ADD, ADHD, Neuro-stimulants, and the Gifted Brain

It’s almost immediately identifiable – the moment a child is put on neurostimulants or, as I like to call them, neurological restraints.  Their eyes glaze over, the sparkle in their eyes that once gave them passion now muted.  Their response and engagement with their surroundings is now sluggish.  It’s as if all their color has faded – a black and white speck in a vibrant movie.  The world keeps going but they’re lost in it.  Sometimes, they know it — sometimes, especially when they’re younger, they’re less aware. 

 

To me, it’s a tragedy.  I’ve had to hold back my tears when some of my most eager students arrived on new medications, usually at the request of a school administrator.  They’ve been temporarily ruined by medications with no more purpose than to “make them normal” — to make them less actively curious.   As I’ve engrossed myself into the study of what makes our gifted children so precocious, namely studying the neurodivergence of gifted minds, I’ve become even more keenly concerned with this trend.  If, as I do believe to be true, gifted minds are wired differently, then what are these drugs really doing to them?  ​​
 
ADD and ADHD
The most commonly prescribed neuro stimulants are Adderall and Ritalin, prescribed to children who display symptoms of hyperactivity and attention deficits, commonly diagnosed as Attention Deficit Disorder(ADD) or Attention Deficit Hyperactivity Disorder(ADHD).  In 2003, nearly 7.4 million children were diagnosed with ADHD, a 130% increase over a ten year period.  In this same year, 6.6 million children were prescribed a neurostimulant such as Adderall or Ritalin.  By 2016, nearly 10% of all children ages 4 – 17 were diagnosed with ADHD.  This number only continues to rise; these drugs becoming as normal as a vitamins in our children’s diets.
 
It is believed that the ADHD brain has different neuronal pathways and that, as such, neurotransmitters act and respond differently.  Moreover, “a study of functional MRI in children and adolescents with ADHD showed decreased connectivity in a fronto-striato-parieto-cerebellar network.”  Other studies suggest a connection between ADHD and neurodivergence, concentrating on the amygdala.  In either case, far more research is required to truly understand what causes hyperactivity and attention deficits in children.  ADD and ADHD are rarely diagnosed through lab work, but rather based on an assessment of symptoms.  Neurostimulants, specifically, amphetamines, such as Adderall and Ritalin, are often prescribed to treat the symptoms of ADD and ADHD.  These medications are based on the assumption that ADD and/or ADHD are caused by dopamine and norepinephrine deficiencies.  
 
Neuro-stimulants: Treating ADD and ADHD
These drugs — Adderall and Ritalin, work by targeting two neurotransmitters — norepinephrine and dopamine, in the brain. A neurotransmitter is, essentially, a chemical messenger. They transmit signals across synapses(connections) to control the nervous system, telling the body how to react.  The brain has over 100 molecularly different neurotransmitters, although it is believed that only a small fraction of these neurotransmitters do most of the work. These prescription medications work by increasing the release of dopamine and norepinephrine whilst slowing down the rate of re absorption. 
 
Norepinephrine Molecule

Norepinephrine’s main purpose is to mobilize the brain and body for action.  It increases alertness, enhances memory retrieval, and even focuses attention.  However, it also increases restlessness and anxiety.  Sometimes, norepinephrine is referred to as the “stress hormone.” 

 It’s also related to “fight or flight” syndrome.  Low levels of norepinephrine are believed to be related to feelings of lethargy, brain fog, memory problems, and lack of interest.  Sudden high levels of norepinephrine are associated with panic attacks.  Moderately high levels of norepinephrine make you happy while very high levels can make you euphoric. 
 

Dopamine is most often associated with reward and pleasure pathways, often coined the “motivation molecule.”  Low levels of dopamine are associated with fatigue, insomnia, mood swings, forgetfulness, memory loss, and lack of motivation.

At a glance, it seems logical.  If ADHD is caused by low levels of norepinephrine and dopamine, then increasing the release of these neurotransmitters seems logical.  It’s not quite that simple. There’s no pill substitute for norepinephrine or dopamine.  Adderall is comprised of amphetamine aspartate monohydrate, amphetamine sulfate, dextroamphetamine saccharate, and dextroamphetamine sulfate.  Sound familiar?  

Meth-amphetamine(meth) and methylendioxym-meth-amphetamine(MDMA/ecstasy) are close relatives. In contrast, ritalin is comprised of methylphenidate.  Methylphenidate, like Adderall, is a Schedule II narcotic and stimulant drug. 

Risk Factors and Side Effects

Given the chemical similarities of Adderall and Ritalin to illegal narcotics such as meth, ecstasy, and cocaine, it’s nosurprise that each have a significant list of side effects and risk factors.  Both medications are highly addictive drugs. Side effects for drugs are usually broken down into several categories, based on their severity and occurrence.  

