Late one night I woke up to the sound of someone rummaging in the kitchen. The noise seemed to go on and on, and then something clattered to the floor. I jumped out of bed and made my way to the dark kitchen. There was my oldest son, standing bent over the stark light of the refrigerator, a partially eaten apple in one hand and bowl of cold pasta in the other. He looked skinny and feral and there was a smear of florescent green — pesto, probably — on the front of his shirt.
“Sorry, Mom,” he mumbled, his mouth full. “I can’t sleep. And I’m starving!”
“It’s three in the morning,” I protested.
“I know. Sorry. I think the drugs finally wore off.”
I helped him put together a makeshift meal, then went back to bed — and lay there, wide awake. My son had recently been diagnosed with ADHD — the diagnosis du jour and one that seems to land on boys far more often than girls. He’d been prescribed an ADHD drug, a stimulant that in my day was called “speed” and was coveted by college students at exam time. Usually calm, mature, and in charge, he was now edgy and hollow-eyed; he couldn’t eat at mealtime, or sleep at bedtime, and had taken to wolfing down food in the middle of the night. I finally heard him turn off the lights and go upstairs to his room, and the house was quiet. How did we get here, I wondered. And where were we heading?
My firstborn has always been antsy, impatient, on the move. When he was a small boy, I learned that I had to take him to the park every day or he’d ricochet around the house until something or someone — usually his little brother or sister — got damaged. He was in constant motion from early morning until he fell exhausted into bed at night.
Not surprisingly, school was a challenge. He had trouble paying attention in class and rushed through his homework in the classroom, on the bus, or in short, rapid-fire sessions at home. This was fine in the early grades, but as he got older, his quick-and-dirty approach didn’t work so well, and his grades were often mediocre.
As reading assignments grew longer every year, my son struggled to sit still long enough to get through them. Books on tape allowed him to “read” while he kicked a soccer ball, lifted weights, or paced the room. Studying for tests — not to mention sitting through them — remained agonizing for him. Since he rarely did well, he developed test anxiety, which only made matters — and his grades — worse.
“Your son is really bright — he could be doing so well if he’d just work a little harder.” This invocation to hard work became a litany from his teachers I heard again and again, always laced with the same note of frustration.
I shared their exasperation, often taking him to task over his slapdash approach to schoolwork. During the worst of it, our arguments about homework soured our evenings and blighted our weekends. But a wiser part of me knew he was struggling, and it occurred to me more than once that he might have something going on. But when I asked his teachers, none of them seemed to think he had what other boys with attention issues suffered from: ADHD. His teachers had experience with kids whose behavior was far more extreme, kids who, even on medication, couldn’t focus well enough to get even mediocre grades. By comparison, my son was a well-behaved, average student.
In his senior year, something happened that made me wonder if I needed a second opinion — beyond his well-meaning teachers. For days I’d been trying to talk to him about his college choices, because decision deadlines were pending. The subject clearly made him anxious, and he’d usually cut me off and say he didn’t feel like talking about it. Then one afternoon we were in the car on the way home from a soccer game. He was sweaty and tired, and he looked discouraged. I assumed it was because his team had lost, when out of the blue he confessed that he was worried about college. “One of my teachers was telling us how hard the workload is going to be,” he blurted out. “Tons of reading, tons of papers and tests. What if I can’t do it?”
I’d been worrying, too, but it was his concern that finally pushed me to have him evaluated for ADHD.
Weird, weird world
And so we entered the bizarre wonderland of ADHD testing. Our doctor referred us to a respected adolescent psychiatrist who interviewed my son and me, together and separately, and then recommended ADHD testing. After evaluating him, she told me privately that she was sure he met the criteria for ADHD; she was just waiting for the test to confirm the diagnosis.
It turns out there is no definitive test for ADHD — you can’t do a blood panel or a brain scan to reach a diagnosis. Instead, experts rely on observation, self-reporting, and various psychoeducational assessments. My son took a long, tedious exam on computer to evaluate a number of different ADHD indicators and we waited.
A few weeks later, we filed into the psychiatrist’s office. There, with unmeasured certainty, she informed us that he “definitely had ADHD.” In fact, she said she was surprised that he’d been able to do as well as he had in school, given just how “impaired” he was. She recommended that he go on ADHD medication right away, and scribbled out a prescription.
As we drove home from the pharmacy, I asked my son how he felt. He was holding the orange bottle of pills, and he studied it as he told me, “Now I finally get what’s going on with me. All these years I thought I was just stupid.” I felt a twist of guilt that I’d waited so long to take this step.
But it wasn’t to be one of those clean roads from diagnosis to recovery. He started on the medication immediately — and immediately felt the side effects. He’d always been a light eater, and now he didn’t touch the lunches I insisted on sending with him to school. He sat with us at the dinner table, but could hardly choke down a bite. He couldn’t sleep, either, and after several weeks of this, he was edgy and ragged.
Worst of all, he noticed no positive effects from the medication. He felt neither calmer nor more focused in school. The psychiatrist had told us that it could take a while to find the right medication and the correct dosage, so I put in a call to get her advice.
