Ritalin Nation
(Filed: 16/10/2005)


Pay attention now…

When both her children were diagnosed with a behavioural disorder three years ago, Charlotte Fisher began reading up on the condition. Having assumed that "attention-deficit hyperactivity disorder", or ADHD, was solely a childhood condition, Mrs Fisher discovered a hoard of literature that told her otherwise.

"I came across a book about the symptoms of adult ADHD and realised that I was reading my entire life," she says.

"I had a terrible childhood as a very wilful child and I always knew I was different. I could never socialise with people. I was disruptive at school and always flying into rages, which eventually led me into drug addiction as a way to escape what was a living hell."

Anti-depressants did not help Mrs Fisher, who believes her condition led to her divorce six years ago, and she became increasingly desperate, unable to hold down jobs or relationships. "My erratic behaviour continued into adulthood but, up until reading that book, I didn't know what was wrong with me."

Mrs Fisher, a 33-year-old psychology student from Warminster, Wiltshire, diagnosed herself with ADHD after answering "yes" to a symptom checklist in the book, which included such questions as, "Are you moody?", "Are you impulsive?" and "Do you procrastinate?"

Her GP referred her to a psychiatrist who confirmed her diagnosis and prescribed Ritalin, an amphetamine-based stimulant that improves concentration and has been nicknamed the "chemical cosh" because of its calming effects.

Mrs Fisher's children, Jazmine, 12, and James, eight, were also diagnosed with ADHD, after showing symptoms of hyperactivity, inattention and unruly behaviour at school.

The family have taken Ritalin for the past three years and although Mrs Fisher still finds it difficult to work full time and receives financial help from her father, she claims that the drug has improved her children's behaviour and "lifted a blanket of fog" from her mind.

She is not alone. Mrs Fisher is one of the growing number of adults who take prescription drugs for ADHD, which allegedly affects more than one million adults and 350,000 children in the UK, according to the National Attention Deficit Disorder Information and Support Service, or ADDISS.

There were a record number of prescriptions last year for methylphenidate - of which Ritalin is the most common brand - at a cost of £10 million to the NHS. Although 90 per cent of the 359,100 prescriptions were dispensed to children - a 180-fold increase since 1991, when just 2,000 were issued - adults are now a fast-growing area.

As with most health "fads", it has crossed the Atlantic. Adult ADHD is already big business in America. A recent study by the Harvard School of Public Health, which compared the behavioural

patterns of 500 adults diagnosed with the condition with 500 adults without, claimed that eight million adults - almost four per cent of the population - may have the disorder.

More than 1.5 million adults in America are now using prescription drugs for ADHD, and a survey there last month found that the use of prescription drugs to treat the condition is growing at double the rate among adults than among children.

All this is excellent news for drug companies such as Shire Pharmaceuticals, a British company that manufactures Adderall, a drug similar to Ritalin and used to treat ADHD. Matthew Emmens, Shire's chief executive, believes that "the adult market is three times the size of the £1.14 billion-a-year children's market and is ripe and moving in the right direction".

Andrea Bilbow, the chief executive of ADDISS, said last week: "Whereas a few years ago we would receive a few calls a week from adults, we now get up to 10 calls a day from people who have experienced behavioural problems, read literature on the subject and believe they may have the condition."

ADDISS, a charity run by unpaid volunteers but which also receives funding from drug companies who make ADHD drugs, claims that up to five per cent of schoolchildren suffer from ADHD and that

70 per cent of these continue the symptoms into adulthood. Miss Bilbow believes that "the myth that you turn 12 and it disappears" is finally being addressed. "As awareness grows and more adult psychiatrists come to accept the condition, I think we will see diagnoses and treatment through medication explode."

Philip Asherson, a professor of molecular psychiatry at King's College, London, runs an adult ADHD clinic at the Maudsley Hospital in Camberwell, south London, one of only two such NHS clinics in the country. It is expanding to cope with the rise in demand.

Since the clinic opened in 1994, Prof Asherson has seen patient numbers soar from a "steady trickle of a few patients a month, to 11 new patients a week", many of whom wait for more than a year to see him. The majority are prescribed with methylphenidate drugs, but he concedes that self-diagnosis of adult ADHD through literature checklists is "a growing concern".

