"In Their Own Words: ‘Study Drugs’ "

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<p><em>eyeroll</em> </p>

<p>Our generation is more productive, hard-working and focused than yours ever was. It’s also currently the least violent and the least hateful toward minorities. It’s also important to keep in mind that our generation proceeded from another (that proceeded from another). Another that has included and voted for leaders that put us so many dollars in debt, ruined our environment, and (apparently) sucked at parenting.</p>

<p>So watch where you’re casting stones, plox.</p>

<p>More focused generation. </p>

<p>lololololololol</p>

<p>I think our generation will have higher highs and lower lows than the ones that preceded us. We have teenagers making huge achievements and contributions to society. At the same time, we have teenagers who take drugs, skip school, spend 8 hours a day on facebook etc. etc. We have greater challenges-we live in a more globalized world and face greater competition. At the same time, we have more opportunities. It will be interesting to reflect on this 50 years from now.</p>

<p>Technology does not make one more immoral; it only provides more means to do immoral things.</p>

<p>Part of the issue comes from a lack of awareness about what those drugs truly are. I see a bit of a parallel between the diet pills of the 50s (basically speed) and the misuse of adderall in some of today’s college students. The reality is, many people simply don’t know about the addictive potential of the drug. Literally the only information many people in my generation get about the off label use of such drugs comes from their peers. I sat through numerous anti drug assemblies in high school, and some moderate consumption stuff during freshman orientation. Never once was adderall or any other study drug mentioned, even though I’ve been offered the stuff three times since September, and many of the people I graduated high school with swear by it. </p>

<p>There needs to be some sort of public health campaign against off label use, or at least efforts by the colleges to highlight the dangers of the drugs. Truly the only information students get comes from the “success” stories, the guy that credits adderall with helping him get into med school, or another person who procrastinated on a final, popped a pill, and managed to get an A on it. Why do we not present the recovered addict’s voices, the ones for whom those study drugs destroyed their lives?</p>

<p>MrsDrz, interesting. I’ve never heard of this before. Probably is a new technique that many physicians are unfamiliar with. In that case, I agree. They should use something more scientific since it’s already available.</p>

<p>“There is a very easy way to diagnose ADD and that is via brain wave evaluation.”</p>

<p>“MrsDrz, interesting. I’ve never heard of this before. Probably is a new technique that many physicians are unfamiliar with.”</p>

<p>Me either. How about a link to a peer reviewed journal with some randomized controlled studies? I don’t believe the literature says QEEG’s or SPECT scans are anything close to diagnostic.</p>

<p>Here is an old one</p>

<p><a href=“http://www.jaacap.com/article/S0890-8567(09)62494-1/abstract[/url]”>http://www.jaacap.com/article/S0890-8567(09)62494-1/abstract&lt;/a&gt;&lt;/p&gt;

<p>"Quantitative EEG Differences in a Nonclinical Sample of Children with ADHD and Undifferentiated ADD</p>

<p>ABSTRACT
Objective</p>

<p>To use quantitative electroencephalographic (EEG) techniques to identify electrophysiological differences between children with distinct disorders of attention and/or hyperactivity.
Method</p>

<p>Forty children from a prescreened community sample were evaluated by means of both spectral EEG and evoked response potential (ERP) techniques. The children were 7 to 13 years of age and were selected on the basis of membership in one of the following DSM-III-R categories: attention-deficit hyperactivity disorder (ADHD) (n = 16), undifferentiated attention deficit disorder (UADD) (n = 12), or no disruptive disorder diagnosis (n = 12).
Results</p>

<p>Spectral EEG revealed that UADD subjects had less delta band relative percent power (RPP) (p < .01), more beta band RPP (p < .01), and ERP findings of a decreased rare tone P300 amplitude (p < .02) compared with the control group. ADHD subjects had spectral EEG findings of increased beta band RPP (p < .05) and ERP findings of an increased common tone N100 latency (p < .02) and a decreased rare tone P300 amplitude (p < .02). Interhemispheric asymmetries appeared to distinguish the groups: the UADD group had spectral EEG asymmetries; the ADHD group had only ERP asymmetries; and the control group had no asymmetries.
Conclusion</p>

<p>Quantitative EEG techniques may prove useful in differentiating specific subtypes of ADHD.</p>

<p>^qEEG (quantitative EEG) is now considered to be 90% accurate in diagnosing ADD/ADHD, I am given to understand (by folks who own the machine ;).</p>

