ATAP: ADD Meds

The primary reason that I haven’t touched ADD meds with a 10 foot pole its because its just asking for me to get the bad-parent-patrol firebombing my site for me implying that only about 25% of the cases of ADD are diagnosed correctly; and the remainder are just parents who don’t want to deal with kids being kids. Since I just dug my own grave right there, lets continue.

TAP, I’m surprised you haven’t done a rant on ADD meds. When is that
coming – or do you restrain yourself because you have the condition
yourself? The media says it affects 3 to 5% of children (and adults, as
you don’t outgrow it but rather learn to compensate) but around here, I’d
say it’s more like 30 to 50%, and I have heard about school districts (not
mine) who are pushing, consciously or not, to get 100% of their students on
some kind of ADD medication. I’m quite aware that many parents (okay,
single moms) who face being kicked off welfare are coaching their kids to
misbehave in school, or act like they are retarded, so they can get SSI
payments for them. This, IMHO, is not what SSI was intended for, nor was
it meant for drug addicts but that’s another story.

I dont touch this issue (and also abortion) because it tends to piss off a lot of people. Yes, even I have my limits, and I tend to not piss off /all/ of my userbase, just /some/. Everyone can take jokes aimed at their profession, or their jobs, or what they call themselves; however talk about their kids and their ‘parenting skill’ and suddenly my biggest fan is calling my internet provider claiming I touched her daughter where she pees.
I will say that I do see children who need it. They usually sit in the store vibrating as their parents scream at them to not explode and rip stuff off of my shelves as their younger (and sometimes older) brother/sister sit there patiently. You can just see it in their eyes that its not the usual high-energy that a kid has, but something obviously wrong. They will take the store check stamp (you know, you stamp the back of a check when you put it in the register) and STAMP-STAMP-STAMP-STAMP-STAMP all over the counter. In almost all cases this patient has a brother and/or sister who is not on medication and acts perfectly normal. The patient goes to a child neurologist and is on not only some sort of Adderall/Ritalin but also Tenex or Clonidine. They will not be on the medication all year round, but only during the school year. The parents have been patients of ours for years and years and never once asked for an early fill, plans trips around when their refills are due, and are those patients that you really do bend over backwards to help when something hits the fan (you retail folk know what I’m talking about).
Then I see a family of 4, all the children are on Adderall. They zombily waltz in as their mother is chatting some drama up on her cell phone using terms that rival ‘baby-daddy’. She plunks down her imitation Gucci purse on the counter as she throws a handful of Rx’s at the clerk as all the kids slunk down into the waiting chairs on the verge of passing out. She talks loudly on the cell-phone looking at all of the hair products as she bitches about when the Rx’s are going to be done. All of the Rx’s are written by some out-of-town doctor that only seems to dump out ADD-C2’s like they are going out of style. One of the children politely asks for a drink of water and the mother just jumps down her throat and tells her to go sit back down. The mother buys about $40 worth of hair products and fake earrings. I sigh as I get the warning that two out of the 4 children’s Adderall were filled by another pharmacy 15 days ago. She gives me some two-bit smart-assed smoke-up-ass story about being stolen/lost/eaten/whatever (I never pay attention). She’s pissed off that her State Program doesn’t pay for early refills and decides to take her stupidity out on me instead of herself.
Now these are two extreme cases with obvious room for gray in the middle, but I tend to go with the extremes for illustration purposes.

In addition, I have never heard of a child being evaluated for it who
wasn’t diagnosed, usually by the first practitioner who saw them, 10
minutes after they walked into the door.That is, with one exception. I
once worked for a pharmacist who thought his B-student daughters could be
turned into A students by taking meds, and took them to 10 or 15 doctors
until he found one who would write prescriptions, no questions asked. I
told him what I thought, which probably contributed to my being fired a few
months later but it was a temp job anyway. I later learned that this man
has a long history of walking out on jobs without giving notice, and
signing up to do relief work and not showing up and being unreachable.

Lesson anyone in the pharmacy biz learns early in life: If you think you have it, some doctor out there will agree with you. You can be sitting at home watching TV and suddenly feel like you have agoraphobia after a paxil commercial. Sure as shit some doc out there will fill out the SSI paperwork and off you go to a life of no-work and a check every month. Parents will think that all of the doctors in town on crazy for thinking that their kid is perfectly normal except for that one quack out there who churns out C2’s by the truckloads. All it takes is a little time and a good sob story to get that Rx written for Adderall for your 3 screaming toddlers (from 3 different fathers, go figure) and off we go reinforcing the stereotype that ADD does not exist. Its sad, I see it all the time, however proving something as subjective and wishy-washy as ADD is like scooping a turd out of the ocean.
So there is no takehome rule from this ATAP episode, I figure I’m going to get the ghetto-parent-patrol jumping down my throat just for posting this.

