Misunderstandings, misconceptions, and ignorance about AD/HD and other disorders

[Matilda]

It appears to me that parents, in the attempt to do whatever they can for their children, are not questioning doctors and not getting second opinions when it comes to this disorder. Unlike some of you, I refuse to assume that every child has a disorder and should be put on drugs. Unlike some of you, I believe that drugs are the last option when dealing with children and unlike some of you I don't implicitly trust what a doctor states without considering alternatives.

 

What makes you think that parents are in a rush to put their children on drugs? I think for many parents, drugs are the last option. I know for many parents it is an agonizing decision to put their child on a drug. And for those parents who have considered alternatives, and have tried other things, and finally realized the best option is drugs, having someone on a message board say that parents are not doing enough to keep their children off drugs, and that their child's disorder is not a disorder at all, but a fad, well surely you can see how that might be offensive.

[Pocky]

Considering the rate that AD/HD is being diagnosed and how many children are now taking drugs I don't think enough is being done as an alternative to taking drugs. Moose has already proven my point regarding children being diagnosed with AD/HD and instantly receiving drugs. The first approach administered by the doctor was to place the child on drugs. Moose took that advice and gave his son drugs, however Moose took the time to consider the options and realized that his child wasn't actually doing better on the drugs. Moose, in my opinion, is the exception. Doctors have become overzealous when diagnosing this disorder and parents don't appear to be aggressive enough to challenge these doctors.

[HokeyReligions]

When my son was young he had some health problems. It took a loooong time to correctly diagnose the problems. There are misdiagnosis for every disease known -- doctors are only human.

 

We had discussed AD/HD ADD and my son - in fact, we saw several different doctors who all told me the same thing. The first step to treating ADD ADHD is DIET.

 

There are and have been several studies (don't know where they are now, maybe moimeme has links) linking diet and exercise patterns in children to ADD and ADHD. Especially HD. Not just "sugar highs" and typical hyperactive behavior, but the actual disease. I remember the doctors telling me that many of the subjects in the various studies (the majority of subject? Close to the majority of subject?) were able to completely keep their symptoms under control with a balanced diet and regular exercise.

 

Anyway, the doctors discussed my son's diet/exercise and we also talked about some of the drugs - but it was up to me to decide if I wanted to try the drugs if the change in diet/exercise did not show a difference. One doctor did tell me I could start him on something (Ridilin?--can't remember) now and was ready to write a 'script for it.

 

I chose to wait and we had further tests done. Turned out he did not have ADD or ADHD. He had an inherited (genetic) heart problem and epilepsy. But I *could* have had him on ADD drugs for a year or so if I had taken that one doctors advice. So I don't doubt that there are children (and adults) taking meds needlessly--for a variety of diseases they don't have.

 

We are ultimately responsible for the drugs we take, and the drugs we allow our children to take so we need to know how to talk to doctors, what questions to ask, and how to monitor ourselves.

[moimeme]

Pocky

However, considering children are raised on sugar, fast food, TV and video games, it's not surprising they have a hard time focusing in school. This doesn't mean they have AD/HD and it doesn't mean they should be on drugs.

 

am not convinced that all children that are diagnosed with AD/HD should be put on drugs. In those cases, the popularity of erroneously diagnosing a child with this disorder is a fad in my opinion

 

Considering the rate that AD/HD is being diagnosed and how many children are now taking drugs I don't think enough is being done as an alternative to taking drugs.

 

Once again, in caps so you'll see it this time

 

IF YOU PUT A CHILD WHO DOES NOT HAVE AD/HD ON MEDS, YOU WILL NOT END UP WITH A 'SEDATED' CHILD OR A COOPERATIVE CHILD. YOU WILL END UP WITH A HYPER CHILD AND REALIZE IMMEDIATELY THAT THE CHILD CANNOT HAVE AD/HD.

 

 

Moose has already proven my point regarding children being diagnosed with AD/HD and instantly receiving drugs.

 

That assumes that the process of diagnosis isn't done properly.

The first approach administered by the doctor was to place the child on drugs. Moose took that advice and gave his son drugs, however Moose took the time to consider the options and realized that his child wasn't actually doing better on the drugs.

 

In that case, he was on the wrong drug, not necessarily that drugs are not needed. There are quite a few meds now for AD/HD and, as with every med, you have to get the right dosage of the right med. That can take time

 

BlueC

don't know much about it at all, but just the sheer numbers of cases alarms me. I know a woman with 3 boys, they are all on drugs - is this statistically average?

 

Yes, absolutely. AD/HD has a huge percentage of genetic correlation - I've seen a study that had it at 90%! If one parent or another has it, it's very likely at least one of the children will have it. It also is correlated with family members with other mental ailments such as bipolar disease.

 

She says they are doing better in school & are calmer at home. I'm not aware of any other methods that were used to adjust their behaviour before resorting to medication. What are the statistics to boys vs. girls diagnosed with attention & activity disorders?

 

Boys tend to be more likely to be hyperactive, which is more easily observed and diagnosed. It seems that girls are more likely to have the 'inattentive' or 'combined' form of AD/HD and so don't become obvious to the teachers or parents. However, the estimates are that AD/HD actually affects both genders at about the same rate.

 

If you know a woman who has a constantly disorganized home and can never seem to get things accomplished, chances are she's got AD/HD. People can function very well at work and manage very badly at home - work provides a structured environment and that can be helpful to some folks with AD/HD. Others fail even despite the structured environment - they still can be chronically late, fail to accomplish things, be forgetful, and can have personality conflicts. So if you know someone like that who can't seem to keep a job despite being very smart, chances are that person has AD/HD.

 

Is this really the same kind of treatment? Do we fully understand the long-term affects that these drugs have on the brain of a child?