 

The following side effects are more easily apparent and more common.  Adderall causes numerous side effects that are deemed, typically, acceptable in return for the benefits including, but not limited to: headache, dizziness, restlessness, irritability, fever, diarrhea, constipation, stomach pain, hair loss, etc.  

 

Serious side effects include: fast, pounding, irregular heartbeat, tremors, hallucinations, high blood pressure.  If individuals experience these symptoms, it is advisable to seek medical attention. Some less common side effects include: blurred vision, altered mental status, mood changes, and muscle damage. Prolonged, heavy use can lead to permanent neuronal damage, neurotransmitter depletion(the body will stop making them), and receptor super-sensitivity.  In essence, these drugs may permanently “re-wire” the brain.  The brain may stop producing dopamine on its own, contributing to chronic depression later in life. 

 

Appreciating Neuro-diversity

Our gifted children, in particular, are often diagnosed with ADD and/or ADHD.  ADD and ADHD are said to be neurological developmental disorders, meaning that most children with ADD and ADHD do not suffer from either disorder as adults.  The signs and symptoms of ADD and ADHD are very similar to how I would describe an active child — a child that doesn’t complacently sit in front of a screen for hours on end, but rather seeks out answers to their curiosities.  Hyperactivity, fidgeting, impulsivity, and even irritability are all fairly reasonable reactions for a child to have when forced to sit still for hours on end.  This is especially true for our gifted children who may spend the majority of the school day listening to mind-numbing lessons that they mastered years ago.  The attention span of a child is, indeed, short.   

 

Let’s imagine for a minute that you, as a parent, were required to sit in your child’s classroom every day.  When you finish your work, you’re required to sit silently.  You spend hours staring at the wall.  When the teacher conducts lessons, you’ve figured out the answer before she even finishes explaining the question.  When the students are completing work independently, you’re finished before they’ve finished the second question.  You finished all the practice problems while the teacher was still explaining the concept.  So, you sit.  You sit and stare.  Eventually, this wears you down.  At first, doodling keeps you occupied.  Eventually, you run out of things to doodle. You start to tinker with the parts of the desk.  You start to rock your chair back and forth.  You stare at the clock.  The school day isn’t even half over.  The school year just started.  The lessons start to wear on you.  You can’t stand listening to the teacher explain something that seems to simple to justify such a lengthy explanation.  Perhaps you start to call out in class.  If you answer the teacher’s question, will the lesson be over sooner?  Perhaps your chair tips over.  You’ve been silently testing the chair’s limits.  How far back can you tilt the chair before it falls over?  It hasn’t yet…until it does.  Perhaps your classmates have started to recognize you as “the smart kid.”  They might start calling you names.  At first, you ignore them.  Eventually, you may start to clown around.  You don’t want to be the smart kid.  You’ll be the funny kid.  

 

I’ve found that these little nuisances quickly start to disappear in my classrooms.  When students are engaged and appropriately challenged, they don’t feel the need to fidget as much.  Their brains are otherwise occupied.  For some children, the need to fidget remains.  However, it becomes less noticeable as time goes on.  My students spend more time in engaging, hands on activities and discussions than they do working silently or independently.  We save the practice problems for homework. We make class time more productive and more fun.

 

It takes time.  Many of my students have perfected the ability to “check out” whether they’ve done this on their own or with the help of medication.  It takes time for students to remember how to “check back in” — how to be engaged and, moreover, how to learn.  Studying does not come naturally.  School has, in fact, taught many gifted students that studying is not a necessity.  School and learning are, unfortunately, not synonymous.  For the child that embraces this new challenge, I celebrate.  For the child that does not, I still celebrate.  I embrace the new challenge that has been set in front of me.  I meet with the student.  I work with the student.  Learning how to learn and learning how to think are the most valuable lessons that I can teach any student.  I explain that this learning is a partnership between myself, the teacher, and the student.  I can teach any number of lessons but he/she must be willing to learn and to work — can we do this together?  Yes, yes we can.  This is the moment in which the true learning journey begins.

Do 10% of our children truly suffer from a neurological developmental disorder or are we, perhaps, demanding a developmental consistency across all children that is simply unreasonable?  Is it really that unreasonable to conclude that some children simply may want to be more active than others?  We require children to sit, without movement, for more hours than we did 20 years ago.  Children spend an average of 6 hours or more a day looking at a screen. Screen time replaces outdoor activities, imaginative play, and other activities that exercise the mind and body.  Surely, this is connected to the dramatic increase in ADD and ADHD diagnosis over the last 20 years.  

Instead of chemically restraining our children, what if we simply accepted the neuro-divergence as a necessary, and beautiful, part of society?  

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