"There is always the danger that somebody can pick up a list of questions and say, "I have those symptoms, so I must have ADHD", which is why consultations are necessary."

Dr Jonathan Dowson, a consultant psychiatrist at Addenbrooke's Hospital in Cambridge, heads the other NHS adult ADHD clinic. "There is a growing demand for consultations and I am seeing more people through self-referral or who have children with the syndrome and think they may have the same problem," he said.

There are no medical tests for ADHD and adults are evaluated on a range of factors, including their childhood behavioural history and questionnaires asking if they suffer from restlessness, lack of organisation and poor time management. Or, as critics of the growing ADHD "industry" put it, reasonably normal behaviour.

Professor Peter Hill, an adolescent psychiatrist and ADHD specialist, believes that the explosion in the number of adults seeking medical treatment for these "symptoms" is in danger of changing the view of the condition. "Most of my patients do not continue their symptoms into adulthood, and very few require medication beyond adolescence," he says.

"ADHD is a developmental condition that gets better as you get older and I think it is terribly important to stress that. The American concept is to see it as something that never goes away, but I do not think that is the case and I have seen no evidence to support that theory."

Others in the medical profession go even farther, expressing deep scepticism about the very existence of ADHD as a medical condition. Some liken the rise of Ritalin to that of Prozac, the wonder drug of the 1980s and 1990s that was supposed to bring medicated peace to millions of depressed minds. Only later did studies link the drug to suicide and violence, charges that

Eli Lilly, its manufacturer, continues to reject.

Dr Sami Timimi, an adolescent psychiatrist based in Lincolnshire and a campaigner against the use of drugs for behavioural disorders, says the medical treatment of anti-social behaviour is "a scandal", with adult ADHD fast becoming a "new social health fad".

"During the 1990s, we saw melancholy and the normal ups and downs of everyday life increasingly diagnosed as clinical depression, and taking Prozac was considered a trendy and easy way of dealing with emotions like unhappiness and anxiety," he says.

"If Ritalin, which is chemically similar to speed, continues to be prescribed for adults who feel they are a bit disorganised, it will become a lifestyle drug for perfectly healthy adults who want an extra hand with the growing demands of daily life.

"ADHD does not exist in children and certainly doesn't exist in adults. Mood swings, forgetfulness and disorganisation are common behavioural patterns in every human being and it is ludicrous that they are now being diagnosed as symptoms for a medical condition."

Dr Timimi believes that an increased awareness and acceptance of adult ADHD provides some doctors with the opportunity to raise their profile and help them secure funding from drugs companies eager to get a foothold in the British market.

"This so-called condition is new territory for psychiatrists who can make a name for themselves through labelling and medicating people's problems, instead of investigating the real root causes and considering alternative treatment, such as therapy," he says. "Doctors who prescribe drugs in these situations give scientific legitimacy for pharmacological solutions to life's normal stresses, and research grants from drug companies are more likely to go to those doctors than to the sceptical clinicians."

Dr Timimi believes that not enough people are aware of the potential health risks and side-effects associated with Ritalin, which include insomnia, psychosis and loss of appetite.

Although little research has been carried out into the drug's long-term effects, a recent report in America found that Ritalin may cause lasting changes to the brain. In the study, carried out by the Harvard Medical School, healthy rats given the drug in their infancy were found to have a reduced sense of pleasure and were more prone to signs of despair during adulthood.

It was these lasting changes to the brain that convinced John Slater - not his real name - to come off his medication after being diagnosed with ADHD. Mr Slater, a 46-year-old marketing manager from Exeter, was prescribed with Dexadrine, a stimulant similar to Ritalin, which he took for 18 months.

"The drugs made me more aggressive and I realised that they were permanently altering my sense of who I was," he says. "Life is still difficult -

I am forgetful and prone to mood swings - but I have learnt to live with my symptoms, which is a far better alternative to medication."

Janice Hill, the founder of the Overload Network, a charity that campaigns against the prescription of drugs for behavioural disorders, believes that the lure of cash benefits is leading more adults to seek the ADHD diagnosis.

Children or adults who can prove, by providing medical references, that ADHD severely affects either their mobility or care requirements,

can apply for a disability living allowance from the Department for

Work and Pensions, worth up to £60 per week.