 

Ritalin is one of the oldest drugs - it's been prescribed and studied for over forty years. Some of the others, like Strattera, are newer.

 

In particular it will be interesting to watch crime & mental-health statistics as millions of these children become adolescents & young adults

 

Estimates now are that up to 60% of people who have been incarcerated may have AD/HD and/or learning disorders. It makes sense - those folks have trouble learning and functioning well in jobs (the ones for whom structure doesn't work) and therefore end up looking for other ways to get money.

 

LR

We are trying to turn them into us, but they aren't us. They are better than us! A great many of them are very different, and much more intelligent and some are even psychic...yes even psychic, and we just don't understand is all.

 

That's all well and fine, and Thom Hartmann has written extensively about how folks with AD/HD are actually just another sort of human, but the fact is that the planet is built for people who turn up at work on time and keep their homes tidy and don't forget their assignments so until we change all of society, folks like this will suffer. And nobody's about to change all of society.

 

would pretty much be the sedated version of his true self.

 

AD/HD meds don't turn kids or adults into zombies. Go read some AD/HD boards sometime. IF a drug does that to someone, it's the wrong drug. When they are on the right meds, the only difference, they say, is that they can finally focus. Some folks with AD/HD say that it's like having four TV stations playing in your head simultaneously.

 

Now, Pocky, and the rest, tell me exactly how you would manage your life well with a constant racket going on in your brain. The meds allow the AD/HD sufferer to 'tune in' to a single channel at a time, as it were.

 

Moose

While this may or may not be true, better than us or not, do you think that our School system should treat children diagnosed with ADD differently? Because in my opinion they shouldn't be

 

I think that slower kids should be treated differently. I think that visual-spatial learners should be treated differently. I think brighter kids should be treated differently. Ideally, schools would help ALL children so that they could learn equally well rather than trying to force them all into molds which don't fit.

 

we saw several different doctors who all told me the same thing. The first step to treating ADD ADHD is DIET.

 

This was some time ago, Hokey, when physicians were convinced that AD/HD was 'hyperactivity' and was caused by sugar. There's been a ton of science since. Sugar doesn't help, but it for sure isn't the cause. In fact, Dr. Amen says there are seven types of AD/HD and a bunch of subtypes and different foods and supplements will help each type but not enough, in most cases, that people won't need meds.

 

There are and have been several studies (don't know where they are now, maybe moimeme has links) linking diet and exercise patterns in children to ADD and ADHD. Especially HD. Not just "sugar highs" and typical hyperactive behavior, but the actual disease. I remember the doctors telling me that many of the subjects in the various studies (the majority of subject? Close to the majority of subject?) were able to completely keep their symptoms under control with a balanced diet and regular exercise.

 

Absolutely not the majority of subjects. Some subjects who don't have many severe symptoms. Hoke, AD/HD is an actual biological dysfunction of the brain. People with AD/HD have different EEG patterns than people without it. Like all humans, folks with AD/HD are sensitive to foods and can display more or fewer symptoms if their seratonin is too high or low, etc. And food can affect those things. But not enough to affect a truly effective treatment or 'cure'.

 

Dr. Amen's books are great because he does advocate all sorts of treatments, including dietary changes and supplements, but he is quite clear that these cannot be considered cures. Nor will you find any of the credible AD/HD researchers claiming it can be controlled fully or cured in most cases through diet and exercise.

[Pocky]

IF YOU PUT A CHILD WHO DOES NOT HAVE AD/HD ON MEDS, YOU WILL NOT END UP WITH A 'SEDATED' CHILD OR A COOPERATIVE CHILD. YOU WILL END UP WITH A HYPER CHILD AND REALIZE IMMEDIATELY THAT THE CHILD CANNOT HAVE AD/HD.

 

Writing it in caps doesn't make it any more true Moi. I think you're confusing the affect of these drugs. They are stimulants and this may be why you keep making the statement that a child would become more active. However, that is not always correct. These drugs cause over stimulation in children that do not have AD/HD and in that case the body is incapable of responding at a normal capacity. The body basically begins to vibrate so quickly that the child is incapable of functioning. This causes them to enter into a a zombie-like state. Since you seem to have such a fondness for quotes and adding links here's a few that support what I have been saying. You don't have to agree with my opinion, but you don't get to write in caps to try and make it seem like I don't know what I'm talking about. Sometimes, you're just not going always be right on a subject.

 

Psychiatrists have found it very difficult to diagnose ADHD; the symptoms are close to mania and depression. Proper assessment is critical because the wrong diagnosis can cause additional problems and the wrong prescription can have little or no effect on the problem. Physicians are the ones responsible for diagnosing ADHD and deciding on the dosage level of Ritalin to give a child. They should spend quality time getting to know their client. The sad thing is that this amount of assessment time is rarely ever done. It has been shown that 50% of all physicians spend an hour or less diagnosing a child and prescribing medication for them. In addition to that, most physicians do not properly monitor the medication they prescribe.

 

There are many side effects caused by Ritalin, some of which are frightening. A parent should be aware of these possibilities and question whether this drug is something they should really be giving their children. Ritalin can cause a decrease of the blood flow to the brain; it can cause gross malfunctions in the development of the brain as well. Research has found that it can cause atrophy, which is shrinkage of the brain, and other physical abnormalities that are permanent. Ritalin can cause growth retardation, a loss of appetite and weight loss; it can cause increases of the heart rate, blood pressure, body temperature and respiration; it can cause skin rashes, irritability, nervousness, anxiousness, insomnia, headaches, stomachaches, nausea and dizziness. Ritalin has been known to cause emotional problems, depression, and a proneness to crying. It can cause a child to become robotic, withdrawn, lethargic, and even suppress creative ability. About one third of all children taking Ritalin experience what is called "behavioral rebound," which causes an increase in the very behaviors the drug is supposed to be treating. This generally occurs late in the afternoon or evening after the medication begins to wear off. An additional dose is recommended late in the afternoon if the behavior is a problem.

