Ian McMahan, PhD
Plugging and Drugging (ADHD, That Is)
The kids’ market for ADHD drugs now saturated, companies are going after adults.
The New York Times recently ran a front-page story by award-winning journalist Alan Schwarz that recounts a 20-year campaign by drug companies, meant to convince parents, teachers, and doctors to give kids pills to treat A.D.H.D. — attention deficit hyperactivity disorder. Was the campaign successful? Wow, was it ever!
In 1990 about 600,000 children were using these powerful drugs. By this year, the number had skyrocketed by almost six times. By the time they reach 18, one in six American children have been diagnosed with A.D.H.D. Clearly those ads on television and in consumer magazines persuaded a lot of people. If their kids forgot to do chores or got lower grades than they would like, the cause must be a medical condition and the remedy must be a pill. A pill, by the way, that some doctors claim they should buy and take for the rest of their lives.
There are a lot more adults than children. If the drug companies can persuade, say, 10% of adults that their problems are due to A.D.H.D, and convince them to ask their doctor for a prescription, Pharma will have more than doubled their market. Hence the online quizzes that supposedly diagnose you. Do you sometimes have trouble getting started on projects or remembering appointments? Is your marriage rocky? We may have a pill for that!
We should be clear here. A.D.H.D is a legitimate condition that does indeed affect some adults — as many as 3% to 5%, according to estimates. And for many of these, medications may indeed offer a degree of relief. But what they probably don’t know — and certainly won’t find out from glossy ads — is that there are other ways to deal with their symptoms, ways that don’t require long-term use of powerful prescription drugs, with their high frequency of side effects including loss of appetite, nausea, disturbed sleep, mood swings, and anxiety. The stimulant drugs for A.D.H.D. also carry the risk of dependency and abuse.
A POTENTIAL DRUG-FREE TECHNIQUE
One contrasting non-drug approach to consider is chronotherapy. Very often, adults with ADHD also suffer from a type of insomnia called delayed sleep phase disorder. In common-sense terms, they are extreme owls that have trouble getting to sleep at night and waking up in the morning. As we explain in our new book, Reset Your Inner Clock, daily timed exposure to bright light can shift the sleep-wake cycle in a more favorable direction. And research has shown that this change is accompanied by improvements in cognitive symptoms of A.D.H.D, as well as improvements in mood and energy.
To work properly, bright light therapy needs to be individually adjusted. It is not just a matter of sitting in front of an east-facing window during breakfast. Crucial factors include the intensity of the light reaching the eyes, the duration of the therapy session, and, perhaps most important, the timing of sessions relative to the person’s inner clock. If the treatment is too late or too early, relative to the circadian rhythm pacemaker in the brain, it may have little effect. In some cases — especially if the light is used too early — it may even make getting to sleep and waking up harder than they were to begin with.
Those who think they might be helped by bright light therapy can start by taking the free and confidential online self-assessment of chronotype (called the AutoMEQ, for short). You’ll learn when your inner clock thinks you should be sleeping, and when to take light therapy to shift it earlier.
Last year sales of ADHD drugs topped nine billion dollars. The profits from those billions can buy a lot: magazine ads, TV commercials, fancy conferences and hyped experts to convince doctors that their patients need those medications, and lobbyists to make sure government regulators don’t slow down the bandwagon. In sharp contrast, no one is getting rich from bright light therapy. No glossy ads, slick commercials, or celebrity endorsements, no paid publicity campaigns aimed at the medical community, or biased continuing education courses for which doctors receive credits. Even so, the word is beginning to get around. Those with mood, attention, sleep, or energy problems may find relief without resorting to powerful, expensive prescription drugs whose long-term effects are still unknown.
The Times reports on February 19, 2014, that “400,000 children in the United States … receive an A.D.H.D. diagnosis each year. . . . A distracted and fidgety boy might not have A.D.H.D. but rather might be the victim of bullying at school. A teenage girl might have been sexually assaulted. . . . Pediatricians and family doctors handle the majority of office visits for children being medicated for A.D.H.D. ‘When I trained, most of pediatrics was treating infectious disease,’ said Dr. William Wittert, 57, a pediatrician in Libertyville, Ill. ‘But we don’t treat bacterial meningitis anymore. We are being asked to evaluate and handle mental-health issues in kids like A.D.H.D. We have to get up to speed’. . . . Harriet Hellman, a certified pediatric nurse practitioner in Southampton, N.Y., who is licensed to make mental-health diagnoses, said that there were times she would identify the disorder through mere instinct, a ‘hair-on-the-back-of-your-neck feeling’. . . . Dr. Peter Jensen, one of the nation’s most prominent child psychiatrists, . . . [is offering] seminars [for nonspecialist doctors], held by the Resource for Advancing Children’s Health Institute.”
Our coda: There is an overlap between A.D.H.D and the circadian rhythm delayed sleep phase disorder. Chronotherapy can help, and we hope to see it integrated into an enlightened treatment regimen for these kids.