<p>(Can’t back that up though – most recent paper seems to be 2005 here: <a href=“Clinical utility of EEG in attention deficit hyperactivity disorder - PubMed”>Clinical utility of EEG in attention deficit hyperactivity disorder - PubMed)</p>

<p>If that were true, why would we have regular docs et al using a loosy-goosey, archaic DSM-IV, whereby the majority of the population would receive a dx?</p>

<p>Dunno, but I suspect the truth may lie along the lines of the following rant/opine by blogger Daniel Goldin:

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<p>That said, the drugs can be a godsend for some – for example, those who truly need them to function reasonably well in society. To someone without true ADHD, adderall IS speed…but to a person who truly has ADHD…it’s not – it’s actually normalizing. A sure sign of a false dx is a kid ramped/amped up by a low dose (eg. 30 mg) of adderall. But I seriously doubt 10% of the child population of America qualifies!</p>

<p>Full disclosure: My son DOES have ADHD-I, rather, ADD (Inattentive type/slow cognitive processing). He was first diagnosed as a child with CAP-D (central auditory processing disorder) which was obvious to his grade 2 teacher, who had specialized in lds. This did not especially surprise us, as he was born with a cord around his neck and oxygen-deprived at birth as a result. A few years later, we found out during a neurology screening for migranes that he had a cyst on his brain. We theorized that this was connected to the CAPD, though since it didn’t calcify, it was treated as a coincidental finding.</p>

<p>Because he is also gifted, he managed to do well enough (very well, actually) at school but required a lot of “executive function coaching.” Although his physician suspected from early childhood that he had some form of ADHD, we didn’t “buy into it.”</p>

<p>Instead, we considered him the absent-minded professor, day-dreamer type, and constantly coached him on organization, fed him high protein and fish oil, etc. In retrospect, this was ignorant of us, though the coaching helped him perform well without accommodations. Ignorant, insofaras his having a bonafide condition that turned out to be helped enormously by medication. Makes me sad to think how he struggled when he needn’t have…all those extra hours. But as he puts it, the universe if perfect and to some degree it was behavioral therapy ;)</p>

<p>As part of an adult neuropsych evaluation after entry to a rigorous U. (and after failing a class where he couldn’t process/understand the accent of the prof), he received the dx, but based on a reasonably thorough workup and set of ld testing…not a few self-selecting true of false questions. </p>

<p>SO…I’ve of two minds about it. I don’t know how to keep it out of the hands of those for whom it is speed…and I am suspicious of the ubiquity of the dx and the increasing marketshare of meds. BUT at the same time, it has really helped my son!</p>

<p>“Drug companies continue to push the message hard. They now spend 20 to 30 thousand dollars per American physician on junkets, free meals, trips, trainings, cash rewards to “high-prescribers” and free samples. It is now nearly impossible to find a researcher who advocates stimulants for ADHD who is not on a drug-company’s payroll. The most famous case involved Harvard psychiatrist and stimulant-treatment guru Joseph Biederman, who admitted to congressional investigators that he had failed to report 1.6 million in payments from drug companies. Even the brilliant Dr. Russell A. Barkley, who wrote the book on executive function and ADHD, acknowledged receiving 24 percent of his income in 2007 as a speaker/consultant for Eli Lilly Co., Shire and Novartic, the makers of Strattera, Vyvanse and Ritalin respectively. It is hard to imagine how these researchers can remain objective when their self-interest leans toward a particular finding.”</p>

<p>When was that written? They haven’t been able to give even a pen in about three years!</p>

<p>Your ncbi link only showed the abstract. Here is the whole paper</p>

<p><a href=“http://www.adhd.com.au/downloads/Loo2005ADHD.pdf[/url]”>http://www.adhd.com.au/downloads/Loo2005ADHD.pdf&lt;/a&gt;&lt;/p&gt;

<p>It ends with the following conllusion</p>

<p>“Conclusion
The clinical utility of EEG in ADHD has yet to be
proven. Though there are some promising results that
require further study, the threshold for using EEG clinically
has not been met. Of the possible uses reviewed
here (diagnostic utility, prediction of stimulant response,
and EEG biofeedback), the diagnostic utility of
EEG appears most promising although considerable
work is needed for this promise to be realized. The EEG
biofeedback studies with the most rigorous methodologies
to date have not supported the efficacy of EEG biofeedback
when compared to no-treatment control or
placebo feedback. Methodological flaws of previous
EEG studies have hampered firm conclusions regarding
its usefulness and precision. Though the field of ADHD
would benefit greatly from a single diagnostic test and
an effective nonmedication treatment alternative, we
cannot recommend the use of EEG in a clinical setting
based on the current empirical data.”</p>

