DO BERNARD LORD READ THE TORONTO SUN????

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Sun, April 9, 2006
Social stigma
ougher warnings on packages of ADHD drugs may cause backlash

By MARILYN LINTON, TORONTO SUN

Five years ago, Sarah Herring's son was "like a bull in a china shop." Constantly on the go, he was "impulsive, interrupting, inappropriate in his behaviour," says his mom. "He was exhausting." Since then, the 13 year-old has been diagnosed with attention deficit hyperactivity disorder or ADHD.

And now that his illness is treated with medication, the difference, claims his mom, is "night and day."

Despite the fact that her son has suffered no adverse affects from his medication, Herring is worried about Health Canada's recent decision to add tougher warnings to the labels of Ritalin and similar drugs used to treat ADHD. Because the stimulants increase heart rate and blood pressure, the warnings should be a red flag to anyone with a family history of heart problems.

But Herring fears that the government's action will feed the negativity that already exists among those who say that ADHD is not a serious disorder and that the drugs are over-prescribed and used only to keep kids in line.

She says that for every one person who understands the complexities of ADHD, there are 10 who don't and criticize those parents whose kids are medicated. "It's already problematic to fill a prescription," says Herring, describing the suspicion that she sometimes feels in filling prescriptions for two of her children, both diagnosed with the disorder. Parents who choose to keep their kids on medication may have to endure the "social aspect of being judged now that there will be a warning associated with these drugs," she says.

Two million prescriptions for ADHD drugs were written in Canada in 2005; it's estimated that in the U.S. nearly 10% of all 10-year-old boys are medicated. "It seems to me, looking at the research, that the findings are very preliminary," says Herring, referring to the 25 sudden deaths and 54 cases of serious cardiac events including heart attack,

arrhythmia or hypertension.

Some experts agree. Dr. Umash Jain, a Toronto child and adolescent psychiatrist has many ADHD patients and says that the drugs, some of which have been around for 50 years, are among the safest of psychiatric medications.

ADHD is a neurological disorder that's present in 5%-9% of schoolage kids in Ontario, he stresses. "Let's call a spade a spade. ADHD is a medical condition that suggests that the brain is behaving differently."

MONITOR MEDICATIONS

While Dr. Jain believes that medications must be closely monitored, he also says that studies have proven that medications for ADHD offer a more successful treatment than psycho-behavioural therapies or special education.

The most common behaviors exhibited by those who have ADHD are inattention, hyperactivity and impulsivity. Everyone shows signs of these behaviours at times, however, so the Diagnostic and Statistical Manual of Mental Disorders (a tool used by psychiatrists) specifies that behaviors must appear before the age of seven and continue for at least six months.

To be diagnosed with ADHD, you must meet a symptom threshold of over six out of nine described criteria, says Dr. Jain. ADHD behaviours must also create a real handicap in at least two areas of life -- such as school, home, work or social settings.

Writing this week in the New England Journal of Medicine, Dr. Steven Nissen, a cardiologist at Ohio's Cleveland Clinic and a consultant on the FDA advisory panel that recommended the black box warning in the U.S., said that while "there are important potential benefits of these drugs for certain highly dysfunctional children," it's inappropriate to administer such potent drugs to the millions who currently take them. He and his colleagues called for "more selective and restricted use."

"The medications facilitate lifestyle improvements, but do not cure," stresses Dr. Jain. "There is still a myth that ADHD burns itself out by the age of 13," he says, adding that there are many adults with the neurobiological disorder. Many people still think that children can't possibly have a mental disorder, he says. "The stigma against ADHD is also a stigma against mental illness. We have a challenge in educating the public."
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