"If adults with behavioural problems think that they might be entitled to this allowance, they are going to look for the diagnosis to plead their case," she says.

"Of course, some adults do have difficulties but the alternatives to drugs, such as cognitive behavioural therapy and anger-management courses are very effective. Life is not a disorder that needs medicating."

Pay attention now…

Although there is no standard test for the disorder, here are some typical questions asked of adults during a diagnosis. The more questions that are answered 'yes', the more likely it is that a person has ADHD, according to psychiatrists.

1. Are you moody?
2. Were you considered an under-achiever at school? Now?
3. Do you have trouble getting started on things?
4. Do you drum your fingers a lot, tap your feet, or fidget?
5. When you read, do you find that you often have to re-read a paragraph or an entire page because you are daydreaming?
6. Do you 'tune out' or 'space out' a lot?
7. Do you have a hard time relaxing?
8. Are you impulsive?
9. Are you easily distracted?
10. Is your memory so porous that if you go from one room to the next to get something, you've sometimes forgotten what you're looking for?
11. Do you change the radio station in your car frequently?
12. Do you change TV stations frequently?
13. More than most people, do you hate queuing?
14. Do you have a hair-trigger temper?
15. Do you frequently resolve to organise your life better, only to find that you're always on the brink of chaos?
16. Would you consider yourself an addictive personality?
17. Are you more flirtatious that you really mean to be?
18. Do you find it hard to be alone?
19. Have you changed jobs a lot?
20. Are you smarter than you're able to demonstrate?
21. Are you particularly insecure?
22. Do you have trouble keeping secrets?
23. Do you love to travel?
24. Do you laugh a lot?
25. Did you have trouble paying attention long enough to read this entire questionnaire?

I know this is an old article but I couldn't resist commenting.

Does anyone else agree with Dr. Sami Timimi? Does anyone else think that ADHD and depression are not diseases by themselves but rather a symptom of something bigger? And doesn't it seem that doctors are diagnosing too many people with these conditions? When I was in middle school, there was about 3 kids in every class room taking Ritalin and now it seems like every college student has a prescription. I don't mean to offend anyone by posting this. I'd just like to hear your thoughts.

I have wondered the same thing myself.

I've read that symptoms of ADD/ADHD can be caused by simple things like poor nutrition or lack of activity. Most people I have talked have never even discussed this with their's or their child's doctor. Has this happened with anyone else here? I know for many people that medication is necessary but ADD medication is not that great for the body as a whole. I would kind of like to know about alternative treatments doctors recommend before the stimulants.

To both of you wondering about ADHD.

I have it big time. I am 53 years old and as far back as I can remember, I have exhibited classic symptons of this. Of course, I didn't learn about my problem until I was nearly 30. I recall my MD telling me that I had impulsivity. I thought she made that up just to shut me up.

Personally, I have never taken Ritalin, and I do know why. But later on that.

One thing I know about this disorder, is that for those of us who truly suffer from it, it is 100% of the time. We are all alike, only our names are different. Years ago I ran a support group for adults with ADHD. Inside of me I used to crack up laughing, because there was nothing else you could do around all of us but laugh. It's amazing that any of us get out of our own way.

This disorder is very serious, very debilitating and as far from self conceived as possible. If you could take a poll from every person in prison, you would find a very high percent of them have ADHD. Remember, it has only been in the last 20 - 25 years that people have begun to talk about this. In my opinion, if you have this, it is not debatable. If you were around someone with a real case, you'd know it.

However, I can hear everyone saying "Well, I can't pay attention sometimes and I get distracted and mouthy and ancy, and I don't have ADHD." They are correct, they don't.
And as to it being caused by a poor diet or sleep problems, etc., give me a break. What you should know to accurately put this in context is this, that most people, a majority of people, can exhibit symptons of ADHD at some time or another, for situational reasons. No differently than one who wouldn't say they suffered from depression, but because their spouse just died, they are legitimately depressed.