<p>From
Medscape Medical News > Psychiatry
Marked Jump in ADHD Diagnoses</p>

<p>Megan Brooks
Jan 21, 2013</p>

<p>"Rates of childhood diagnoses of attention-deficit/hyperactivity disorder (ADHD) increased markedly in the United States during the last decade, new research shows.</p>

<p>Investigators from Kaiser Permanente Southern California’s Department of Research and Evaluation found that rates of ADHD diagnosis increased from 2.5% in 2001 to 3.1% in 2010, a relative increase of 24%.
Dr. Darios Getahun</p>

<p>“This is a significant increase over the 10-year period,” lead investigator Darios Getahun, MD, PhD, told Medscape Medical News.</p>

<p>The study also revealed “disproportionately high ADHD diagnosis rates among white children and notable increases among black girls.”</p>

<p>“While the reasons for increasing ADHD diagnosis rates are not well understood, contributing factors may include heightened ADHD awareness among parents and physicians as well as increased utilization of screening and other prevention programs,” said Dr. Getahun.</p>

<p>I believe I read elsewhere that the increase was primarily among teens and young adults, and with families or relatively high income.</p>

<p>I am lucky to study in a college where physics majors don’t take study drugs…</p>

<p>kmcmom13 – on the brain chemistry stuff, strictly as a parent, I have often wondered about the connection between my son’s pre-natal and birth diagnoses and later brain chemistry issues. </p>

<p>Ultrasound at 5 months pregnancy showed he had Choroid plexus cysts in his brain, a genetic marker for massive genetic defects in some small percentage of cases. Amnio then showed he was genetically fine, and cysts resolving. At delivery, he was in neonatal ICU with what turned out to be fluid in the lungs, but difficulty breathing etc. </p>

<p>As he grew up, we realized first that he obsessive compulsive disorder, a serotonin issue, and then later, ADHD. While there had been executive function challenges throughout middle and high school, it was only when he tried recreational adderall in spring of senior year and reported that it had no affect on him, while everyone around him was high as a kite – that we thought maybe something else was going on in terms of brain chemistry. Comprehensive testing (including actual reports from early years teachers about informal accommodations in the class room for attention issues), and he is now on meds – and able to be himself, minus the screwy brain chemistry. </p>

<p>As an adult, I am skeptical of “performance” drugs. As a parent, I see the impact on someone I love, who had the bad luck to be be born with slightly-off brain chemistry. </p>

<p>Tough stuff.</p>

<p>“The researchers also observed a much higher rate of ADHD diagnosis among children living in high-income ($70,000 per year or more) households (P<.001).”</p>

<p>This is where I saw that;</p>

<p><a href=“http://www.healio.com/psychiatry/add-adhd/news/online/{CDD35307-EC2F-41D1-9267-D95BF6DBA0B9}/Rate-of-ADHD-diagnosis-increased-in-past-decade[/url]”>http://www.healio.com/psychiatry/add-adhd/news/online/{CDD35307-EC2F-41D1-9267-D95BF6DBA0B9}/Rate-of-ADHD-diagnosis-increased-in-past-decade&lt;/a&gt;&lt;/p&gt;

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<p>I’m certainly not surprised by this after hearing teachers in affluent districts talk about how parents automatically push for their kids to be diagnosed with a learning disorder if they’re doing even mildly sub par in elementary school.</p>

<p>The only reason I would caution against the natural knee jerk, oh the rich kids are gaming the system, is this: when public school teachers go to seminars about LDs, the seminars are really all about how to DENY services. The are invested in NOT dx-ing.</p>

<p>So, even in the case of glaring dyslexia, a child from an impoverished school district is less likely to get the help they need than one in a wealthy district where the parents can pay for the computers and the voice technology and the books from blind/dyslexic.</p>

<p>I only say this because I imagine it is part of one thing and part of another. There are probably some very undiagnosed impoverished districts, where kids are not getting what they actually “need,” and other places where it is at least slightly over diagnosed.</p>