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31 Comments

  1. Lj says:

    I’ve seen both extremes as well. However, when a family member was evaluated as possibly having ADD, the pediatrician simply asked Mom, “Can the child sit through a 30-minute TV show of his favorite cartoon?” His Mom replied, “yes,” and the pediatrition took this opportunity to point out that children with ADHD have difficulty focusing on all things, not just selectively choosing to be attentive at times and non-attentive at other times. In many years of working in community pharmacy and filling ADD scripts, this is the definition I find myself referring back to over and over again.

  2. murgatr says:

    Funny – as a tech I see the same things you do all the way up here in Canada. My Daughter has ADD, and until her school performance REALLY suffers, we are trying other things – the meds are the last resort.
    Love yer blog TAP!
    murgatr

  3. Chris B says:

    Agreed but what about people using amphetamines like Adderall for off-label purposes? I myself have a prescription for Adderall XR for a non-ADD purpose (and no it isn’t weight loss) and the medicine works where other solutions have not.
    Another little thing on amphetamines… there seems to be a lot of students from my university who are on Ritalin, Focalin, Concerta, Adderall, etc. and it is quite obvious that they simply dumb rather than have attention/focusing issues. I say it is obvious because most of these kids suffer from amotivationalism – they just don’t give a flying fuck and never attend class. They never do assignment, etc. Their parents just simply paid for them to go away to school and have a grand old time for a few semester until the Office of the Registrar kicks them out. Actually the passivity of the parents is, I think, a pretty good indicator that the student doesn’t suffer from ADD or ADHD. Rather they just had really shitty parents who allow them to do whatever they want, even if they shell out thousands of dollars on wasted classes. But I believe that is the case. And anyways many of them don’t even fucking take it – they use 20 of their 30 pills and make a good amount of cash selling it to people who want to get good study sessions in prior to exam day. Sad … but I suppose that is where we are in America. We can’t differentiate between stupidity, bad child-rearing, and legitimate neurological problems.

  4. Chris B says:

    http://forums.studentdoctor.net/showthread.php?t=457410
    This is an on-going debate of psychostims in academia. Hope you don’t mind my link (studentdoctor) AP.

  5. intern2010 says:

    I’ve know one or two kids years ago who had ADD bad and were bouncing off the walls. Thankfully they got treated and now are fine. I don’t know if its me or the pharmacy I work in but it seems like almost all the ritalin/adderall scripts are for people who have ADD, of course the one I work at is more small town like and we don’t get many, of course state laws seem to help curve that. Another state I worked in though over the summer a short while ago had kids on benzos like candy. When the kid walks into the pharmacy with their parent and is walking like a zombie, something is wrong.

  6. Jonathan says:

    When I was a child one of my teachers “diagnosed” me with ADD since I was out of control in her class. They put in “remedial” English for some reason and they assumed I just didn’t care, rather than see all of my A’s and realized I was in the wrong class.
    Instead she calls my parents and says I need Ritalin. I see my doctor who half-agreed and gave me 5 dose for a month to see how it goes. Next month he asks how its going and I said no real change I noticed, so he gave me an “increase” of the dose.
    Later in life I found out that upgrade was instead a placebo and since there was no change again, he took me off completely. And btw– How does that work? How does a doctor prescribe a placebo and how do pharmacies fill them? How do they even get charged? Is this a normal thing doctors can do?
    In short, I think the teachers who diagnose their students is a problem. I also saw on the news where these teachers also raid the medicine locker and take the students ADD-CIIs themselves.

  7. anom says:

    I work in a pharmacy that services 3 of our countries best boarding school.
    And we will at least 25 rx’s a day for each school for different students every time… all brand name ritalin, adderall xr, focaliln, etc etc etc.
    I think rather than investigating a childs poor school performance… the parent would rather throw money at the problem and medicate them.
    BRAND NAME MEDICALLY NECISSARY!!!