The same is true for people with ADHD. (For simplicity in writing, I refer to ADHD, but include ADD as well.) Lots of factors can and do affect the severity of ADHD, again, not unlike many other illnesses or disorders. A child who may or may not have ADHD, (yet to be determined maybe until they are older) but they display the symptoms and maybe their school and or MD feel they need to be on medication, this could be simply to help a child blend in when placed in a very orderly structured environment . Without the help of meds, they struggle to perform. Children, and adults for that matter, can be very disruptive with this problem. And much to the dismay of others around them. Some people view them as being manipulative. Some feel they are just acting out and wanting attention. In my personal opinion, when children do either of these things, they are trying to let someone know that things aren't right in their world, and they simply lack the maturity to verbalize it. A true ADHD child may behave the same as those 2 examples, but they are not one ounce of conscious of it. Nor do they understand why it is that they are always in trouble. Nor do they think there are any problems in their home, because the problems, (if they exist) are not severe enough to be obvious or their parents hide them well. Whatever. When they live in a very dysfunctional home, no routine, no limits, no consequences, no order, just chaos, indifferent caretakers, folks who may be suffering from some addiction, this child will most certainly exhibit symptoms of ADHD. If this child genuinely does suffer from ADHD, whether they live in that environment or not, the severity of their disorder can and will be affected. A child with only mild symptons, situational times, living in a horrible place can exhibit severe symptoms. But remove them from that place and put them in a loving, structured, consistent, attentive environment, and those symptoms will calm right down.

Take someone who genuinely has a severe case of ADHD, put them in the best of the best of environments, and you may not even know they have a problem if you do not live with them. My point is that how you live greatly impacts your problem. And what disorder can you not say the same thing about?

Back to the folks in prison. ADHD is so prominent because of kids who grow up to be adults with this, and were never diagnosed. Simply by virtue of their own behavior, they most likely had an upbringing that no one would choose. A young child who is disruptive at school, constantly in trouble, and the school cannot get the parents to deal with this, (because the parents are pretty dysfunctional) you can bet that kid will grow up ito be someone not wanted in your neighborhood.

For me, I always knew I was different, I always knew that I never fit in anywhere, but I didn't know why. I never knew when I had done or said something wrong, as most people would be in such shock at my extreme behavior, they wouldn't dare say anthing. My parents decided when I was very young that I was insane, and treated me accordingly. They had me institutionalized when I was 14, and to no avail, it didn't change a thing. So I grew up believing I was nuts and NEVER knowing why. Try to understand the lonliness a kid feels when no one wants to be around them because they don't know how they will behave, or they don't want their life to be disrupted or whatever. Even they can't put their finger on what it is that is wrong, they just know that something is.

I don't know how to describe my environment when I was growing up. Not that I am old, I do recognize that we fit the criteria for being dysfunctional, but it took me many years to get that! My father was a Colonel in the Air Force. He was a navigator. My mother was an RN, the head charge nurse on her floor at the hospital. My sister and brother were typical, nothing notable in their past. They both attended college and today live very successful, normal lives. Then there is me. I was the black sheep as I wasn't like any of them. I never finished school because I just couldn't do it. College was never an option for me. I am very capable of reading, yet I can't. I have so many books in my home, you might think that all I do is read. Yet there isn't a one of them that I have read even 25% of. With every book I buy, I think, this is the one I'll be able to read. But I can't hold my attention for even 2 or 3 minutes. I am up and down, have 10 things going at once. I'm just a ball to live with, not that anyone does.

Getting back to diets and sleep etc. Certainly those can affect the symptoms. But they also affect the behavior of any and every child! They do not cause the problem at all. The adults version of how I have explained this at times is this: People with ADHD are like cars that have no brake fluid. They are traveling along life, all is well, and then they are on a hill and need to put on the brake, but they can't. There is no brake fluid so they can't stop - what is about to happen. No one would knowingly drive with no brake fluid.
But this ADHD doesn't remember to check and see if there is any brake fluid. And since they walk on the wild side to begin with, we would never believe that anything wrong could ever happen to us.

