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HOUSE CALL WITH DR. SANJAY GUPTA
Attention Deficit Hyperactivity Disorder
Aired July 30, 2005 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SANJAY GUPTA, HOST: Good morning and welcome to HOUSECALL. I'm Dr. Sanjay Gupta. Today, we're talking about a very controversial condition, Attention Deficit Hyperactivity Disorder. Just mentioning ADHD can spark a debate. Questions like are children over medicated, is ADHD under or over diagnosed?
Paula Zahn has the stories of two children living with this complex disorder.
PAULA ZAHN, CNN ANCHOR (voice-over): Mary Beth and Tommy's Burrow's first son Thomas was a handful from day one. But when Thomas went to preschool, teachers thought there might be an even bigger problem.
MARY BETH BURROW, THOMAS' MOTHER: He's walking out of the classroom, he's doing this, he's, you know, taking away from the other children learning. And so they were suggesting that I go see somebody about Thomas to find out kind of what's going on.
ZAHN: A doctor delivered the news. Thomas had Attention Deficit and Hyperactivity Disorder, and was given a prescription for Ritalin. Thomas did well during the school day, but at night when his dose wore off...
M. BURROW: And it's -- all over the place. Just jumping on furniture, jumping on the table, making weird sounds, not caring if he breaks things or pushes somebody down.
ZAHN: Thomas was given a different ADHD drug to try, Concerta. This time Mary Beth and Tommy noticed an even more disturbing change in their son.
M. BURROW: Everyone's picking teams or whatever and Thomas doesn't get picked or doesn't, you know, raise his hand to be picked. He's just standing there like a zombie and it was awful. I mean, so sad. Then my mother went up one day and she's like: It makes me want to just cry to watch him.
PETER BREGGIN, DR., CHILD PSYCHIATRIST: You have a young child whose brain is being bathed in a toxin that's disrupting multiple neurotransmitter systems. And the brain's trying to adapt to that while it's growing.
ZAHN: Dr. Peter Breggin, a child psychiatrist and author of the book "Talking Back to Ritalin," thinks that drugs like Ritalin can alter a child's brain chemistry, stunning their growth and suppressing their personalities and their creativity, even possibly leading to depression.
And the FDA has been taking notice, recently tracking reports of possible side effects like suicidal thoughts, hallucinations and violent behavior, trying to determine whether Ritalin and other drugs in its class should carry stronger warning labels.
Dr. Harold Koplewicz, founder and director of the New York University Child Study Center, thinks that used wisely, drugs like Ritalin can be transforming for struggling children and their families.
HAROLD KOPLEWICZ, NYU CHILD STUDY CENTER: There are reports that are coming out of the FDA deserve our attention and should be investigated carefully. And if there is concern, then there should be a warning label.
But there -- turns out that this is not significant, then there shouldn't be a warning label, because the one thing we don't want to do is we don't want to prevent children who really have this disorder from getting treated.
ZAHN: Eleven-year-old Allison Stoll is an energetic big sister.
SUSANNAH BUDINGTON, ALLISON'S MOTHER: She's outgoing. She's personable and she's just a great kid to be around.
ZAHN: But five years ago, this family's story was quite different.
BUDINGTON: We were just watching her struggle so much. Always talking, talking, talking, which was great, but you know, interrupting, a lot more oppositional, a lot more temper tantrums.
ZAHN: At the age of 6, Allison was put on Ritalin.
BUDINGTON: And within the first day at school and at home, we saw a remarkable difference in her, without changing her personality, which was important to us, too.
I don't think anybody would ever meet her and say: Oh, she's drugged. You know, it's something -- it's just one tool that we use to help her.
ZAHN: Allison is still on medication. Even so, the daily struggles go on.
ALLISON STOLL: Sitting here right now is really hard because I want to get up and like, I don't know, walking around my room or something.
ZAHN: But Allison believes that the medication is helping.
A. STOLL: And medicine just helps me be a better person because I'm not really being me because me would be hyper, not paying attention, bouncing off the walls. But it helps me be a better, more nicer, calmer, a little more on task person.
ZAHN: Thomas Burrow's parents recently took him off his ADHD medication. Mary Beth and Tommy are experimenting with diet changes and testing Thomas for allergies that they think may be contributing to his ADHD. A very active Thomas will start first grade in the fall.
GUPTA: Really interesting stuff. Paula, thanks.
And we are going to talk more about whether diet can play a role in helping ADHD later on in the show. But first, let's bring in our guest, Dr. Andrew Adesman. He's director of the ADHD Center in the Department of Pediatrics at Schneider Children's Hospital in New York. Thanks very much for being with us, doctor.
ANDREW ADESMAN, DR., ADHD SPECIALIST: Good morning, Sanjay.