  8. Sarah says:

    I think you did a pretty good job covering this. I am a single mom and my son receives SSI. My son was diagnosed with ADD at the age of 4. This diagnosis was changed, at the age of 6, to an autism spectrum disorder (PDD-NOS). My son has never been on medication, although I’ve had a few doctors recommend risperdal or ADD meds. Meds is not the answer for my boy, not at this juncture. He is an amazing little boy who needs a lot of help and assistance to make it in places like school and stores. The trick to bringing him to a store is always having someone who is going to be one-to-one with him (not shopping) but also to work with him outside of the store on what types of behaviors we want to have in the store. My son understands that even though he really hates the store and they are really hard for him, that when he grows up he is going to have to be able to go to them on his own. So he keeps trying, we all do. I also have NEVER trained my son to act out in school just to receive SSI benefits. What type of person would do that? My son would love to be able to function in class like all the other kids, and it makes him unhappy with the struggles he does have in school. SSI was the end of the road and a means to acquire needed benefits for my son that commercial health insurance just doesn’t cover.

  9. Norcross says:

    I agree 110%, and this is coming from someone who’s been on Adderal for over a year now. I was diagnosed at the age of 12 by my mother (a special ed teacher who dealt ONLY with crazy kids, and who did her masters thesis on ADD / ADHD), but didn’t start taking the meds until I was 26.
    Like you mentioned, I compensated for as long as I could (longer, actually), until it got to the point where I could not focus on a written page for more than 3 minutes without it actually swirlling out of focus.

  10. rxholly says:

    Ok, I’m gonna catch hell for this one, but I agree with you AP, there are true cases of ADD out there. BUT did people ever stop to think in these crazy busy lives we lead where so many kids don’t even see either one of the two people that spawned them on a daily basis b/c we are so busy working so hard and sending our kids to daycare that the kids just want some damn attention from their parents and don’t know how else to get it???

  11. rph3664 says:

    When I was in pharmacy school, I worked with a woman whose 10-year-old son had been put on Ritalin. I sort of groaned, but she proceeded to tell me that in two months, he had improved 6 grade levels in reading.
    That’s what it’s for. And unlike so many such parents, she didn’t brag about it.
    Contrary to popular belief, ADD DOES NOT cause kids to do things like kill pets, act out sexually at single-digit ages, spread accelerant around the house and try to burn it down, assault teachers, etc. etc. etc.
    I’ve also noticed that ADD did not seem to exist in non-white children of any socioeconomic class until the past 5 years or so. We all know that real mental illness cuts affects all ethnic groups – so what’s this about one that mostly affects low-income white children?

  12. one_angry_tech says:

    Hell, our Pharmacy Supervisor is on Adderall. What the hell can I say to that??!

  13. Lets not forget that there is a difference between ADD and ADHD. The missing H in ADD is extremely important. I think that there are alot more misdiagnosed cases of ADHD than there are ADD. I know very few people who are misdiagnosed with just ADD and see any difference with medication. The kids bouncing off the walls is more likely to be diagnosed with ADHD. I do know people who were checked out with for learning disorders, and they just ended up with a tutor.

  14. Emilie says:

    “You can be sitting at home watching TV and suddenly feel like you have agoraphobia after a paxil commercial.”
    I just wanted to add that in Canada (well in Quebec at least…) it’s illegal to advertise a prescription drug (on TV or anywhere else)
    Well… they can do it, but if they say the name of the drug, they cannot say what it’s used for, and if they mention the indication, they cannot say the name of the drug. I’m glad it works this way..
    Ok, we also get TV from the USA and some people talk to us about it (but only the ones who speak english…) And one last thing, is it just me or all those adds are concentrated during “The price is right” ?
    (sorry if my english is bad…)

  15. rph3664 says:

    **We all know that real mental illness cuts affects all ethnic groups**
    What I had meant was either “cuts across” or “affects”. I must have edited it incompletely.
    Sarah, your child is what SSI was intended for. It sounds like your son is fairly high functioning, and your love and good parenting has certainly contributed to that.
    I have a friend who gave birth at 26 weeks and found out their daughter was eligible for SSI while in the hospital, since she met Socialist Insecurity’s (LOL) definition of not living with them. She’s 12 now and is totally normal. 8)
    Thing was, my friend was a social worker who sometimes referred clients for SSI evaluation, and she had no idea her daughter was eligible until the NICU social worker explained it to them. They were very grateful for the benefits they received.
    Its abuse is leading to people (I know of several) who had been declared permanently and totally disabled, being re-evaluated to see if they really need benefits, not just SSI but private disability insurance and worker’s comp as well.
    When I worked retail, there was a certain doctor (family practice to boot) who wrote a LOT of ADD prescriptions, and we knew his were legitimate. Why? He was diagnosed with it in his mid-30s. Long story made short: he saw himself in a lot of those ADD kids he saw in his practice.