 

http://www.n8chiro.com/article-ritalin.htm

 

 

So at first the kid is hyper and you put him on Ritalin. Then, he feels down all the time and gets depressed, so you put him on antidepressants. When he attempts to commit suicide, you put him on anti-suicide drugs and end up writing three checks to your local pharmacy instead of one. That’s good business, according to the FDA, because now the children are being taken care of by the very best high-tech medicine available anywhere in the world.

 

Are there really depressed, bummed out kids running around our country who need prescription drugs? Buy those kids an X-Box and hook them up to some interactive video games. Get them some cool science projects or some construction kits where they can build their own robots. It seems to me that these drugs for children are really marketed and purchased for the benefit of the parents who are probably more drugged out than the children ever deserved to be in the first place.

 

http://www.newstarget.com/002082.html

 

There is a sinister feeling that some similar process is at the root of the rapidly rising diagnosis of attention-deficit hyperactivity disorder in children and its treatment with Ritalin,

 

http://www.newstatesman.com/site.php3?newTemplate=NSArticle_Economy&newDisplayURN=200411150020

 

With 17 million new cases of Attention Deficit Disorder diagnosed in children each year, Ritalin has quickly become an alarming "quick-fix" solution. But for millions of children, drugs aren’t helping.

 

http://www.newsnet5.com/familymatters/3911163/detail.html

 

For starters, there is no scientific basis for the diagnosis of ADHD. If a child is bored, distracted and/or boisterous in the classroom, he is often believed to be suffering from ADHD as opposed to, say, childhood.

 

Every child in public school is required to undergo testing for attention-deficit disorder. The most recent analysis from the Centers for Disease Control and Prevention reports that 1.6 million elementary school children were diagnosed with ADHD between 1997 and 1998.

 

By drugging these children into complacency, the pharmaceutical companies make lots of money off of children acting like children. A recent study published in The Journal of the American Medical Association revealed that Ritalin has addictive qualities and cardiac side effects similar to those of cocaine. Nonetheless, doctors, school counselors and misinformed parents continue to push the stuff to kids.

 

http://www.myrtlebeachonline.com/mld/sunnews/news/opinion/10095088.htm

 

While you my disagree with my opinions regarding the rampant diagnoses of AD/HD your attempts to prove me wrong are, as I stated before, pointless. As far as the effects of the drug, if you happened to read Moose's comment you would have seen that when his son was prescribed prescription drugs he appeared to be "down" and not up like you keep claiming. Some children that do not need these drugs to lead productives lives are being turned into zombies.

 

Have you had enough? I have.

[moimeme]

Thanks for the quotes. Now let's try some credible sources like NIH, add.org, the APA, the AAFP, etc. I'm not interested in people on soapboxes touting pseudo-science.

[bluechocolate]

]Originally posted by Pocky

My dispute is that I am not convinced that all children diagnosed with AD/HD actually have it. I am not convinced that all children that are diagnosed with AD/HD should be put on drugs.[/b]

Pocky, I agree with you.

 

This from an article Examining ADHD: A Theory Constructed? by Rand Partridge, ph.D.

Whatever the end result of the journey, the development of a theory of ADHD is still at the beginning of the journey, the search for a homogeneous population resulting in consistent findings of potential interest, proving the utility of the construct.

I happen to agree that we are still at the beginning of this journey. I am not stating that ADHD doesn't exist nor that people should not be treated, but when there is still much to learn & understand I will always be cautious about treatments, whatever the ailment. But especially when those treatments consist of giving millions of children pharmaceuticals.

 

Once upon a time electric shock therapy was common practice in mental health practice and you would have found many learned doctors who could cite research in support of their theory. History is replete with medical theories which time & further study have proven wrong.

from moimeme

That assumes that the process of diagnosis isn't done properly.

The experts are still very divided on the issue of whether there even is such a thing as proper diagnosis.

 

A consensus conference of independent scientists convened by the US National Institutes of Health in 1998 found no conclusive evidence for brain dysfunction and characterised all current theories about ADHD as speculative. The conference noted that there was no simple and reliable diagnostic test and that most assessments were carried out by family doctors, with the result that there was no consistency in diagnosis, treatment or follow-up.

 

This from the medical library of the American Academy of Pediatrics:

You may have heard theories about other tests for ADHD. There are no other proven tests for ADHD at this time. Many theories have been presented. But studies have shown that the following tests have little value in diagnosing an individual child:

* screening for high lead levels in the blood

* screening for thyroid problems

* computers continuous performance tests

* brain imaging studies such as CAT scan, MRI's, etc.

* Electorencephalogram (EEG) or brain-wave test

This from A Public Health Perspective Conference, sponsored by the Center for Disease Control and the US Department of Education, September 1999

Although investigation of ADHD has been quite extensive over the past 30 years, the scientific process has been significantly slowed by the lack of a single, consistent and standard research protocol for case identification.

This from The British Medical Journal 321:975-976, October 2000 - Evidence and belief in ADHD

No validated diagnostic test exists to confirm the clinical diagnosis.

Do we fully understand the long-term affects that these drugs have on the brain of a child? Apparently not:

 

This from the National Institute of Mental Health:

Although much controversy about ADHD pertains to the number of children and adolescents using psychotropic medication, there are even more concerns about preschoolers using that same type of medication. A key worry is that there are no long-term studies evaluating the safety of using psychotropic drugs with young children. Most of the uneasiness about this age group's use of psychotropic medication relates to little or no proven efficacy for very young children, according to a study - Trends in Prescribing of Psychotropic Medications to Preschoolers.