GUPTA: You know, this is a confusing issue, a confusing disorder. Parents trying to figure this out. I know many blame themselves ultimately, but what are some of the latest theories for what causes ADHD?
ADESMAN: Well, we don't know exactly what causes ADHD. We know that genetics and heredity plays a part for a significant number of children. In cases where's genetics aren't a factor, there may be other factors in terms of the birth history, whether it be prenatal exposure to alcohol or drugs or possibly lead in the environment for young children or other medical factors that may be contributing.
GUPTA: And we're going to give it some of that, and sort of work through this issue. Some critics believe, for example, that we're over diagnosing children with ADHD, misinterpreting for example typical inquisitive and active child behaviors with a disorder. And a question's coming in about that.
Donna in Connecticut is concerned. How do you tell the difference between ADHD and just a normal, active four-year old? What do you say so that, doctor?
ADESMAN: Well, the younger the child, the harder it is to be sure about whether the diagnosis is accurate. And I think that clinicians, parents, educators all need to be very, very conservative and cautious before making a diagnosis of ADHD in a young child.
In terms of separating, you know, a 4-year-old who might have ADHD versus a normal 4-year-old child, who can at times be an active and rambunctious is really to what extent it's interfering with functioning.
And I think that, you know, in general, clinicians, parents and others really need to pay attention, not just to sort of symptoms, but the functioning of the child and whether the child is compromised, whether it be in peer acceptance, learning, or behavior in the household. GUPTA: Let's try and drill this down a little bit further. Another question on diagnosing ADHD specifically. Lisa from Maine writes this. "What is the normal procedure identifying ADHD in children?"
And doctor, there's no specific tests which, of course, can make the diagnosing difficult. No blood test, no scan, for example. So, how do you say for sure a child has ADHD?
ADESMAN: Well, first of all, I think what you said is important that we don't have a blood test or a brain picture that can help us with the diagnosis. And so, it's really important to get a good history on the part of a physician or a psychologist, reviewing the family history in terms of other family members, looking at the developmental history, looking at the expectations of the child, and most importantly getting a sense for the child's behavior and functioning in more than one setting.
Preschool kids may not necessarily be in a preschool setting so you won't get that feedback. But once kids are in a school age setting, then we can always get feedback from a teacher.
GUPTA: And here's the thing as well. I mean, you know, sort of getting at this, there's other problems in childhood that maybe ADHD could be confused with. Or you know, again, just a rambunctious 4 or 5-year-old child.
You know, are there specific things you can tell parents or people watching today that make you say for sure someone has ADHD?
ADESMAN: Well, again, the things that we're really looking for are the severity, the pervasiveness in any impairment or function. So severity in terms of you're not just, you know, mildly overactive or mildly inattentive at times, but something that's really prominent, not just on an occasional day but from day to day consistently.
ADESMAN: Pervasiveness in more than one setting. And again, the importance of having symptoms not just at home, but in school as well.
ADESMAN: And then lastly, the issue of impairment. And impairment really means that the child's not able to function. That's really a critical, critical distinction, because it's not just a matter of a child occasionally being off task or being distracted, but a child who really can't meet expectations that are otherwise developmentally appropriate.
There are rating scales that have been developed, rating scales that parents can fill out, rating scales that teachers can fill out. And these help us quantitate how much of a problem there is for a given child.
GUPTA: OK, really helpful stuff. We're talking about ADHD, Dr. Adesman. Much more to come up on HOUSECALL. How safe are the drugs being prescribed for ADHD? Important question. Find out after the break.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Many children who are minimally affected, but whose parents are worried are now flocking to the doctor often pushed by the teacher to get a diagnosis and the drug.
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UNIDENTIFIED FEMALE: Are we over prescribing drugs to our kids?
Plus, was Tom Cruise right about Ritalin? First take today's quiz. Can sugar cause ADHD? That answer coming up.
UNIDENTIFIED FEMALE: Before the break we asked, can sugar cause ADHD? The answer, at this time, there's no evidence that sugar or diet has any impact on ADHD.
GUPTA: And for most doctors, the strategy for treating ADHD is two pronged. Some type of therapy, some type of medication.
But parents are looking for other options and possibly other causes as well for their children's behavior. Dr. Andrew Adesman is a specialist on ADHD with Schneider Children's Hospital in New York.
And doctor, we've got lots of viewer questions lined up on this topic. Let's get started right away. Jeremy in South Carolina asked this question. "What are some ways to help a child with ADHD other than medication?"
And we just heard, doctor, that sugar doesn't cause ADHD, but other diet changes or things like exercise, can those things help?
ADESMAN: Well, people emphasize children getting a lot of rest and that exercise may help in terms of getting the energy out of hyperactive children. I think it needs to be remembered, first of all, that not all kids with ADHD are hyperactive. And so the exercise per se, may not necessarily help in that regard.