  16. M2 Pilot says:

    Don’t forget, that in some cases the baby-mommas of the kids that get the amphetamine scripts for free (paid for by you & me), also get a “crazy money” check every month because the child has a “disabiltiy”.

  17. rph3664 says:

    Rxholly, you forgot about the sorry excuses for parents who aren’t raising their kids because they’re more interested in chasing their dicks from bar to bar, can’t disconnect themselves from their cell phones, are more interested in their McMansions than they are in their trophy children, send the child support money they do receive to guys in prison, etc.
    And some of these people have been surprising well educated.

  18. http://openid.aol.com/roshanakf says:

    What’s your opinion on violence in the workplace? I read about it in last months Drug Facts magazine, and how all these pharmacists are getting shot at work, basically for pissing off patients….??!!!

  19. Grasshopper says:

    I’ve dispensed my share of ADD meds and have an opinion, but my wife is a special ed teacher of the preschool variety. She’s seen it all and we talk about it. So many of her parents are losers that do not put much effort into parenting (love, positive reinforcement along with punishment and negative reinforcement) and the kids just don’t have any boundaries, structure and encouragement. This, in her experience in 10 years of teaching, is the majority of cases. No, not all of them. The one’s you really root for are the parents that work hard on their kid that really is ADD.
    ADD is a legit mental health disorder but the meds are so overprescribed it’s not even funny.

  20. Jeff says:

    Couple of questions for you you…
    I don’t understand why AD/HD meds would cause a non AD/HD kid to be a zombie, I thought it would cause the opposite? How does a stimulant cause a non AD/HD kid to become a zombie?
    What about the kids who are ADD, not ADHD? Are you able to ascertain which kids are not ADHD, simply ADD?
    Thanks,
    Jeff

  21. rph3664 says:

    M2 Pilot said:
    Don’t forget, that in some cases the baby-mommas of the kids that get the amphetamine scripts for free (paid for by you & me), also get a “crazy money” check every month because the child has a “disabiltiy”.
    That’s what I meant by SSI abuse. I have heard of this being done for children as young as ONE YEAR OLD. Not SSI for something like Down Syndrome or spinal bifida, but ADD/ADHD or bipolar disorder. In babies!
    And yes, the money is known as “crazy checks” and there is no shortage of doctors who will happily fill out the paperwork.
    I work with a woman whose son goes to a well-known, prestigious college. He told her that Adderall, Concerta, etc. is easier to get than beer. A lot of it is ordered online but not all of it. Diversion, anyone?

  22. elway paul says:

    WHO IS THIS ANGRY PHARMACIST WHO WONT FILL VICODEN WITH OUT BUGGING THE DR. AND WONT FILL RITALIN OR OTHER DRUGS THAT THE DR. ORDERS IN WHICH HE CANT KNOW IF ITS APPROPRIATE OR NOT FOR ONE THING HE HAS NO DR. DEGREE LET ALONE MD.HE NEEDS TO FIND ANOTHER PROFESSION BECAUSE SOON THE 100K HE MAKES AND HIS NICE CAR AND HOUSE HE OWNS IS GOING TO BE ONE OF THE PATIENTS AND HE WONT HAVE HIS PILL COUNTING LICENCE ANYMORE. FROM THE DISGRUNTLED PHYSICIAN

  23. 1R1SHN0M4D says:

    My step daughter who just turned 14 was just prescribed Strattera. After 7 years of fighting to see her (because her mother refuses contact with the father/my husband since we started a family of our own) he finally won visitation. The child has had it beaten into her head that “her daddy doesn’t love her because he has two other daughters now and proved by the fact he never sees her”, yet the fact that most times when we spend a couple hundred $ on travel expenses to pick her up the mother has refused. Even with court papers cops wouldn’t enforce the order. So finally when she told the judge the daughter doesn’t want to see him the judge told her its her job to make sure she does want to! Now after 4 years of, yeah you heard that right 4 years of trouble with the law, getting permanently expelled from the school district she takes her to a psychiatrist who tells my husband that she won’t put her on any meds unless both parents agree. The choices, Strattera, Concerta, or Adderall. We had her for two months during the summer and not one outburst, behavioral issue, we did go through about $75 worth of books (the girl LOVES to read)We take her home and he tells the dr. NO MEDS we don’t believe she needs them. We believe the problem is environmental. The Dr. then prescribes Strattera because the only way to get her back into her home school is to dope her up, per the super intendent, AND its not a good idea to give her a CII since her and her friends were already busted for selling her mother’s pain meds. But GOD forbid the father take custody, I mean everyone knows the best and only place for a child is with its mother.

