ADD's Black Box Scare, Part 2
One may argue that the reported deaths represent only a small fraction of actual deaths, or that side effects such as strokes and heart attacks are overlooked. Good point - let's do studies to determine the true risks. But if the data don't yet warrant a black box warning, why scare the daylights out of everyone?
I think the FDA panel reacted so strongly because so many people are being put on stimulants that it is hard to believe a proper work-up is being done on each of them. This objection makes more sense. Most primary care doctors don't have enough time to do the in-depth work-up a diagnosis of ADD requires. Some doctors are writing too many prescriptions for stimulants; others refuse to write any at all. Most neglect to offer treatments that do not involve medication. Stimulants are not always effective or necessary.
Getting enough sleep, lots of physical exercise, and eating right help with ADD (and everything else). And it's important that people with ADD get help in learning to organize themselves and that they get plenty of positive human contact. In addition, there are promising developments. For example, UCLA researcher Susan Smalley has shown that using mindfulness-type practices to treat ADD in teens and adults may improve behavioral symptoms and attention ( ADHD.UCLA.edu ).
Another new treatment that has shown good, albeit uneven, results is cerebellar stimulation. This involves exercises such as juggling, balancing on a wobble board, and standing on one leg with eyes closed, all of which are designed to stimulate a region at the back of the brain called the cerebellum. I am biased: My son has benefited greatly from cerebellar stimulation, and I now consult for a company that offers the treatment. Nutrition, biofeedback, and neurofeedback also hold promise in treating ADD.
There is a benefit to the FDA panel's alarm. It means that such new approaches will get the attention they deserve. But the most important intervention needs no more study. It is the understanding that ADD can be a gift - if it is unwrapped properly.
People with ADD (as well as those with dyslexia, depression, bipolar disorder, or anxiety disorders) usually have extraordinary talents that get buried under troubles and disappointments. The most powerful help is the identification and development of their strengths. I have seen this, more than any other intervention, transform patients' lives.
Every treatment for ADD should involve a program aimed at identifying and promoting talents and interests, whatever they might be. Viewing ADD only as a disorder creates far worse disorders: shame, loss of hope, and giving up on dreams. That's what really deserves a black box warning.
This article comes from the April/May 2006 issue of ADDitude.