Addiction, anxiety, and psychosis
While I was waiting to hear back from the psychiatrist, the Centers for Disease Control released a new report on ADHD. Since 2007, diagnosis of ADHD in the U.S. has risen 16 percent and — over the previous decade — a whopping 41 percent. For boys, the incidence is particularly acute: one in five high school boys in the U.S. carries a diagnosis of ADHD, and the great majority are being medicated.
As I read the New York Times article, I felt I was looking into a mirror of what was happening to my son: “About two-thirds of those with a current [ADHD] diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety and occasionally psychosis.”
A comment by psychiatrist and ADHD researcher James Swanson hit home: “There’s no way that one in five high school boys has ADHD. If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable — some of them are going to end up with abuse and dependence.”
As I read and reread the report, I wondered again where my son fell on the great spectrum of boys who hate to sit still and would rather be running around a field. Was his restlessness an actual disease or an energetic predilection? Of course I wanted him to excel in school, but was I doing the right thing by allowing him to seek a chemical cure to his academic ills? My son wasn’t a stellar student, but he was doing okay. Should we just leave well enough alone? I knew from friends whose kids had been diagnosed that the right medication can be transformative, helping kids not only survive but flourish after years of struggle in school. But what if my son was one of the overdiagnosed? I thought I was smart enough to discern hype from reality, but was I actually jeopardizing his health and his future?
No magic pill
When I finally reached the psychiatrist to complain about the medication, she surprised me by saying that, in fact, she wasn’t sure if my son had ADHD. He had scored so high on the ADHD scale that a therapist who evaluated his test results thought there could be an error in the test. “He needs to be retested immediately,” she told me.
After he was retested, we received the results quickly: my son did not have ADHD after all, the psychiatrist informed us. She was remarkably unapologetic and never acknowledged her 180-degree reversal: after being so adamant that he had ADHD, she was now just as sure that he did not — with seemingly no need for explanation in between. Instead, she suggested that he suffered from anxiety and recommended therapy.
We left the psychiatrist’s office in a daze. We’d both initially welcomed the diagnosis — and the possibility that a pill could solve his problems. It was such a clear-cut solution to a vexing problem. But after almost a month of dealing with the side effects of the medication, my son and I both realized just how high a price he was paying for this miracle cure. The insane ride on the ADHD roller coaster had turned our world upside down only to drop us right back where we’d started — with no answers and even more questions.
Pills — or PE?
Once he’d stepped off the ADHD roller coaster, my son was left to his own devices — the same devices he’d been using all along. Instead of drugs, he developed his own treatment plan, regulating his energy levels with powerful doses of daily exercise. He’d always played sports, but now he became more methodical about getting exercise every day. Though he didn’t know it, a growing body of research vindicates his impulse to self-medicate with sweat.
One recent study found that exercise boosts “executive control” — that is, the ability to resist distraction and stay on task. Another study found that kids who participated in physical activity for just 30 minutes before school every day exhibited significantly lower inattention and moodiness, both at school and at home.
Physical activity is particularly important for kids who have trouble staying focused, but it benefits every child, says Harvard psychiatrist and author John Ratey, an expert on the brain-boosting benefits of exercise. “Kids with ADHD and other learning issues may get a bigger bang for the buck from vigorous exercise, but science shows that it boosts tests scores for all kids,” Ratey says. “And it reduces discipline problems significantly, too.”
So it’s ironic that as a society we’re heading in the opposite direction. As writer James Hamblin observed in The Atlantic, the cautious calls for additional research on the benefits of exercise stand out in stark contrast to the exuberant — and growing — distribution of ADHD drugs to children. Between 2007 and 2011, ADHD prescriptions increased from 34.8 million to 48.4 million. “The pharmaceutical market around the disorder has grown to several billion dollars in recent years while school exercise initiatives have enjoyed no such spoils of entrepreneurialism,” he writes.
Hamblin also notes the illogical inverse relationship between mounting evidence of exercise benefits on health and learning — and languishing investments in school exercise programs. Many districts and schools around the country have cut both physical education and recess for budgetary reasons and to increase time for back-to-basics academics, according to a report by the Institute of Medicine.
Looking back, I think we dodged a bullet. I don’t think my son has ADHD — or maybe he just falls on the milder end of the spectrum. But under different circumstances, he might have received (as he briefly did) an ADHD diagnosis and spent years taking stimulants. Instead, he figured out something important about himself, a lesson that will serve him his whole life.
Now in his first semester of college, he knows that as long as he exercises he’s able to put in long hours reading and studying without climbing the walls. He recently spent days preparing for a comparative government midterm, taking meticulous notes and carving out a few hours every day to study. As he described his study routine and the A he received on the exam, I could hear new confidence in his voice, confidence I’d seldom heard him express about any matter related to school.
For some kids, medication can bring relief and productivity they might never enjoy without it. But I wonder how many kids are like my son. Given all the evidence, shouldn’t a daily, structured exercise program be the very first line of treatment — before we pass out the pills?