This from the Center for Disease Control really gives me pause for thought:

 

Responses to methylphenidate in ADHD and normal children: update 2002. Rapoport JL, Inoff-Germain G.

Investigation of effects in normal children and adolescents and in those with disorders unrelated to ADHD, as well as in young adult samples, however, indicate that stimulants appear to have similar behavioral effects in normal and in hyperactive children.

from moimeme

This was some time ago, Hokey, when physicians were convinced that AD/HD was 'hyperactivity' and was caused by sugar. There's been a ton of science since.

 

The National institutes of Health Consensus Development Conference Statement on ADHD-2000 states that "some of the dietary elimination strategies showed intriguing results suggesting the need for future research". -- that was the year 2000.

from moimeme

Hoke, AD/HD is an actual biological dysfunction of the brain. People with AD/HD have different EEG patterns than people without it.

 

Yes, absolutely. AD/HD has a huge percentage of genetic correlation

Speaking of ADHD as a biologic entity, or more specifically, of it's being genetic, F.X. Castellanos, MD of the National Institute of Mental Health states in the January 2000 Readers Digest - "incontrovertible evidence is still lacking".

 

Jay N. Giedd from the National Institute for Mental Health cover article "Using Brain Anatomy to Diagnose ADHD.":

...when in fact the only physical variable between the ADHD group and normal controls was the chronic stimulant treatment status of the ADHD group. The chronic stimulant therapy, not ADHD, is the only plausible cause of the relative smallness (atrophy) in the "three major areas of brain difference in children with ADHD......... they are not specific enough to be used diagnostically."

Dr D B Double, Consultant Psychiatrist, Norfolk Mental Health Care NHS (National Health Service) Trust:

...it is not clear whether brain differences have been shown in unmedicated children

from moimeme

Estimates now are that up to 60% of people who have been incarcerated may have AD/HD and/or learning disorders. It makes sense - those folks have trouble learning and functioning well in jobs (the ones for whom structure doesn't work) and therefore end up looking for other ways to get money.

This also from A Public Health Perspective Conference, sponsored by the Center for Disease Control and the US Department of Education, September 1999:

Additionally, pharmacologic interventions often do not normalise behaviour. Research, albeit limited, suggests that even with long-term treatment, children and adults with ADHD experience substantial problems in the school, home, workplace, and community settings. this raises questions about the effectiveness of pharmacologic interventions as a long-term approach.

 

And this meta-analysis conducted by the Queensland University of Technology, the University of Auckland and the University of Queensland examined 74 different studies in which there had been an intervention that aimed to improve the behavioural, cognitive and/or social functioning of people with ADHD and ADD.

Overall, there were larger effects for medical interventions than for educational, psychosocial, or parent training interventions, but there was little support for flow-over effects, from the reduction in behaviour problems to enhanced educational outcomes. The effects on educational outcomes were greater for educational interventions than for other types of intervention.

In other words the drugs helped behaviour but did not improve grades. I've seen other studies which cite similar - that whilst the drugs seem to have a positive effect on behaviour they do not improve education and employment prospects. I've also seen a study which showed that up to 30% of children given a placebo ADHD drug show an improvement in behaviour (a huge number) and studies that show some children diagnosed with ADHD "grow out" of the behaviour in their mid to late teens with no drug intervention.

 

Larry Goldman, director of the Illinois Department of Mental Health in Chicago:

"It is clear that there are high rates of psychiatric comorbidity with ADHD that a little Ritalin is not going to solve."

Granted Lawrence Diller (author and behavioural pediatrician) has a bias, but he makes a good point when he says:

"There are powerful market forces operating on the system to promote drugs. And there are no powerful forces to promote special education and counselling." Diller cites as an example of market forces at work in a national advertising campaign by Alza Corporation, manufacturer of Concerta (a long acting stimulant medication approved by the FDA for use with children who have ADHD). Alza's one and two page advertisements have been appearing in national parent and family magazines. The ads promise that this latest treatment for ADHD can help make homework a more relaxing time.

The following statistics were sourced from the US Food and Drug Authority some of which was cited in The American Medical Association Journal:

* The number of preschool children being treated with medication for ADHD tripled between 1990 and 1995

* The number of children ages 15 to 19 taking medication for ADHD increased by 311 percent over 15 years

* ages 5 to 14 also increased by approx. 170 percent

* White suburban elementary children are given medication to treat ADHD at more than two and a half times the rate of African American students

* Ritalin is manufactured at two and a half times the rate of 10 years ago

* The majority of children and adolescents who receive stimulants for ADHD do not fully meet the criteria for ADHD

* Many children who do meet the criteria for ADHD are not being treated

* 80 percent of 11 million prescriptions for methylphenidate (Ritalin) are written for children each year

* production of Adderall and Dexedrine (also used to treat ADHD) has risen 2,000 percent in nine years

* The United States produces and consumes about 85% of the world's production of methylphenidate according to United Nations data

[moimeme]

Sighhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

 

History is replete with medical theories which time & further study have proven wrong.

 

Look, BlueC, I'm not saying caution is not warranted, but there's a difference between being cautious about any drug therapy and being skeptical. I don't think skepticism about AD/HD is warranted at all due to the newest research. Certainly it would be ideal if other than drugs worked, but so far, that's all we got. It would be ideal if chemotherapy didn't destroy good cells, too, but you don't let the cancer patient die because chemotherapy has unpleasant effects. You keep working - HARD - to improve diagnosis and treatment, but you don't refuse to treat the patient just because the existing treatments aren't perfect.

 

A consensus conference of independent scientists convened by the US National Institutes of Health in 1998 found no conclusive evidence for brain dysfunction and characterised all current theories about ADHD as speculative.