Also realistically in the school setting and the context of a five-hour day exercising, rest are not likely enough. I think in terms of treatments other than medication, what we're typically looking at are behavioral interventions and also educational interventions or educational accommodations.
And children with ADHD oftentimes have been shown to benefit from behavior management strategies, both at home and in school by teachers and parents, and then also educational accommodations, whether it be preferential seating, reduced homework assignments, perhaps tests being given in a separate setting, things such as that.
GUPTA: OK. Let's move on to something that's probably one of the most controversial aspects of this, the drugs that are used to treat ADHD. Ritalin and Concerta both are stimulants seen to boost certain levels of the brain chemical dopamine, which helps control activity.
Then there are amphetamines as well, Adderall and Dexedrine, and Strattera, which are the only - which is the only FDA-approved non stimulant treatment for ADHD. But how safe are these drugs?
Canada pulled the long acting form of Adderall from shelves after reports of deaths connected to its use. And the FDA has added warning labels to Ritalin and Concerta about possible psychiatric side effects.
And Patty, a mom from North Carolina, is concerned as many others are as well. She writes this. "My son has been on Ritalin for seven years. Has anyone found long-term consequences of being on this medication?"
And doctor, there have been no long term studies as far as we can tell to determine the safety of some of these drugs. Is that right?
ADESMAN: Well, depends how you define long term. It's very, very hard to do 10 or 20 year follow-up studies on the one hand. On the other hand, certainly we do have studies looking at efficacy and safety over a year or two. And the data is very reassuring.
I think it needs to be remembered that Ritalin was first approved by the FDA in 1955. So at this point in time, we have 50 years of experience of a medicine that's been scrutinized very, very carefully. Obviously it always generates a lot of attention in the media. And now the FDA is looking more closely as well.
The FDA, by the way, is not specifically aware of any new or major problems. They are looking at side effects in terms of the psychiatric issue. But we've known that in the past there are rare cases, for example, with hallucinations.
The issue with Adderall and you know, the concerns about heart safety and Health Canada, that's a slightly different issue. But again, these are medicines that have been on the market for years. And the statistics are extremely reassuring.
GUPTA: You know, Tom, you probably saw this, doctor. Tom Cruise brought attention back to the debate on ADHD and drugs. Take listen to him on NBC's "TODAY" show with Matt Lauer.
(BEGIN VIDEO CLIP)
TOM CRUISE, ACTOR: Here we are today, where I talk out against drugs and psychiatric abuses of electric shocking people. OK? Against their will, of drugging children with them not knowing the effects of these drugs. Do you know what Adderall is? Do you know Ritalin? Do you know now that Ritalin is a street drug?
(END VIDEO CLIP) GUPTA: I mean, that's interesting stuff. And the government surveys do show that ADHD drugs like Ritalin and Adderall are being sold on college campuses as a sort of study boost.
Doctor, are these drugs becoming a problem for kids? And could they, as some critics charge, be gateway drugs leading to drug abuse?
ADESMAN: Well, they're two very, very different issues. There is a legitimate concern about diversion. Diversion meaning that a teenager or a college student being given the medication and then possibly sharing it with friends. And that does happen to a small extent on college campuses and perhaps in even in some high schools.
That's a very, very different issue from the issue of gateway drugs, where children being treated with Ritalin are going to go on to use other drugs.
And in fact, the data is very, very compelling in the reverse. We know that kids with ADHD are at increased risk for later substance abuse problems, cigarettes, alcohol, cocaine, etcetera.
However, and this is an important point, that when you treat them with medication, when you use the stimulant medications, you can actually reduce, significantly reduce that later risk for substance use and substance abuse.
GUPTA: Well, that's got to be somewhat reassuring at least for parents who are watching. Important stuff. Dr. Andrew Adesman is our guest. More HOUSECALL coming up. Stay tuned.
UNIDENTIFIED FEMALE: Out growing ADHD, is it possible?
Plus, our bod squad checks out strategies to stay cool during the heat wave.
But first, this week's medical headlines in "The Pulse."
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): More than five million women have used the Ortho Evra contraceptive patch as an alternative to taking the birth control pill every day. Ten women announced in a lawsuit this week though against Johnson & Johnson and its subsidiary Ortho-Mcneil, the makers of the patch.
Their lawyer says the patch caused them to suffer strokes and get blood clots. And they claim the patch is defectively designed and unreasonably dangerous.
Blood clots are a risk with any type of birth control. And the company says their product is just as safe as a birth control pill when used as directed.
And researchers say Echinacea may not be the answer for your cold, despite its popularity. A study reported in The New England Journal of Medicine says scientists exposed 399 volunteers to a common cold virus and found that Echinacea did very little to prevent colds or significantly lessen their symptoms.