<p>JMO</p>

<p>Where I live ADHD gets you a 504 an not an IEP. Its not considered a LD here, and schools dont have to provide sevices for the diagnosis alone. Its much cheaper and easier for them to say “go see your doctor”, than to do a psychoeducational evaluation. </p>

<p>If the doc says put your request in writing, it can get…complicated.</p>

<p>I was prescribed Adderall for ADHD last summer after a bad freshman year. As long as I can remember, I’ve been academically unmotivated in general, with spontaneous week-to-month bursts of extreme interest and concentration in particular areas. When I’m unmotivated, I’m highly error-prone: reading slowly because I don’t process information well without backtracking over paragraphs, feeling mentally paralyzed by writing-intensive math problems like a little kid facing a huge mess in his room to clean up, etc. I’m also a maladaptive perfectionist. I figured that I either lacked self-discipline or had some learning difficulty without knowing it, but that it couldn’t hurt to talk to a psychiatrist about it. I was honest about my lifestyle and he said I meet the criteria for inattentive ADHD. He prescribed me a very low dosage (15 mg daily of IR tablets) and told me to increase it gradually, under his supervision, if it was free of side-effects but insufficient.</p>

<p>When I took it at work (software development summer job), it was wonderful. It made me hyper-motivated and even helped with my perfectionism. Coming down in the afternoon was only slightly uncomfortable and lasted for a few minutes.</p>

<p>But on the first day of my sophomore year, still on 10 mg morning / 5 mg noon, I had a massive panic attack with >160 bpm palpitations. My body locked up, my limbs almost went numb, I could barely see, and I was convinced I would die. I didn’t know what to do but go to the emergency room. They told me that stimulants like amphetamine and cocaine often do that (though normally at several times my dosage), and that I was slightly hypokalemic, so after an EKG I went home with potassium supplements and I drank plenty of water. It took two days for my heart rate to return to normal and for the anxiety to subside. I knew stimulants can cause anxiety and even psychosis, but I had no idea it could happen at 10 mg.</p>

<p>Since then, I’ve tried it a couple times in doses as small as possible (<1 mg chips of tablets), at home in my mom’s presence, and each time I became jittery and anxious. Even writing about it is uncomfortable because I partially relive the panic attack. I’m now very cautious about every drug I might potentially take, regardless of its function or legality. That’s driven more by paranoia than by a rational belief that every drug out there would likely kill me.</p>

<p>My rational opinion of drugs is that they are a perfectly legitimate, if risky, way to improve life in any number of ways. Some people need them to function while others want them for recreation or performance enhancement; all of the above are personal, amoral decisions. I am deeply bothered by people who criticize otherwise-healthy drug users on the grounds of lazy shortcut-taking or “you’re not smart or motivated enough on your own so you cheated like a doped athlete.” That’s extremely hypocritical from anyone who drinks caffeine or smokes tobacco, and it demonstrates willful ignorance (don’t make wild judgments about something you refuse to try for yourself), arrogance (you’re not better than someone else just for doing something unaided), and a backward view of science and technology (artificial enhancements to the body aren’t inherently evil). Study drugs are just one of those high-risk, high-reward opportunities in life. I’m also a long-time critic of drug laws, as the government shouldn’t tell people what to do with their bodies and banning drugs or restricting them to prescriptions only pushes the trade underground.</p>

<p>However, I agree that taking study drugs without medical supervision is dangerous due to side effects and addictiveness, and demonstrates ignorance or a lack of care for the user’s own health and safety. Doctors should also be far more careful in determining how much patients would benefit from ADHD medication and they should thoroughly explain all risks. They should also take into account psychological risks like anxiety disorders (which I seem to have) and addictive behavior because those are just as important and consequential as physiological risks like heart disease and contraindications. The advisory role of a doctor is underrated. Likewise, someone who gives large quantities of a drug to a friend is a pretty bad friend, especially if the drug is sold for profit instead of given in the interest of the receiver’s well-being. I think the world would be a healthier place overall if doctors and patients knew more and cared more about what ADHD medication can do to someone. Parents are equally at fault for pressuring their kids early in school and assuming their kids have learning disabilites because of less-than-perfect performance. Again, it never hurts to talk to a psychiatrist, but that requires healthy skepticism and an understanding that kids are kids.</p>

<p>Furthermore, overuse of ADHD medication is bringing unnecessarily bad publicity to it. Many drugs are illegal even though they shouldn’t be (e.g. LSD) because so many people jumped on the bandwagon that a moral panic ensued. I hate to see the same kind of stigma attached to medication that can help people overcome severe problems.</p>