 

This is all very new research. 1998 was six years ago. Things have moved forward very rapidly. It behooves people who wish to discuss the issue to check out the most recent information.

 

there is general consensus that AD/HD is a valid disorder with severe, lifelong consequences (NIH, 2000; U.S. Surgeon General's Report, 2001)

http://www.help4adhd.org/en/about/myths#myth1

 

And again this year

"The compelling results of this survey reinforce the fact that ADHD is a serious medical condition causing significant, life-long impairments," said Joseph Biederman, MD, professor of psychiatry, Harvard Medical School

http://www.medscape.com/viewarticle/488329?src=search

 

What is ADHD? What are its signs? 2001

http://www.aafp.org/afp/20010901/831ph.html

 

Roughly 100 scientists from the international community created the consensus statement as a reference on the status of the scientific findings concerning this disorder. "As a matter of science, the notion that AD/HD does not exist is simply wrong. All of the major medical associations and government health agencies recognize AD/HD as a genuine disorder because the scientific evidence indicating it is so overwhelming."

from chadd.org

 

2002 International Consensus Statement on AD/HD

Citation: Clinical Child and Family Psychology Review 5(2): 89-111, 2002

Full-Text:

http://www.kluweronline.com/issn/1096-4037/contents

 

ADHD continues to be a serious health problem. Adequate treatment is needed to avoid academic impairments, social dysfunction, and poor self-esteem. This treatment includes consideration of stimulant medication, nonstimulant medication, as well as alternative therapies. The child with ADHD is likely better served with a mutimodal treatment plan, including medication, parent/school counseling, and behavioral therapy. Implementing an evidenced based algorithm for the treatment of ADHD may prove to be most effective.

Curr Opin Pediatr. 2004 Apr;16(2):217-26

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uid15021207

 

The experts are still very divided on the issue of whether there even is such a thing as proper diagnosis

 

Well, not really. All the major medical associations have established clinical guidelines for the 'proper' diagnosis of AD/HD.

 

http://www.aafp.org/afp/20010901/817.html

Parents and teachers should understand that a careful and complete evaluation will span several office visits and may require special testing or consultation. Parents and teachers can better accept the postponement of immediate treatment if the physician communicates an understanding of the behaviors that concern them, indicates a shared commitment to doing what is best for the child and explains the elements of a stepwise, comprehensive approach to the proper diagnosis of the child's problem behaviors.

 

Clinical Practice Guideline: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder, May 2000

Citation: Pediatrics 105 (5): 1158-70, 2000

Full-Text: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b105/5/1158

 

Current ADHD symptoms can be assessed using standardized rating scales.54 Scales for adults typically contain the 18 ADHD symptoms from the DSM-IV,1 each of which is rated on its frequency in the past 6 months using a 4-point scale, from 0 (never or not at all) to 3 (very often or very much). A patient is considered to meet the diagnostic criteria for ADHD–inattentive type if he or she has significant difficulty (a score of 2 or 3) for 6 or more of the 9 items on the list of inattentive symptoms. A patient is considered to have ADHD–combined type if he or she also has significant difficulty (a score of 2 or 3) for 6 or more of the 9 items on the list of hyperactive/ impulsive symptoms

http://www.cmaj.ca/cgi/content/full/168/6/715

 

But there may be problems in your country with what physicians are doing in this regard:

However, deficiencies have been reported in the way that physicians in the United States assess and manage children presenting with features of ADHD.9,14,15

CMAJ • November 27, 2001; 165 (11)

 

Do we fully understand the long-term affects that these drugs have on the brain of a child?

 

You are citing concerns about preschool kids. Not sure why you'd start treatment in preschool years anyway. Meds have been used for kids with AD/HD for 50 years so short-term use is seen to be safe. In terms of long-term use, it is possible, I think, that if kids are diagnosed early and receive a lot of therapy to learn how to deal with AD/HD issues and to learn coping strategies, they may need fewer meds. There are, as I said, reasons that diet and exercise and supplements can work, too, for some types of AD/HD, to lessen the symptoms.

 

Children with ADHD treated with stimulants for as long as 2 years continue to benefit from the treatment, with improvements observed in ADHD symptoms, comorbid oppositional defiant disorder, and academic and social functioning, with no significant problems of tolerance or adverse effects.

Long-term adverse effects from stimulant treatment in childhood regarding adult height or future substance abuse have not been supported by existing studies.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uid14658920

 

This from the Center for Disease Control really gives me pause for thought:

 

 

I think you'll want to wait for a bunch more studies to show the same results before you jump on that one. The meds work for kids with AD/HD. That's the important fact.

 

Despite wide variations in subject selection, types of trials, degree of methodological rigor, and the decade in which the studies took place, the evidence is remarkably consistent The overall results suggest significant clinical impact upon the core features of ADHD. More studies of long-term effects and special populations such as older adolescents and adults will be necessary, though existing evidence strongly supports similar findings as for the younger patients with a diagnosis of ADHD.

from pubmed article cited above

 

Additionally, pharmacologic interventions often do not normalise behaviour. Research, albeit limited, suggests that even with long-term treatment, children and adults with ADHD experience substantial problems in the school, home, workplace, and community settings. this raises questions about the effectiveness of pharmacologic interventions as a long-term approach.

 

Yes, I imagine that it is limited given the wealth of research that shows otherwise. Too, many experts think that counselling is also required to help people manage their symptoms and behaviours.

 

Wilens and McDermott have reported benefits of using cognitive behaviour therapy in combination with medication in this population.73 It is hoped that future studies will investigate the efficacy of other psychological treatments designed to help adults with ADHD.

http://www.cmaj.ca/cgi/content/full/168/6/715

 

The bedrock of ADHD treatment, many experts believe, is behavioral therapy, emotional counseling, and/or practical support. Combining these three approaches with medication offers the best chance of significant, long-lasting improvement, according to the National Institute of Mental Health. Clinical trials are underway to test this idea.

