In many cases the diagnosis of ADHD is complicated because doctors often believe it coexists with other psychiatric ailments. Twelve-year-old Alex McCarty is one of those cases. His parents, Diane and Tim McCarty, were first concerned about Alex's depressed attitude. Diane began to worry that it was more than just a case of pre-adolescent moodiness.
She took Alex to see Asa Yancey, a psychiatrist, who diagnosed Alex with depression and prescribed a low dose of Effexor, an antidepressant. Three months later, while still on Effexor, Alex attempted suicide. The suicidal thoughts and depression finally went away after his Effexor dosage was increased, but Alex's problems at school continued. "Toward February or March it became clear that some people really thought he had an attention problem," said Dr. Yancey. "Those people included one of his teachers [and] one of his parents."
Dr. Yancey had three of Alex's teachers and both his parents fill out a variety of child behavior checklists. The results were inconclusive. In an effort to clarify, Dr. Yancey tried another kind of test, a computer program called Test of Variables of Attention (TOVA). This time, Dr. Yancey didn't question the results.
"[Dr. Yancey] said there is a chemical imbalance in my brain which doesn't allow me to concentrate correctly," said Alex. "So he gave me some medication for that and told me that a lot of times attention deficit disorder can be linked to depression. So if I get rid of the ADD, I get rid of the depression."
Alex took his first dose of Adderall on his 12th birthday. "So far Alex has improved a lot over the time of this school year," said Lynn Sis, Alex's teacher. "When he came, he was not doing too much work at all. Over the course of the year, he is doing most things on a modified scale." Alex gradually noticed the effects, too. "I liked to do school, and I wrote stories and concentrated more in math," he said. "So I felt better about myself."
Alex is still taking his medications. He plans to stop taking Effexor in the summer of 2001, but his doctor says he will likely be taking stimulants for the foreseeable future.
In "Medicating Kids," FRONTLINE examines the dramatic increase in the prescription of behavior-modifying drugs for children. Are these medications really necessary--and safe--for young children, or merely a harried nation's quick fix for annoying, yet age-appropriate, behavior? FRONTLINE follows four Denver, Colo., families over the course of one year. From school complaints of disruptive behavior and parent-teacher conferences through multiple doctors, medications, and dosages, "Medicating Kids" offers an intimate portrait of how American families grapple with the decision to medicate their children and the stress such decisions place on the family. Viewers meet Nicolas DuPerret
, barely three years old, whose doctor suspected he might have ADHD; Noelle Demo
, 13, whose fidgeting and disruptive behavior resulted in poor grades and school suspensions; Alex McCarty
, 12, whose ADHD was compounded by severe depression; and Robin Day
, 16, who has endured multiple diagnoses, one hospitalization, and ultimately his parents' divorce.
Interwoven with these stories are examinations of the role of doctors, advocacy groups, and pharmaceutical companies in advancing the medication trend, as well as a look at the strong anti-medication movement that has filed lawsuits charging that drug companies and doctors have conspired to exaggerate the number of ADHD cases in an attempt to boost drug sales. "You can't ignore the fact that there is a lot of over-diagnosis of ADHD," says FRONTLINE producer Martin Smith. "But we've tried to look at both sides of the issue. There are no easy answers here." Indeed, the case of each child profiled in the documentary is unique. Despite school complaints and the psychologist's opinion, for example, Nicolas DuPerret's parents decided not to put Nicolas on medication, viewing their son's behavior as "intense," but normal. "[Medication is] just a quick fix," says Nicolas's father, Cyrille. "We would never do that."
But for other families, medication appears to be a godsend. Before taking Ritalin and later Adderall, Noelle Demo was getting Ds and Fs on her report card. She had also been suspended twice for fighting with another student. Her teachers urged medication. Soon thereafter, the Ds and Fs turned into As and Bs, while her improved concentration had a positive impact on her gymnastics performance. The medical community, however, still is unable to explain why these medications help relieve ADHD symptoms in many children.
"We still don't really know much about how Ritalin or Dexedrine or Adderall work," Dr. Xavier Castellanos tells FRONTLINE. The head of ADHD research at the National Institute of Mental Health, Castellanos freely admits that much remains unknown about the nature and cause of ADHD. "The problem is," he says, "we're searching in the dark and don't know where that clue is going to be." This lack of basic understanding about the nature of ADHD concerns some parents. Others are concerned about the role played by pharmaceutical companies, which have not only provided financial support to ADHD advocacy groups such as CHADD (Children and Adults with Attention Deficit Disorder) but also paid physicians to make speaking appearances to raise awareness of ADHD. Such support, critics claim, is an attempt to boost diagnoses of ADHD--and thereby drug sales. For parents, meanwhile, the decision to place their child on medication remains a difficult one. In "Medicating Kids," even the parents who credit medication with "saving" their children admit wrestling long and hard with the decision. "Of course I'd not want [Alex] to take medication if he didn't have to," Diane McCarty says. "But for Alex it's working ... and I know in my heart I've gone the distance and I'm helping my son."