<p>I also think the use of study drugs to handle the pressure of grades is sometimes an unhealthy attitude. I can’t fault someone for trying different methods to improve studying. I applaud someone who uses study time efficiently, whether by finding the right time of day for mental activity or by using drugs within reason. But in reality, most people use drugs to cram before finals when they learn how unprepared they are. Procrastination/cramming is a weakness of mine and I’m sad to see how many people share it. (I just haven’t used substances to help me cram, not because I believe it’s evil, but because the side effects of caffeine and Adderall are miserable in different ways.) Alternatively, overachievers use it to cut into their sleep and leisure so they can handle huge workloads. I just don’t like that lifestyle; I prefer a more leisurely pace of life that lets me focus on extracurricular intellectual interests for enjoyment. I think many intelligent students would be happier if they didn’t cram so many difficult units into their schedules. It would certainly alleviate the pressure to use drugs to keep up with school.</p>

<p>And I don’t claim to have a learning disability; my doctor and I think the speed-like effect of amphetamine is convincing evidence that I don’t have ADHD. Maybe I’m just lazy; I’m still trying to get to the root of it. But I made a cautious, calculated decision with professional guidance and a mind open to things I might not know about myself. I learned much from it without permanently harming myself, so I don’t regret it despite how unpleasant it was.</p>

<p>Shrinkwrap, that data is to be expected. Higher income people want children to succeed-leads to more adhd diagnosis. I’m sure doctors know this. Doctors probably do what they do because they judge that the loss from not diagnosing someone with ADHD is much higher than when some is misdiagnosed. I think that might be why they continue to perscribe Adderall when they know that have a good chance of being tricked. Adderall is potentially very harmful for sure, but someone with ADHD without medication is absolutely severely harmed. </p>

<p>That being said, I think they definitly should be more strict with their diagnosis as long as it doesn’t hinder someone with ADHD from getting help.</p>

<p>^ That reminds me of a chi square thingy comparing false negatives to false positives. Maybe it’s not a chi square. Do you have a link to that?</p>

<p>Here’s one for depression.</p>

<p><a href=“http://www.hawaii.edu/hivandaids/False_Pos,_False_Neg,_and_Validity_of_Dx_Depression_Primary_Care.pdf[/url]”>http://www.hawaii.edu/hivandaids/False_Pos,_False_Neg,_and_Validity_of_Dx_Depression_Primary_Care.pdf&lt;/a&gt;&lt;/p&gt;

<p>Still, my consternation comes from my real life, which is not with college confidential folks, and the whole concept of “a level playing field”.</p>

<p>Findings from a study in Germany</p>

<p><a href=“http://www.sharpbrains.com/blog/2012/03/22/is-adhd-overdiagnosed-findings-from-a-new-study-in-germany/[/url]”>http://www.sharpbrains.com/blog/2012/03/22/is-adhd-overdiagnosed-findings-from-a-new-study-in-germany/&lt;/a&gt;&lt;/p&gt;

<p>" these differences depended on the gender of the clinicians. Female clinicians did not differ in the rate of false positive and false negative diagnoses according to whether the child described was a boy or girl. For male clinicians, how*ever, the false positive rate clearly depended on the child’s gender, and was incorrectly assigned by 39% of the clinicians diagnosing boys vs. only 13% of clinicians diagnosing girls. Thus, male clinicians diagnosed ADHD nearly 40% of the time in boys who did not meet diagnostic criteria. This is striingly high.</p>

<p>The authors also examined factors other than gender of the clinician that were associated with the over diagnosis of ADHD, including years of experience, reported familiarity with the DSM diagnostic criteria, theoretical orientation (e.g., cognitive behavioral vs. psychodynamic), and professional occupation (i.e., psychiatrist, psychologist, or social worker). None of these factors were found to be significant predictors of the diagnoses that clinicians assigned"</p>

<p>That is really quite interesting Shrinkrap. It explains why I am always slightly puzzled by this “overdiagnoses” talk.</p>

<p>I frequently see young women who are primarily inattentive who were not dx’d until very, very late, though in hindsight it’s quite clear. So, when I think of adhd, I think it tends to be overdiagnosed in boys and underdiagnosed in girls. And, my theory, though I’m not writing it up, yet, is that there is an unfortunate tendancy to dx children based on how they impact the lives of the adults around them and not based on what is really going on with the kid.</p>