over a year to find the right regimen for our son. We started with Concerta 18mg (a time-release version of Ritalin; one pill a day instead of two), which worked okay, but didn’t have enough “kick.” We moved up to 36mg and he turned into a zombie. So we tried, in order: Adderal (he couldn’t fall asleep until midnight), Wellbutrin (made him feel like he had to pee all the time), and Strattera (which did absolutely nothing). So we went back to Concerta 36mg; by that time he was a little older and heavier, and the medication had less effect on him. Then he started to develop tics — heavy blinking, grimacing, constant urge to cough. So we added a 1mg dose of Clonidine to suppress the ticcing. That actually has been a pretty good combination — Concerta in the morning, Clonidine in the afternoon to help with the tics and ease him off the Concerta.
Now we’re struggling with him not responding as well to 36mg of Concerta — he’s growing, and the dose doesn’t have the kick it did when he was smaller and lighter. We tried 54mg (the third and highest tier), but he started ticcing again. So we’re back on 36mg and making sure he gets his homework done immediately after school.
The whole time we’ve felt tremendous guilt. It’s hard not to think of yourself as some kind of laboratory researcher conducting experiments on your own child. But despite all the struggles, pain, and heartache, we know we did the right thing for him. He’s very, very smart, does well in school, and is an all-around “good kid.”