 

The National institutes of Health Consensus Development Conference Statement on ADHD-2000 states that "some of the dietary elimination strategies showed intriguing results suggesting the need for future research". -- that was the year 2000.

 

Speaking of ADHD as a biologic entity, or more specifically, of it's being genetic, F.X. Castellanos, MD of the National Institute of Mental Health states in the January 2000 Readers Digest - "incontrovertible evidence is still lacking".

 

HYPERACTIVITY OF CHILDHOOD

Gene map locus 17p11, 16p13, 6q12, 5p13, 5p15.3, 4p16.1-p15.3

 

TEXT

 

A number sign (#) is used with this entry because of evidence that multiple loci may contribute to the phenotype of attention deficit-hyperactivity disorder. Several loci have been found to be associated with susceptibility to ADHD, including ADHD1 (608903), ADHD2 (608904), ADHD3 (608905), and ADHD4 (608906).

http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=143465

 

However, family, twin and adoption studies have provided strong evidence for a genetic etiology of the disorder

http://www.cmaj.ca/cgi/content/full/168/6/715

 

Adoption and twin studies confirm that genetics play a significant role in the evolution of ADHD. Monozygotic twins demonstrate a 2-fold greater risk of ADHD compared with that for dizygotic twins. The dopamine receptor has been implicated as a possible genetic factor. Several subtypes of the dopamine receptor have been identified and the dopamine-2 (D2) receptor has been implicated most frequently in schizophrenia. The D4 receptor is distributed in the frontal cortex as well as in the hippocampus and entorhinal cortex. There are 8 variants of the D4 receptor. The D4,4 variant is found in 66% of the population. The D4,7 receptor variant is more commonly found in individuals with high scores on tests of impulsiveness, excitability and novelty-seeking behavior. D4,7 is also found most often in patients with ADHD.

http://www.medscape.com/viewarticle/412883?src=search

 

 

 

Dr D B Double, Consultant Psychiatrist, Norfolk Mental Health Care NHS (National Health Service) Trust:

it is not clear whether brain differences have been shown in unmedicated children

 

Don't know if he's been to the conferences or read the articles on the dopamine differences.

 

Growing evidence suggests that the pathophysiology of ADHD may be closely related to how dopamine modulates the frontostriatal pathways, but this may not be a disorder that is exclusively affected by a single neurotransmitter system.

http://www.medscape.com/viewarticle/464789?src=search

 

In other words the drugs helped behaviour but did not improve grades. I've seen other studies which cite similar - that whilst the drugs seem to have a positive effect on behaviour they do not improve education and employment prospects.

 

I find that hard to believe and would like to see those studies. However, improving behaviour, mood, and self-esteem may prevent people with AD/HD from suffering the considerable difficulties that beset untreated adults who have AD/HD:

 

The self-esteem of children with Attention Deficit Hyperactivity Disorder (ADHD) has been shown to be low. The effects of stimulant medication upon their self-esteem have not been systematically studied. The present study employed a reliable self-report instrument to measure the self-esteem of children with ADHD medicated with stimulants vs. those who were unmedicated. Results showed that stimulants were associated with significantly higher self-esteem. Children with ADHD prescribed stimulants reported feeling more intelligent and more popular than unmedicated children with ADHD. Children with ADHD and Oppositional Defiant Disorder (ODD) prescribed stimulants reported feeling better behaved. Significant correlations indicated that higher doses were associated with higher self-esteem. The present results suggest a need for a well-controlled study to determine if stimulants were responsible for the observed differences in self-esteem.

Pediatrics. 2004 Nov;114(5):e541-7.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uid10521011

 

The results support prior findings of high ADHD prevalence in prison inmates and suggest that emotional and internalizing abnormalities are prominent problems in this population. Further studies are needed to elucidate the role of ADHD as an independent factor for life-persistent criminality, since specific treatment may help to ameliorate the legal prognosis.

Eur Arch Psychiatry Clin Neurosci. 2004 Aug;254(4):201-8.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uid15309387

 

Many negative consequences result from the untreated condition including antisocial behavior, poor vocational and social functioning, and difficulties with substance abuse. Despite these many difficulties, psychopharmacologic and therapeutic interventions may successfully improve the negative outlook.

 

I've also seen a study which showed that up to 30% of children given a placebo ADHD drug show an improvement in behaviour (a huge number) .

 

"A" study does not conclusive evidence make.

 

The scientific literature concerning the treatment effects of stimulant medications is the largest in child psychiatry and one of the largest in general psychiatry. By 1996, 155 controlled studies involving more than 5000 children had been reported.3 Over the years, a number of reviews have concluded that the administration of methylphenidate dramatically decreases the core symptoms of ADHD, which include hyperactivity, impulsiveness and inattention.4 The data also consistently indicate that methylphenidate is more efficacious than nonpharmacological interventions.,

http://www.cmaj.ca/cgi/content/full/165/11/1505

 

Short-term studies ranging from several weeks up to 3 months indicate that approximately 70% of patients respond to the first stimulant agent administered, with resulting improvement in their ADHD symptoms. Moreover, extended trials over 12 months or longer suggest that symptomatic improvement persists as long as the stimulant medication is taken.[3]

http://www.medscape.com/viewarticle/464377?src=search

 

and studies that show some children diagnosed with ADHD "grow out" of the behaviour in their mid to late teens with no drug intervention

 

Um. Don't think so. In fact, studies overwhelmingly show differently.

