Use of drugs treating attention-deficit/hyperactivity disorder rose nearly 19 percent among adults in 2005, according to a report from pharmacy benefits manager Medco Health Solutions, Inc.

Two Oklahoma City psychiatrists, Dr. Janita Ardis and Dr. Art Rousseau, said there are many reasons for the increased usage, but the recognition of ADHD as a condition that affects adults is relatively new and could explain the rise in prescriptions.

Rousseau said that until recently, it was thought that ADHD was a condition that only affects children, who eventually grow out of it.

"What we have found out is that it doesn't always happen," he said. "Some people don't outgrow it, and it continues into adulthood."

Count Christine Miggins, a public relations junior who never grew out of ADHD, as one of those. Miggins was diagnosed with the disorder when she was about 10 years old and has been taking the drug Adderall ever since.

"I tried to get off of it for a while because I didn't want to be dependent," she said. "But when I wasn't on it, I would start homework and not finish it. I had to start taking it again."

Ardis said the symptoms tend to be different in adults than in children, or the symptoms just show up later in life.

"Sometimes we get adults that have just compensated for it because they're smart," she said. "The smarter you are, you can compensate for it more. But then maybe when they get a higher degree and get a job that needs organizational skills, then they notice a problem.

"It's a problem that has been there all their life but has only come to be realized later."

On Medco's Web site, an informational page about ADHD, it says the reasons behind ADHD existing in some people is unclear. It says the symptoms include having trouble focusing. a short attention span, poor impulse control and hyperactivity, but symptoms often change between childhood and adulthood.

"The most common changes occur during adolescence and are a reduction in hyperactivity and better self-control," the Web site says. "Difficulties with attention change the least between childhood and the adult years."

Rousseau simplified the characterization of ADHD symptoms, saying normal people have the ability to focus and filter information.

Miggins said her symptoms became apparent in elementary school.

"I was always a good student, but I would have trouble with reading comprehension and long tasks," she said. "I couldn't stay focused."

For years, many people and media outlets have speculated that ADHD has been over-diagnosed, and the medications have been overprescribed. But Ardis said that in terms of the drugs' effectiveness, the proof is in the pudding.

"You have to look at results," she said. "You have kids who go from straight Fs to straight As, and that's pretty dramatic."

Rousseau also pointed out recent media attention to psychiatric drugs caused in part by a public spat between actors Tom Cruise and Brooke Shields.

Shields advocated the use of anti-depressants that she took to combat post-partum depression, but Cruise, in keeping with views he shares with the Church of Scientology, opposes the use of all psychiatric drugs.

"The media and people who use the media who feel that people should not take any (psychiatric) medications put fear into others," he said. "Sometimes people who need medication aren't getting it."

Some of the causes for the rise in diagnoses of ADHD in adults also has to do with the fast-paced and ever-changing modern world, both Ardis and Rousseau said.

"Part of the problem is we live in an ADD world," Rousseau said. "People in marketing know that people don't want to spend more than 15 seconds on something before we switch to something else. If we can't keep up with all the multi-tasking, we think we begin to think we have ADD."

Ardis also points to Internet questionnaires as tools for self-diagnosis.

"People do questionnaires on the Internet and come in and say, 'I did an ADHD questionnaire, and I think I have it,' " she said.

Sometimes those people do have ADHD, and sometimes they do not, she said. There are tests for psychiatrists and psychologists to perform to determine whether or not a patient actually has ADHD.

"You don't want to give [medication] to someone who doesn't meet the criteria," she said.

Ardis also said some symptoms of ADHD overlap with other psychiatric conditions, such as bipolar disorder and depression.

There are also side-effects that can come from taking ADHD drugs like Adderall, Ritalin and Concerta. In February, a Food and Drug Administration advisory panel called for "black-box" warnings on ADHD medicines because of possible links between cardiovascular problems in some people.

"Right now the FDA is so extremely sensitive to side effects from medications that it's to the point where they're going too far in the other direction," Rousseau said. He said that he thought the FDA decided not to put the "black-box" warnings on the medications.

"We need to understand that all medications are going to have side effects," he said. "But with these medications, the FDA began to be concerned with the number of prescriptions being issued."

He said that if a patient is considered at risk for complications from side effects, such as a patient who has ADHD and also pre-existing cardiovascular problems, then a decision is made between the doctor and the patient on whether or not medication is appropriate.
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