Rise seen in ADHD prescriptions filled by women in region including Arkansas

Effect on babies raised as a worry

Graph showing the Percent of women 15-44 who filled prescriptions for ADHD medication
Graph showing the Percent of women 15-44 who filled prescriptions for ADHD medication

The percentage of privately insured women in the South who take medication for attention disorders has nearly quadrupled since 2003, raising questions about the dangers the drugs pose to unborn children.

These women, classified as "reproductive-aged," filled prescriptions for themselves in ever-increasing numbers nationally. The biggest rise was in the Southern region, which includes Arkansas, according to a report from the Centers for Disease Control and Prevention that was released in January.

The percentage of women between the ages of 25 and 29 who are taking attention disorder medications grew the most -- from less than 1 percent in 2003 to 4 percent of privately insured women. The total number fluctuates by year -- from about 2.5 million in 2003 to 6.8 million in 2012 because it is dependent on the number of women who had private insurance.

The study called for more research into the effects of medication used to treat attention deficit hyperactivity disorder (ADHD) on fetal development. Nearly half of the pregnancies in the U.S. are unintentional, so women who are on ADHD medication may not know initially that they are pregnant, according to the report.

There is not enough evidence-based research on the impact of stimulants -- such as Ritalin or Adderall -- before and during pregnancy, the report stated.

Most studies of the subject do not include humans. If they do, the sample size was so small that scientists could not reach a conclusion about the effects on unborn children, according to several papers from the National Institutes of Health.

Martha Hibbard, 38, said the lack of research concerns her because she recently decided to see a doctor to get tested for ADHD, at the suggestion of her counselor. The Conway resident said she's always struggled with inattentiveness.

"They're going to have to really think about taking precautions to protect an unborn child," Hibbard said.

Hibbard said she has a hard time with follow-through on projects and forming short-term memories, especially for names and dates.

"I can make lots of notes, but I cannot remember things," she said. "Even things that I have heard in one day will be gone in a few hours. It's crazy."

Her symptoms have also affected her social and working life: She has trouble focusing on long conversations. Hibbard teaches high school Spanish classes.

"They'll be talking to me, and I will answer and not even have a clue what they're talking about or what I've said," she said.

In the past, diagnosing women with attention disorders has proved difficult, and advances in understanding the differences in the ways symptoms tend to manifest may have contributed to the increasing percentage of women being medicated, said Dr. Justin Hunt, chief medical officer at Ozark Guidance. Ozark Guidance is a nonprofit mental health treatment center with clinics in four counties in Northwest Arkansas.

"I think part of it might be that the generation that has now aged, if they were maybe children in the early 2000s or late '90s, and now they've aged up into adulthood, there were many more diagnoses of ADHD being made then," Hunt said.

Young girls tend to exhibit symptoms different from boys. Boys generally have more problems with hyperactivity and inability to focus, Hunt said.

"It's much easier for teachers and church leaders and maybe even parents to miss the inattention symptoms than the hyperactivity," he said.

Hibbard is the Arkansas organizer for Children and Adults with Attention Deficit/Hyperactivity Disorder, a national nonprofit that provides education and support for people with ADHD. She meets individually with families, helps to set up lectures with experts and runs a support group in central Arkansas for families with ADHD.

Her son Jacob has been diagnosed with ADHD.

She said she has seen the difference between getting girls and boys diagnosed, and it is a common complaint for parents with daughters.

"They're just really at the bottom of the barrel, not knowing what to do, stressed out with their children," she said.

Girls with ADHD are less likely to be noticed because their symptoms manifest differently. The disorder is often labeled as a personality quirk -- they are "daydreamers," "show-offs" or "boy-crazy," according to ADHD support sites for parents.

Edie Bomar, a Vilonia resident, said the process of getting her daughter Sadie diagnosed was "long and treacherous," even though the child refused to stay in her seat at school and couldn't focus on what the teacher was saying.

"She could tell me posters on her teacher's wall, everything her teacher wore that day," Bomar said. "She was very descriptive, but could not finish a math problem."

Even with her kindergarten teacher's suggestions that Sadie see a doctor for her attention problems and several appointments, it took months for the girl to get a diagnosis.

Sadie, who is now 13, takes daily medication, and Bomar said she doesn't anticipate that changing.

"As she's gotten older, she has learned some coping mechanisms, but at this point I foresee her having to do it if she has to sit in the classroom or sit in a job," Bomar said.

Only about 1 percent of ADHD research is focused on symptoms in girls, and boys are about three times more likely to be diagnosed with it, according to a study from the Journal of the American Academy of Child & Adolescent Psychiatry.

Hibbard said getting her son diagnosed was easy because as soon as he started school, it was obvious that he had ADHD. But she still had to attend a course for several weeks to make sure his behavior wasn't a result of her parenting skills.

Jacob was diagnosed with ADHD when he was in kindergarten because he would interrupt the teacher and interject when he shouldn't.

He is doing better because of at-home behavior therapy Hibbard does with him to practice on social skills and focus, she said.

Some experts contend that children can outgrow ADHD. That idea is controversial -- some researchers say almost half improve, while others say no one does, they just learn to cope.

It's also simpler to get an ADHD diagnosis as a child than as an adult, Hunt said. Collateral evidence is easier to gather from school, church and home; kids need to exhibit at least six months worth of symptoms in more than one setting to meet the criteria for the disorder.

Hunt said adults tend to have fewer symptoms related to hyperactivity and more problems with attention span.

For the people who don't get diagnosed until adulthood, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders states that they need to show at least five symptoms, which Hunt said some college mental health centers are starting to uncover through more rigorous psychological testing to avoid drug abuse.

Adderall, a drug commonly used to treat ADHD, is also used as a stimulant more potent than caffeine that students use to stay awake and study longer.

"We didn't want to have to hand out the controlled substance if it wasn't needed," he said. "You can see the natural quandary."

The number of high school and college students using ADHD medication without prescriptions nearly doubled between 2008 and 2013, according to the National Institute on Drug Abuse. These numbers are derived from the Monitoring the Future project, a grant-funded partnership at the University of Michigan. Researchers have been surveying students for this project since 1991.

Hunt said these stimulants are the most effective methods of treatment for ADHD, although sometimes the disorder can be treated with less powerful drugs or only with therapy.

The medication is "still the first-line treatment for both children and adults," he said.

Hibbard tried medication with her son for a while, but found that the side effects weren't worth it. Jacob had mood swings out of character for a kindergartner.

"He was not the funny little Jacob that he is," she said. "He was just serious and did not laugh and carry on. ... They tell me that it's really a trial-and-error to find the right medicine, and it really is. I just felt bad because he was so little, and he really couldn't tell me what was going on."

Jacob is now 11, and not on any medications, and Hibbard said as long as his grades stay up, she won't put him back on them.

Bruce Wiseman, the national president of the Citizens Commission on Human Rights, said in the United States, psychiatrists prescribe too much medication, especially for children. The California-based commission investigates and exposes human rights violations in the field of mental health.

"Psychiatrists take life's problems, and rather than have them deal with them in the normal way, they drug it or shock it," Wiseman said.

Advocates from the National Institute of Mental Health and other researchers write that ADHD is overdiagnosed and overmedicated, especially in children.

However, Hibbard said that, if her doctor recommends it, she won't hesitate to take medication.

"If you needed glasses, would you go get glasses?" she said. "It's the same thing. If you are having a hard time focusing and really cannot put your thoughts together, well it's the same thing."

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