 

Statistically, the effect of methylphenidate is considered "large," that is, the difference between methylphenidate and placebo on rating scales of ADHD symptoms is about 0.8 standard deviation or greater. Clinically, this can mean the difference between a child who has major problems concentrating, and is viewed as problem by teachers and parents alike, and a child who is very close to normal for the age group. The rate of improvement approaches 80% on methylphenidate and is less than 15% on placebo

http://www.cmaj.ca/cgi/content/full/165/11/1505

 

Early research suggested that ADHD should resolve with age and maturation and that initial perception of ADHD as primarily a childhood disorder has been an obstacle for diagnosis and treatment in adults. However, follow-up studies have suggested that up to 60% of children with ADHD will have symptoms persisting into adulthood.[3] In their review of more than 1,700 cases of adults with ADHD diagnosed in childhood, Spencer et al[4] found that 663 of those studied continued to meet criteria for ADHD as adults. Borland and Heckman[5] compared adults who had ADHD with their normal siblings. They found that 50% of the adults with ADHD diagnosed during childhood had a syndrome of restlessness, difficulty with concentration, and impulsive behavior that persisted into adulthood, as opposed to just 5% of their unaffected siblings. That ADHD indeed does persist into adulthood and the growing perception that the adult version carries with it a significant comorbidity with affective, anxiety, personality, and substance abuse disorders has brought about a growing recognition that addressing adult ADHD should be an area of investigation and treatment.

http://www.medscape.com/viewarticle/439439?src=search

 

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) IS ESTIMATED to affect 2%–6% of adults. The symptoms in adults with ADHD mirror those in children with the disorder and are associated with significant educational, occupational and interpersonal difficulties[.b]

http://www.cmaj.ca/cgi/content/full/168/6/715

 

 

The following statistics were sourced from the US Food and Drug Authority some of which was cited in The American Medical Association Journal:

 

Lies, damn lies, and statistics. One man was employed in the only company in a tiny nation. He was laid off. Newspapers reported 'Unemployment Rate Rises To 100%'

 

Goldman et al. (1998) reported that 2.8 percent of elementary-aged students were on medication, and that stimulants accounted for 99 percent of the prescribed medications. So while there has been an increase in the number of prescriptions, a relatively low overall rate of stimulant use is reported in school-aged children. Physicians in the community tend to use less than optimal doses, have fewer follow-up monitoring sessions, and less medication compliance than recommended by the MTA study (Jensen et al., 2001).

from chadd.org

 

You may have heard theories about other tests for ADHD. There are no other proven tests for ADHD at this time.

 

I'm not saying that tests are regularly used at this point, but that they have been found to work and will likely be expanded on in the future.

 

PET, SPECT Studies Find More Evidence of Dopamine's Role in ADHD

Released here at the 50th annual meeting of the Society of Nuclear Medicine, the studies offer new evidence of the role played by methylphenidate (Ritalin) in modifying behavior, and at least one laboratory test shows promise as a diagnostic to objectively diagnose ADHD.

June 24, 2003

http://www.medscape.com/viewarticle/457770?src=search

 

and, in fact, from your own citation of Rand above:

In developing marker tasks and utilizing functional neuroimaging applicable to normal populations, these researchers are advancing the field of AD/HD and bringing the day closer when a positive test for AD/HD will be possible, for at least some form of AD/HD.

[bluechocolate]

::::SIGH H H H H H H H H H H H H H H H:::::::::::::: and yawn

 

My concern is the very real possibility that millions of children are being wrongly diagnosed or diagnosed improperly & on the basis of such are being fed billions of dollars worth of drugs. The jury is still out on some rather important factors, such as diagnosis, prevalence and treatment (we can quote studies back-and-forth, that only serves to prove my point). To my mind those are things we should be a little more certain of before we start doping up the nation. Your own citings here say things like:

.....at least one laboratory test shows promise as a diagnostic to objectively diagnose ADHD.

Shows a promise? At least one test?? This is hardly deductive.

Despite broad endorsement for using ADHD-specific behavior rating scales and DSM-IV criteria to diagnose and monitor ADHD, most primary care physicians use neither.

I lifted that from your link: http://www.aafp.org/afp/20010901/817.html

 

 

This is all very new research. 1998 was six years ago.

 

And some of the research I looked at was conducted less than 24 months ago. What exactly is your acceptable time frame?

 

 

You are citing concerns about preschool kids. Not sure why you'd start treatment in preschool years anyway

 

Because hundreds of thousands of preschoolers are being prescribed the same drugs & have been since the early to mid 90s.

 

The data also consistently indicate that methylphenidate is more efficacious than nonpharmacological interventions. http://www.cmaj.ca/cgi/content/full/165/11/1505

More efficacious for treating what? Behaviour only? I've mentioned studies which show little flow-on benefits (ie. better grades, less tendency to crime, etc.) but we'll dismiss those out of hand also. What are the measurable benefits from the massive increase in the amounts of these drugs that are being taken? And I refuse to discount the role that multi-national pharmaceuticals play in marketing & distributing their products. Don't kid yourself, they do not have the nations health in their mission statements.

 

and studies that show some children diagnosed with ADHD "grow out" of the behaviour in their mid to late teens with no drug intervention

Um. Don't think so. In fact, studies overwhelmingly show differently.

 

Now that's strange. This again from one of your links:

 

An evidence-based review by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) found that most studies of ADHD treatments were limited by one or more design deficiencies in sample size, descriptions of primary outcomes, measurement of compliance or assessment for comorbid disorders.4 Despite these limitations, the authors of the review concluded that ADHD symptoms tend to improve over time with or without treatment, ...http://www.aafp.org/afp/20010901/817.html

 

"A" study does not conclusive evidence make.

 

Now you're just being funny.

