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"I don't do it often enough to be worried about being hooked on it," she explains. "I see it as in another category" from other drugs. "It's something that's prescribed to people and it's something that's been approved."
She got 35 minutes of sleep the night before the exam, but she ended up scoring the second-highest grade in the class. When Julie graduates from college she hopes to become a pharmacist.
When 19-year-old Joe, then a student at Southwestern University, needed to finish a book in one night for an English course he was taking, he welcomed the offer of some free Adderall from a friend.
"It was the equivalent of drinking a pot of coffee, basically," he says. "It was like I was just born to plow through Pride and Prejudice. It was like I was made for it. There was nothing but these stupid characters I'm sorry, but I hate that fucking book."
Joe says the friend who gave him the pills had a prescription for the drug, but he rarely took the pills himself. Instead, he gave them away to people he liked and charged about $5 a pill to the people he didn't.
"He was supposed to take it every day, maybe twice a day," says Joe. "But he only took it himself maybe three times a week, when he had a lot of reading to do or a big assignment. He figured maybe he's got ADD a little bit, but, like, that it wasn't really necessary. It was more the parents and doctors freaking out, like, 'You need this stuff.' "
Dr. Jay Tarnow of Houston's Tarnow Center for Self Management has worked in the field of ADD for more than 30 years. He's heard that kind of thinking about the disorder before, and it troubles him. For many teenagers and young adults with ADD, taking the pills is a downer, not an upper.
"When we take a stimulant, it stimulates," says Tarnow. "So why is it paradoxical? Why does it calm people with ADD down?" The answer, explains Tarnow, is that drugs like Ritalin and Adderall stimulate the part of an ADD brain that increases certain neurotransmitters. It's that lack of those neurotransmitters that causes some of the hallmark symptoms of an ADD child: hyperactivity, difficulty organizing and focusing, trouble reading social cues and problems curbing impulsive behavior.
So while the ADD drugs might cause a normal brain to get hyped up, they actually help the ADD child slow down -- therefore, they often don't want to take their pills.
"That's why kids who have ADD almost never, and I'm saying 99.9 percent, almost never abuse these stimulants," says Tarnow. "They don't like the effect. They like being hyper. The most common thing we hear is 'Gosh, everything is so much more boring on this medicine.' That's why they sell it."
Tarnow says that's why doctors who work with ADD patients must take the time to explain to their patients why the medication can help them. It starts with a proper diagnosis, an extensive process that Tarnow says should involve a battery of tests and in-depth discussions with both parents and teachers. And that's not easy to do.
"ADD is considered, research shows, to be the most overdiagnosed and the most underdiagnosed disease in childhood," says Tarnow. The disorder can be missed when managed care companies insist it should be pinned down in one 15-minute session with a pediatrician, something Tarnow says is just not possible. And sometimes the disease is overdiagnosed because of parental pressure.
"There are some people, some parents, they want something to be fixed right away," says Tarnow. "Where does it get overdiagnosed? With parents who are very concerned about school, who are upwardly mobile, who put a lot of pressure on their children to accomplish and do well, and who have them in schools that may not be the best environment." Tarnow notes that children with anxiety or depression problems may have symptoms that mimic those of ADD.
But, says Tarnow, for kids who truly have the disorder -- about 3 to 5 percent of the general population -- the medication in conjunction with therapy can do a world of good. Studies have shown that kids with untreated ADD have a higher incidence of drug abuse, suicide, dropping out of school and reckless behavior.
"I just don't believe that all you do is put the child on medicine and say good-bye to the parent," he says. "Anytime I put a child on medicine there's always psychotherapy. I'm always working with the parents, teaching the parents how to teach the child to self-manage." That combination will ensure that kids will realize how useful the drugs can be to them and make them less likely to give away their pills, says Tarnow.
And, he adds, that realization will hopefully stay with the teenager when he or she goes on to college. More and more college students are remaining on their medication into their twenties and beyond, which wasn't the case ten years ago. Tarnow explains that as students get older, the hyperactivity that is so often seen with ADD usually goes away. Therefore many people think they've outgrown the disease. But problems with organizing and focusing remain.