  24. Gail says:

    I actually learned that social anxiety disorder existed from a Paxil commercial. Before that, I thought everyone was so terrified of social situations to the point of thinking they’d die, and that I was just a wimp for not getting over it. I remember sitting there and going “OMG, really, this isn’t normal?”
    (First thing people tell you when you are shy/socially anxious – “Everyone is nervous in social situations”. Yeah, but not everyone is so scared that they have panic attacks. I got to the point where I could go to work, and talk to my boyfriend, and that was it.)
    Anyways, 8 years later, and my social anxiety is under control, thanks to lots of gabapentin and a little bit of zoloft, plus therapy. I even go to parties now.

  25. GingerB says:

    I’m with those who think that school systems push drugs at kids to control them.
    At 12 my angel baby got in a shoving match in the lunchroom. He was provoked! The next thing I know the school is telling me he needs an “evaluation.”
    So we go see a Shrink. He looks at my kids grades (the kid can read!) and says, “I have parents in the waiting room who would trade kids with you for free!” And tries us out on Adderall since my kid wasn’t having anything to do with talk therapy.
    My kid refuses to take the stuff. I find it under the kitchen table in the mornings. To make school happy I send it off for them to give him at lunch, except he doesn’t ever show up to take it. After a week of calling me to tell me he wasn’t coming and getting his meds they quit with that – thank goodness.
    Know what? Four years later, my kid is doing fine. OK, he hasn’t passed his driver’s test yet but that’s another story. But his grades are good and he’s not on drugs, at least legal ones, and that little twerp he got in a fight with in the lunchroom is his friend.
    So I say, think twice when some school tells you a perfect good kid needs drugs. It’s part of the social scheme to emasculate our boys.

  26. rph3664 says:

    Actually, the reason schools are so aggressive about having kids diagnosed with all these conditions is because they get extra money for them.
    I just read in yesterday’s paper that 30% of the students in my school district – which is mostly middle class – have IEPs. Certainly there can’t really be that many special needs kids out there.
    jmho
    There are urban legends floating around about teachers who keep bottles of Ritalin or whatever in their desks, which they give to misbehaving kids. I couldn’t imagine a teacher keeping a job for very long if s/he did that, but I do know of a woman who gave her own son’s Ritalin to a misbehaving nephew she was babysitting, and when word got out, nobody in the family wanted her around their kids, and of course she was clueless as to why.

  27. Anonymous says:

    There is a really excellent must-read book on this topic. It is balanced and not extreme.
    The title of the book is “Making the Connection: A parent’s guide to medication in ADHD” by Mohab Hanna.

  28. Judy says:

    25% of kids on ADHD meds actually have ADHD? Something must have changed or you’re an optimist.
    I did have one kid on ADHD meds (kid couldn’t pay attention to LUNCH, much less his teachers), but we were eventually able to wean him off.
    Many of my friends asked for my input when teachers asked them to have their kids evaluated for medication because I helped in the classroom. Kids with good grades who were respectful MOST Of the time and just being kids the rest. Probably less active than the 2 of mine who didn’t need medication. Yep. I think you’re an optimist.

  29. Becky says:

    Wow, have I learned a lot. I found this web site because my pharmacist pissed me off and I wanted to find a way to complain. I could not resist following the link to

  30. Jen says:

    I just had to add my 2 cents. I have a 6 y/o son who was just diagnosed with ADHD. For 3 years he has struggled in school. Every teacher had a problem with him. He was constantly in trouble. Was evaluated several times during preschool, but nothing came of it. He finally got 2 paras to work with him during kindergarten after a particular rough month and numerous trips to the principals. The adderall has changed our lives. He is a completely different child in and out of school. I am a SAHM. I had held on to the ADD eval forms for months b/c I languished over the decision. I also am in close contact with every teacher he has had. I meet with his kindergarten teacher every few months, and e-mail her alnost daily. Yes, there are children who should not be on the meds. Yes, it’s overdiagnosed, but when a child truly needs the meds, it can transform their lives. Also, I have a 2 1/2 year old son who is definitely not ADD. He can sit and focus much better than my older son ever could prior to the meds.

  31. Drive Thru Wench, CPht says:

    And here I was, years later, idly clearing out some old feeds and came across this post. When I first read this, I had a 6 month old niece and this was the last of my concerns. Now I have a super active 4 year old, and I had concerns- anyway, reading your comment section with the “can your child focus on a half hour tv show?” and I slapped my forehead and laughed. Now I know my niece might just need a whooping! (just kidding, folks- she definitely needs one.) Thanks again!

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