Echinacea is included in many over-the-counter cold products and it's touted for its effect on the common cold.
Christy Feig, CNN.
GUPTA: All right, we're back with HOUSECALL. Recent studies show that for 30 to 70 percent of kids suffering from ADHD, this disorder will continue into their adult years.
Some people out grow ADHD. We're asking that question, along with many others to Dr. Adesman. He's director of the ADHD Center of the Department of Pediatrics at Schneiders Children's Hospital in New York.
So doctor, will ADHD simply go away in some kids as they mature?
ADESMAN: The answer is yes. Perhaps 30 to 50 percent of children, symptoms will improve. And there won't be a need for treatment. And they can function quite successfully. In other instances, as you mentioned, this can dog them into their adolescence and adult years as well.
GUPTA: Is it easier to diagnose than in an adult than in a child?
ADESMAN: Actually, it's in some ways more difficult to diagnose in an adult. And the reason is because the diagnostic criteria for ADHD specifies that there needs to be an onset of symptoms during childhood by age 7. And if you're dealing with an adult, then you're not going to be easily getting, you know, copies of report cards. You're not getting rating scales from teachers and the like. And you're relying more on both the patient - the adult patient and perhaps a spouse or the family member.
GUPTA: All right, we've got to take another quick break. But grab a pen. I'm going to have some great Web sites for you when we come back.
UNIDENTIFIED FEMALE: Coming up on HOUSECALL, surviving a scorcher.
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UNIDENTIFIED FEMALE: It's really hot. It's burning up. The humidity is crazy right now.
(END VIDEO CLIP)
UNIDENTIFIED FEMALE: The heat can be miserable and deadly. Find out who's at risk. Stay tuned.
GUPTA: All right, welcome back to HOUSECALL. The dog days of summer have turned dangerous. Temperatures rising well above 100 degrees. Our bod squad gives you some tips to chill out.
HOLLY FIRFER, CNN CORRESPONDENT (voice-over): The mercury is rising from coast to coast and as the temperature increases, so do concerns about heat-related illness.
The best plan for a hot day is to stay hydrated and stay inside. If you have to be outside, drink lots of water, stay away from beverages with alcohol and caffeine and wear light, loose-fitting clothing.
To protect your skin from the sun's scorching rays, stay in the shade as much as possible, wear sun-protective clothing like a wide brim hat and wear sunscreen SPF 15 or above.
At high temperatures, your body has a hard time regulating temperature. So make sure to watch out for signs of heat exhaustion, cool, moist skin, dizziness, weakness and nausea or vomiting.
Also, make sure to check in frequently with very young children and the elderly, who are at special risk for heat-related illnesses.
Holly Firfer, CNN.
GUPTA: All right, Holly, thanks. Really important stuff today. Dr. Andrew Adesman has been our guest. A couple questions, doctor. Should patients be taking this medication year-round and summers as well? A lot of people stop them in the summers.
ADESMAN: Well, I think it really needs to be an individualized decision. There are some children who have significant behavior issues, significant social problems, perhaps even going into summer school. And for those children, medication during the summer is very, very important.
If children don't have behavior problems, aren't having socialization issues, perhaps not driving a car, because we've seen also that medication can make a difference even for ADHD kids at risk with motor vehicle accidents, then there may be reasonable in some cases to not give the medication over the summer.
GUPTA: And we talked a lot about the medications, obviously, today. Our viewers like to know a lot about alternatives as well. We talked about Echinacea just now in the show. Are there any alternatives that might work for ADHD that you've come across?
ADESMAN: Well, there are a multitude of alternative therapies. Unfortunately, there's far too little research being done looking at them. And I think that The New England Journal study with the Echinacea really suggests that getting good research studies done is important.
The ones that are out there that parents are sometimes pursuing, things like EEG feedback or neuro feedback, nutritional supplements. There's something called interactive metronome. But I think in general, these are not seen as mainstream therapies and we really don't have a good research base yet to endorse them.
GUPTA: All right, really important stuff. For more information about ADHD, check out the Web site for the National Institutes on Mental Health. That's at nimh.nih.gov. You're going to find the latest news and research about this disorder, plus current clinical trials as well.
And to find support groups near you, click onto chadd.org, chadd.org, that's the Web site for children and adults with ADHD.
Unfortunately, we're out of time today. I want to thank our guest, Dr. Adesman, for taking us through this very controversial topic. Thank you very much.
ADESMAN: Thank you.
GUPTA: And make sure to tune in next weekend as well, as we take on an important topic, childhood obesity. Are schools to blame, television, fast food, parents? It's a complicated issue with few straight answers. We're going to try and get to them, all of that next weekend, 8:30 a.m. Eastern.
E-mail us your questions in the meantime -- HouseCall@CNN.com. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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