Brenton Cox sits at a tall glass table in his grandmother’s kitchen. Bills, papers and cans of food are scattered in the room. It’s almost dinner time as he looks through his homework folder. His grandmother, Rhonda Parker, walks around the room in her pajamas as she prepares chicken pot pie. Brenton walks to his room and returns with a bag of toys that he places on top of his homework. He’s wearing a white Yo-Kai watch on his wrist, a toy that plays music when you insert plastic medals in it.
“Nana doesn’t like me playing with it cause it gets too loud,” the 9-year-old says as he looks back at his grandmother.
“You can play with it, just don’t do it when everyone’s trying to watch TV, you should be working on your homework though,” she replies.
Brenton grabs his red folder. The words, “Park City Elementary School,” are written across the front. He goes through a few pages of his reading homework before returning back to playing with his Yo-Kai medal toys. His grandmother looks disapprovingly at him.
“He hasn’t been taking his medicine lately,” she whispers.
Brenton was diagnosed with ADHD a year ago in Glasgow, Kentucky, after suffering from outbursts and inability to stay focused in class. His teachers recommended that Brenton should be tested for ADHD as they believed he displayed a few signs of the disorder.
Attention Deficit Hyperactivity Disorder, commonly known as ADHD, is a neurological disorder that is usually diagnosed during childhood and often lasts through adulthood. According to the National Institute of Mental Health, ADHD is an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Symptoms often include difficulty staying focused, fidgeting, forgetfulness and interrupting others. Students diagnosed with the disorder are more likely to struggle and fall behind in school.
Brenton is not alone. In fact, Kentucky has the highest rates of children being diagnosed with ADHD. According to the Centers for Disease Control and Prevention, 19 percent of Kentucky children ages 4-17 have ever been diagnosed with Attention Deficit Hyperactivity disorder, compared to the 11 percent of children nationwide. Kentucky tops the nation with the highest rate of children currently being diagnosed, while Arkansas, Indiana and Louisiana are not so far behind.
ADHD levels have risen rapidly in the past decade across the country. Based on a national survey by the CDC, 6.4 million children have been diagnosed as of 2011. The percentage of children with an ADHD diagnosis has increased from 7.8 percent in 2003 to 11.0 percent in 2011. Rates increased an average of approximately 5 percent per year from 2003 to 2011. Though the CDC hasn’t released any recent surveys, with a pattern like this it’s safe to assume that current rates have climbed as well.
At 14.8 percent, Kentucky has the highest rate of children currently diagnosed with Attention Deficit Hyperactivity Disorder, according to the CDC. Approximately 68 percent of the children diagnosed are receiving medication. Some believe that the high levels of poverty and drug use could be a contributing factor to the high rates. While others believe that it’s an issue of over diagnosing and more awareness of the disorder.
Nurse Oleva Burks sits in her office at Barren County’s Red Cross Elementary School. Bright and colorful posters cover the walls. Her desk is surrounded by papers, medicine cabinets and first aid kits.
Burks spends her day taking care of cuts, fevers, the occasional stomach virus and distributing daily medications.
She searches through a binder to find the amount of students she medicates for ADHD.
“1…2…3,” Burks counts out loud as she flips through the students files.
“Several are medicated at home,” she says as though she thought the number of students would be higher.
She believes that there are at least 50 students or more that are diagnosed with ADHD at Red Cross Elementary, where around 700 students currently attend. Though the number of students she distributes medication to is significantly lower, Burks has seen an increase in the amount of students that come into her office to receive ADHD medication over the past few years. She feels that perhaps it has progressed to the point where by lunch time the medication is wearing off and they have to come into her office to get more.
There are many types of treatments for parents to consider when it comes to treating their child’s ADHD. These options may or may not work depending on the severity and kind of ADHD a child has. What might work for John might not work for Sally. For children between the ages of 4-5, the American Academy of Pediatrics (AAP) recommends behavior therapy as the first line of treatment before considering any kind of medication. For ages 6 and up, the AAP recommends both behavior therapy and medication as treatment options, preferably both together.
Rachel Wetton, a psychologist for the Barren County Schools System, considers all the different possibilities as to why she thinks the state ranks so high.
“There’s a drug use correlation between high ADHD rates, and with high levels of poverty and genetics, it can create a kind of pattern like that.” Wetton said during a phone call. “Some of these kids are living in homes where they’re making meth every year.”
With 285,000 people currently uninsured in Kentucky, according to HealthInsurance.org, Wetton believes that a lot of people don’t have great insurance or a primary physician. Children with symptoms end up going to an urgent care or ER where the doctor might have only seen them one time and they end up being diagnosed with ADHD. While Wetton believes that high drug usage have contributed to the high rates in Kentucky, she doubts that all of the students have the disorder.