To children who have this and even those that don't, I explain it this way.
Imagine all the children in a classroom are really porcupines. They all behave pretty much the same. When all is well and nothing is bothering anyone, their quills are down and everyone is relaxed and calm. But now and then, one of them does throw their quills up because something is bothering them. And everyone notices. The teacher may deal with this child on a private level, knowing what it is that caused that porcupines quills to go up.
The porcupine with ADHD always has their quills up, even when there is nothing outwardly bothering them. They are hearing every conversation going on around them, even though is has nothing to do with them. They have no filters that enable them to tune things out. They hear every pencil drop, every yawn, every chair being scooted. Whereas all the other porcupines don't even notice these things. Except, they do notice that this one guy ALWAYS has his quills up. This poor guy can't pay attention to his assignment, because so many things are distracting him. He is not able to keep his focus on his assignment. When he should be sitting still, totally engrossed in the great story the teacher is telling, his legs are twitching so hard that he is rocking his chair. He can't sit still, he needs to walk around, to move, to tap his pencil, make heavy loud sighs, anything to get this story over with so he can talk and move. His mind races, he jumps from thought to thought to thought. There is no brake fluid. He can't concentrate. Hence, his behavior disrupts everyone else. Now he is in trouble. He never finishes his assignments, he is always late, he can't remember a thing, and he is always speaking out of turn and loudly at that. When he has a thought, he has to spill it or he will forget it. He has to go first all the time for fear of being overlooked, but worse, the excitment is truly too much for him to control. The day comes, and it doesn't take long, when this childs own behavior keeps him from being successful at anything, ever. He is always in trouble, his parents are always mad, they don't understand why he just doesn't do what he is supposed to, and neither does he. He doesn't even know that he isn't doing what he should!

This kids only immediate help is medication. Most rational, intelligent parents can tell after a period of time, when the child doesn't need the meds anymore. Lots of kids take holiday breaks they are known as, like during the summer, when they go off the meds as the demands being made of them are not so high. Their time is free, they can run around and scream their lungs out to their hearts content. So no need. They may go through their entire life only needing medication under certain conditions. (This is a person that does NOT have a severe case!)

The severe ones never go off their meds, or they simply cannot function in a socially acceptable manner. AND we talk too much. hmmmm

This does not go away as one reaches adulthood. It can become more manageable, with medications and therapy and the RIGHT environment! This means that they work at a job that does not restrict their behavior. I once worked at Walt Disney World. It was a great place for me to deny that I had any problems. My position was such that I could walk around the park freely, not in costume but my own clothes so other people didn't know I was an employee. The demands of each day were typically so different, that it held my interest. I never got bored. The number of new people and new situations were endless. So it worked. It's typical that for someone with this disorder to be able to hold their focus on anything, is if they can be constantly stimulized to keep that interest and focus up. This can be equal to a 'novelty,' hence the ability to hyper focus on computer games/video games. When I left that job, my world crumbled. I couldn't work in an assembly line such as IBM or GE. You can't nail me to a desk. So if I took jobs like that, I am setting myself up for failure. Relationships? Forget about it. I don't have them. The only successful marriages I see (for people with ADHD) is when they have a spouse who is completely calm and patient and tolerant and maybe even becomes amused at the antics. But they love the person despite the chaos that circles them. Not a lot of people are like that.

I've said way too much I know, but I could go on for days, believe me.
Thanks for your patience if you were able to read all of this. I believe I just unburdened my soul for today.
I hope I helped someone to better understand this problem.
Always Trying

I have to admit i skimmed through the article but read the entire questionaire, and you described me to a tee.

i am a super under-achiever in fact i would say i have a lifetime of under-achievement. i have trouble finishing things i start and i never finished college but went for seven years. i use a fake degree since "society" teaches us if you want a decent job you better have one. i feel bad about myself and want to die too. i feel like a failure and i am almost forty.

i have done nothing with my life and have 500 dollars to my name. i have changed jobs so many times that i must be up to about a hundred by now. my resume is complete lies of course because i know what HR people look out for. but what else am i to do? if i tell the truth, who the heck is going to hire me? answer: no one. so my whole life is a lie. but i really have no choice. actually i do have a choice, i can lie or commit suicide. that is the only choices society gives someone like me.

yet, i do have loads of computer skills (mostly self taught). i know software like the back of my hand. i dont program anything, i just know how to use software. i could have become a programmer, i was tested with a high enough aptitude but i just never got the right help. i could've and should've done a lot with my life but did squat. in fact i want that written on my tombstone when i die.

i could be one of those dot com billionaires, but instead i am worthless. they have billions before they are 30 and i have 500 bucks to my name. i guess i am just like them but without the success. and yes, i do hate myself very much. i pray everyday that i would die. that my heart would just freakin stop beating. that God, if He does really exist, would just end my freakin misery already. i know that even if i go to Hell it cant be that bad because i am already there, it's called my life.

