Biology 202
2002 First Paper
On Serendip

Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are behavioral disorders affecting attention span, impulse control, and self-discipline. They are usually associated with children, although adults can suffer from the same disorders. It is estimated that 4% - 6% of the U.S. population suffers from AD/HD, and children with the disorders carry them into adulthood more than half the time. Typically medicated with psychostimulants such as Ritalin or Adderall, (methylphenidate and dextroamphetamine, respectively), concern over these disorders surrounds problems such as over-diagnosis or misuse of the prescription medications.

ADD is characterized by an inability to concentrate, poor self-control, and short attention span. ADHD is essentially characterized by the same deficiencies except it includes hyperactivity and impulsiveness. The two are generally grouped together in the acronym AD/HD and are treated the same way, although each diagnosis can be labeled with a subtype of predominantly inattentive type, predominantly hyperactive-impulsive type, or a combination type. Treatment involves psychological, educational, and social remedial measures along with medication, but frequently the more time-consuming efforts for treatment are disregarded in today's impatient world, with parents and patients hastily looking to medication for a quick solution.

Ritalin is the brand name for methylphenidate hydrochloride, a stimulant which was introduced in 1956 and affects the way the brain filters and responds to stimuli. This can be helpful to a person with AD/HD who feels bombarded by stimuli and is easily distracted. Although its workings are still largely not understood, methylphenidate helps the brain to focus more selectively, and is therefore often prescribed for AD/HD.

In addition to increasing attentiveness, methylphenidate increases energy and a feeling of well being, and comfort, and often causes the user to become more loquacious. Other short term effects include faster heart rate and breathing, increased blood pressure, dilated pupils, dry mouth, perspiration, and a feeling of superiority. More severe side effects include aggression and hostility, or even strange, incessant behavior. Flushing, tremors, and hallucinations are common of overdose. The effects of methylphenidate are often likened to those of cocaine and studies have shown similarities in the two. Both drugs have the ability to block dopamine transporters. The reuptake of catecholamines noradrenaline and dopamine are blocked, leaving them in the synapse in increased concentrations, promoting the elevation of mood and the feelings of alertness, well-being, verboseness, or superiority (1). In addition, a study using baboons showed that the regions of distribution of methylphenidate and cocaine in the brain are similar, and there is competition for binding sites between the two on the post-synaptic terminal (1).

In 1996, the FDA approved Adderall, a combination of mixed amphetamine salts amphetamine and dextroamphetamine, for the treatment of AD/HD. Adderall is an alternative medication to Ritalin (methylphenidate), and is often prescribed as the Plan B when Ritalin is not effective. With duration in the brain lasting twice as long as methylphenidate, Adderall can be administered half as frequently and is advantageous to parents who would prefer to avoid in-school doses.

Like methylphenidate, this amphetamine combination may improve attention span, self-control, and the ability to concentrate. The cocaine-like feelings of courage and superiority are not as common in higher doses of Adderall as they are with methylphenidate, but the amphetamines of Adderall often improve the mood and productivity similarly to methylphenidate. Instead of blocking the dopamine reuptake, amphetamines trigger the release of more dopamine and noradrenaline.

However, the question lingers: Does giving amphetamines to kids make sense? Interestingly enough, CNS stimulants such as Adderall are known to decrease hyperactivity and aggression in children, while in adults they more frequently lead to increased motor activity, the common result for which they are usually known. The marketing strategies of this drug must be clever enough to differentiate Adderall from the alarming word 'amphetamine,' to relieve the concerns of parents associating the amphetamines in Adderall with the threatening cousin methamphetamine, whose name is associated with crank addicts and dangerous street speed. The difference is subtle, the addition of a methyl group on the amphetamine molecule gives the molecule better fat solubility and therefore somewhat quicker entry in the brain (4).

All this is fine for the 3rd grader who can't concentrate on his math homework, but what about adults suffering from AD/HD in an age of more responsibility? And with all these advantageous side effects, who couldn't use a little improvement in their concentration, productivity, and mood? Diagnoses of AD/HD and subsequent prescriptions of psychostimulants for adults are subject to rigorous clinical exams, involving psychiatric histories and histories of school, employment, health, and behavior patterns throughout their life, as well as psychological tests evaluating memory, attention, and intellectual function (5). The stringency of the basis for adult prescription causes many adults desiring the benefits of these psychostimulants to turn to the black market, where the illegal resale of Ritalin and Adderall provides a less guilty form of street cocaine or speed.

A major demographic of people who abuse or illegally obtain these drugs are college and graduate school students, with their attention spans and motivation waning in the long, late hours of all-nighters and cram sessions. Often pills are crushed and snorted, providing a quicker and stronger effect, which has been a major push for the latest releases of these psychostimulants to be manufactured in time release capsules, making it difficult to crush them into powder for snorting. Adderall and Ritalin are also becoming popular as party drugs on college campuses, high school scenes, and at raves, where they are combined with other drugs such as ecstasy to enhance the effects (6). Excessive recreational abuse can cause users to become irritable and withdrawn from normal social interactions, experience insomnia and depression, and seem vacant to their friends and family--much like the long term effects of cocaine or amphetamine abuse.

With psychostimulant prescriptions and their popularity rising in recent years, parental reports of abnormal behavior and concerns of overdiagnosis have been growing. However, according to the Journal of the American Medical Association, the percentage of patients being treated for AD/HD does not exceed the estimated percentage of the population thought to have the disorder (7). Still, although not necessarily receiving treatment, many people may be led to believe they have AD/HD by over-concern of related symptoms of which most people suffer to some degree. For example, the author of this paper was determined to be a potential candidate for AD/HD by the short self-exam link cited in reference (8).

Although the severity of symptoms leading to the diagnosis of AD/HD may be ambiguous to some, treatment via prescription is highly regulated by the DEA. The dopamine reuptake block or trigger of release is neurochemically similar to SSRIs like Prozac and the once prescription, now illegal mood-enhancing drug MDMA (ecstasy), with the exception of seratonin for dopamine. Everything in moderation--methylphenidate and amphetamines can be beneficial for academic focus, but dangerous if their guidelines are not respected.

References

1)Biopsychiatry, Methylphenidate/Cocaine Comparisons

2)CHADD Children and Adults with Attention Deficit/Hyperactivity Disorder,

3)National Attention Deficit Disorder Association,

4)Erowid,

5)Assessment of Adult AD/HD,

6)ADD Drug Abuse Rising,

7)Overdiagnosis Unlikely,

8) Self-Test for AD/HD,

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