COMMENTARY

ADD and Stimulant Use: An Epidemic of Modernity

Michael E. Ruff, MD, FAAP

Disclosures

February 06, 2007

Summary

The belief that ADD is a biologically based disease predominates the pediatric literature. However, this overemphasis on neurobiology has diminished the extremely relevant contributions of family dynamics, discipline, class size, economics, drug marketing, and cultural tempo. My fear is that in tacit response to this biological bombardment, many pediatricians unknowingly fail to seriously consider the environmental underpinnings of this complex diagnosis before writing a prescription.

This is not a call to discredit the diagnosis of ADD or stimulant therapy. But as pediatricians responsible for the collective welfare of our children, what does relying more and more on stimulants mean? Ours is a changing, complex world and there do not appear to be any simple answers. However, the following recommendations may serve as reasonable starting points:

  • Educate parents about preemptive strategies to deploy as part of early childhood anticipatory guidance -- eg, the importance of exercise and limiting exposure to television and video games.

  • Advocate for tougher divorce laws. Currently, in many states it is easier to walk away from a marriage than to make a commitment to buy a used car.

  • Press for more thorough disclosure declarations by authors who research and write the majority of the ADD literature. The efforts of New York Attorney General Eliot Spitzer have led to legislation that makes it mandatory for CEOs and Boards of Directors to disclose salaries, options, and bonuses so that we can make more informed investment decisions. Likewise, researchers should be required to reveal just how much compensation, in the course of a year, they are afforded by companies such as Eli Lilly, Shire-Richwood, and Ortho-McNeil. We may then be able to better assess the merit of their conclusions and recommendations.

  • The American Academy of Pediatrics (AAP) should staunchly and more visibly advocate for studies on the environmental contributions to this epidemic. Unfortunately, the extensive recent practice parameter published by the AAP made only perfunctory mention of this need.[60] ADD is a public health issue and the AAP has the resources to effect real social change. For example, in response to articulate pleas from infectious disease experts, unnecessary antibiotic prescriptions have been significantly reduced.[61,62]

  • Finally, the balanced, perspicacious writings of authors such as Lawrence Diller, Mel Levine, and Stan Turecki should be required reading for anyone who prescribes stimulants.

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