After some prior research on the subject and skimming through (how can they write something so inhumanly long for people who have ADD?) the first post, I have come to the conclusion that I most definitely have ADD. In fact, I now believe that my depression probably stems from that; the former's been around a lot longer. Shaking legs, restless hands, memory relapses, daydreaming, completely missing parts of conversations, rereading a line four times just to catch the first word, progressive decline in grades since my school days (I was a straight A student, now I'm on academic probation in college), failing to meet deadlines, utterly forgetting important chores, disorganization, indecision; it's all been with me since childhood.

This post has been edited by Oblivion: Feb 23 2008, 01:38 PM

This is really strange but ive had depression for a ling time but ive always knew there was something more going on, my doctor thinks i have o.c.d, and this makes sense due to the fact i often get intrusive shameful thoughts, however i answered yes to every single question in that questionaire, and not just moderately do i do these things , i mean i do all of these things all the time.

is it possible to have both OCD and ADD?

This post has been edited by danielandstuff: Oct 4 2008, 08:23 AM

I got bored so never read that part of her long article. What was she thinking blathering on like for that length about ADHD did she mean to exclude us!

I think ADHD is an ailment (I can't bring myself to use disease for it) and I think that for me my depression arises out of the ADHD and ensuing frustrations.

I know that I have ADHD and that it has had some bad affects in my life but at the same time I was able to cope and be succesful. One of my greatest successes was to complete my PhD and work as an anthropologist. Being an academic researcher allows me to engage in multiple topics, ideas and events all at once to allow me to enjoy my ADHD in a way. I have developed coping mechanisms and behaviours that allow me to work to deadlines so I do get some things finished on time. It was a struggle with the PhD to get it done on time and the number of jobs I have held over the years makes for an eclectic career. I am not on any drugs for the ADHD but as things occasionally fall apart I do think about getting some.

Having ADHD is not a guarantee for failure.

Admittedly today is a tough day - which is why I am online posting on forums instead of writing a project that is due.

I know people close to me sometimes battle as I get easily distracted and forget to do things for them or just forget what is we were doing or going to do. It must be frustrating at times when I am sent to the shop to get eggs and come home with none or have something important to do like pay a bill and just forget (oh s23$ electricity is due! - still).

On the other hand I do get frustrated when my wife says, "focus" or "I'm over here" as she tries to engage me on something. She always assumes its my ADHD and not what she is saying - sometimes I have legitimate reasons for not paying attention to her. She also forgets that it takes effort and work to focus and she can get demanding about focus time during times when I wish to be able to relax and let my mind jump.

Imagine:
I am playing solitaire on the computer
she calls me to talk about something
I say I am working on a paper
she can see solitaire on the screen
"No your not" she says
I switch back and say see I am
you just started
no I have been working for the past hour
I saw you playing solitaire
so, I am still working
Thats a recipe for cookies on the screen
What, oh that I wanted to bake cookies later
I wanted to talk
I want to bake cookies now
Aren't you working on your paper (sarcarsm)
Yes I am - off I go to the kitchen
I still want to talk she says following me
Ok talk
Blah blah blah - I can't remember what she said something about her dad his new wife and some complaint about her.
I proceed to bake muffins
I return to my computer while muffins bake
She follows and is angry that I haven't responded to what she was saying
I lose my temper and tell her to leave me alone I'm busy
She is saying I am not because i am busy doing nothing she deems important and jumping from topic to topic that doesn't interest her.
I try to explain - its Sunday I want to be able to be me I don't want to have to sit and focus and force myself to follow her agenda.
She says she has never stopped me from being me.

You get the idea. And yes I burnt one tray of muffins and if I wasn't in my office I would start to bake the cookies I actually wanted. I know I can be unreasonable and sometimes I am unfair because of the ADHD, but there are times when I want to be able to shift at will and let my mind jump around and do all sorts of tasks at will. She never seems to understand that. Maybe a forum for partners of ADHDers would be a good idea.

Anyways, I am rambling today