“Compared to their teachers and family members who see them daily, the people making the decision are people that don’t really know them.” Wetton said, “They just base their decision off of what the parents tell them. So it’s a lot easier to say, ‘yeah, they have ADHD’.”
Stimulants are the most commonly prescribed medications for ADHD. Stimulants work to improve concentration in the brain. Brand names of these stimulants include: Adderall, Ritalin, Concerta, Dexedrine and Vyvanse. Side effects include: sleeping difficulty, irritability, weight loss and anxiety, according to RxList. Younger children have more side effects from ADHD medications than older children.
Medication costs vary based on insurance and stimulant type. Brenton’s grandmother, Rhonda Parker, said his prescription costs $30.00 for a six month supply with his medical card. Normally it costs $72.00 but Brenton uses a coupon for Vyvanse. Parker believes that Adderall is a more popular ADHD stimulant is because it’s cheaper and has faster effects on the body.
“Adderall is a lot cheaper than Vyvanse because Adderall is like the junk part of the drugs– what I mean is that it just gives it all to you at one time, where Vyvanse is like a time-release.” Parker said, “That’s why a lot of college kids like Adderall over Vyvanse because it gives them that speed.”
Based on a national survey by the American College Health Association/National College Health Assessment (ACHA-NCHA), the number of college students who reported using stimulants that were not prescribed to them, increased from 7.5 percent in 2012 to 8.3 percent in 2014.
According to a report by the market research firm, IBISWorld, ADHD medication sales have grown 8 percent each year since 2010 and predict it will take in $17.5 billion by 2020. As the awareness of ADHD increases, there seems to be a growing trend in the amount of stimulants being bought. While the number of children being medicated has appeared to decrease in the state of Kentucky, there has been a growth in ADHD stimulant sales due to the Affordable Care Act and Medicaid, which now require insurance providers to cover mental-health services including treatments.
As more children are being diagnosed and the rates of ADHD medication sales skyrocket, Kentucky is at risk. Kentucky’s high levels of prescription drug abuse make it vulnerable and susceptible to even more damage as rates of ADHD continue to rise.
Kathryn Steward, Assistant Director of Western Kentucky University’s Health Education and Promotion program, expresses that Kentucky has implemented several programs to prevent further prescription drug abuse of ADHD stimulants. Programs like Kentucky’s All Schedule Prescription Electronic Reporting System (KASPER) tracks Schedule II –V controlled substance prescriptions dispensed within the state, including Adderall and other ADHD medications.
“KASPER required our physicians to be more accountable for conducting drug tests for their patients to make sure they were using those drugs.” Steward said, “Adderall is a schedule one drug, so technically physicians are supposed to be drug testing to make sure there taking it and that it’s in their system.”
If the prescribed drug is not in their system, doctors have to make sure there not selling it to anyone else. Doctors are thus responsible for looking into KASPER and making sure that their patient is not going anywhere else trying to get the same prescription. Under Kentucky Law, if someone is found selling a controlled substance or using a controlled substance that isn’t theirs than doctors are not allowed to prescribe them anymore medication
Drug Take-Back Programs have also been implemented across the state as way to properly dispose of unused, unneeded, or expired medications. The program provides individuals with a secure and convenient way to dispose of controlled substances that will help prevent abuse and temptation to sell medication. Several take-back events have occurred around Bowling Green, Kentucky as a means of educating the public about safe and effective drug disposal.
Back at his grandmother’s home in Smiths Grove, Kentucky, Brenton describes what it’s like to take his medication that helps him, “be good.”
“Well it’s kinda like one of those pills you have to drink after you put it in your mouth. It doesn’t have a taste.” Brenton said.
Though his grandmother, Rhonda Parker, believes that Brenton does a lot better with his medicine, she expresses that there should be other ways of coping with the disorder as she doubts that all children diagnosed actually have ADHD.
“I think people are too quick to diagnose.” Parker said, “I think there needs to be more brain research to really tell if a child has ADHD, instead of just going by a person filling out a piece of paperwork.”
As far as her grandson, she believes that he will no longer need medication for his ADHD in the future as he continues his education. Sometimes when Brenton runs out of his 6-month supply of Vyvanse, she doesn’t rush to refill his prescription, as she wants to see how he reacts without it.
“The funny thing is, with Brent we went without his medication for a while and he was doing better in school without it, to a point and then they asked, ‘ Is he on his medicine?’ and we were like “Oh no, we gotta get back to a doctor,” Parker said.