 

The following statistics were sourced from the US Food and Drug Authority some of which was cited in The American Medical Association Journal:

Lies, damn lies, and statistics. One man was employed in the only company in a tiny nation. He was laid off. Newspapers reported 'Unemployment Rate Rises To 100%'

 

And now you're being hysterical. You have something against the FDA & the AMA?

 

I think you'll want to wait for a bunch more studies to show the same results before you jump on that one. The meds work for kids with AD/HD. That's the important fact.

 

What about that particular study didn't you like? Was 2002 not recent enough? They showed that the meds also appeared to work for kids without ADHD. Don't you find that important too? Nevermind, we'll just over look that one.

 

 

and, in fact, from your own citation of Rand:

In developing marker tasks and utilizing functional neuroimaging applicable to normal populations, these researchers are advancing the field of AD/HD and bringing the day closer when a positive test for AD/HD will be possible, for at least some form of AD/HD.

And your point? "bringing the day closer when a postive test for ADHD will be possible, for at least some form...." ?? So we don't have such a test but we'll prescribe these drugs in exponential quantities anyway. Sounds wise to me.

 

Dr D B Double, Consultant Psychiatrist, Norfolk Mental Health Care NHS (National Health Service) Trust:

it is not clear whether brain differences have been shown in unmedicated children

Don't know if he's been to the conferences or read the articles on the dopamine differences.

 

Oh well, he musn't have anything worthy to say on the subject then.

 

In other words the drugs helped behaviour but did not improve grades. I've seen other studies which cite similar - that whilst the drugs seem to have a positive effect on behaviour they do not improve education and employment prospects.

I find that hard to believe and would like to see those studies.

 

Oh well, 3 Universities looked at data from 72 different studies & you find it hard to believe.

 

and again from one of your links:

Although stimulant medications improve core ADHD symptoms in up to 80 percent of properly diagnosed children, the diagnosis of ADHD cannot be reliably confirmed or excluded based on a positive or negative response to stimulants.3,19-21,24 Stimulant medications may improve excessive physical activity, inattention, impulsivity and poor self-control, physical and verbal aggression, and low academic productivity. Treatment with these agents may not improve antisocial behavior, reading skills or academic achievement.

[moimeme]

My concern is the very real possibility that millions of children are being wrongly diagnosed or diagnosed improperly & on the basis of such are being fed billions of dollars worth of drugs.

 

Well, if you are intent, as apparently you are, on believing a myth, be my guest. I posted a ton of links saying differently and you chose not to believe so go ahead.

 

The jury is still out on some rather important factors, such as diagnosis, prevalence and treatment (we can quote studies back-and-forth, that only serves to prove my point).

 

No, actually, the studies you quoted were older. I told you already that a lot of research has been done recently. So even 1988 is real old news when it comes to AD/HD.

 

Shows a promise? At least one test?? This is hardly deductive.

 

What's your problem? There is a very extensive protocol for diagnosing AD/HD. I posted several practice guidelines for it. You could always read them.

 

Because hundreds of thousands of preschoolers are being prescribed the same drugs & have been since the early to mid 90s

 

Oh really. And where's your proof of that?

 

More efficacious for treating what? Behaviour only?

 

'only'? That's massive. I bet you haven't lived with someone with AD/HD. I bet you haven't the faintest idea what that kind of behaviour can be like. Behavioural problems cause problems in every single walk of life. 75% of people with Ad/HD have trouble relating to people. I posted links talking about the incarceration rates and other social issues. Behaviour is HUGE and is the key to them living better lives. I bet you also haven't talked to anybody with AD/HD and heard their stories or any spouses or partners of ADHD sufferers. You're just spouting stats over a concern about something that's not touched you, aren't you?

 

and studies that show some children diagnosed with ADHD "grow out" of the behaviour in their mid to late teens with no drug intervention

 

Now that's strange. This again from one of your links:

to improve over time with or without treatment

 

Um again. 'Improve over time' does not mean 'improve dramatically' or 'improve radically' and it absolutely does NOT mean 'grow out of'. That people get a little less forgetful or a little less scatterbrained does not mean they aren't still forgetful or scatterbrained. You've misinterpreted the results - I also posted a number of comments from professionals to the effect that AD/HD poses significant long-term difficulties in people's lives.

 

And let's not play 'quote only a tiny bit of the study', shall we. The very next sentences state:

 

that stimulant medications and desipramine improve core symptoms more effectively than placebo, and that currently available stimulants have equal efficacy.

 

Although stimulant medications improve core ADHD symptoms in up to 80 percent of properly diagnosed children, the diagnosis of ADHD cannot be reliably confirmed or excluded based on a positive or negative response to stimulants.3,19-21,24 Stimulant medications may improve excessive physical activity, inattention, impulsivity and poor self-control, physical and verbal aggression, and low academic productivity. Treatment with these agents may not improve antisocial behavior, reading skills or academic achievement.

 

And now you're being hysterical. You have something against the FDA & the AMA?

 

What is it with men and name-calling? No, I have something against one-liner stats being used out of context.

 

They showed that the meds also appeared to work for kids without ADHD. Don't you find that important too? Nevermind, we'll just over look that one

 

Once again, that was a study. One single study. And so what? The fact that it works for kids with AD/HD is what's important. They need it. I still am not about to consider a single study to be definitive.

 

we don't have such a test but we'll prescribe these drugs in exponential quantities anyway

 

Now it's hyperbole. There are extensive diagnostic guidelines, which you seem not yet to have read. And it is just that now more kids with AD/HD are being diagnosed where before people thought the kids were lazy, stupid, or selfish. Now they get treated and manage better where before they were considered problems, mistreated by kids and teachers, ended up with crappy self-esteem, and often landed in jail. Now what is your complaint again? Oh, you'd prefer kids with real disorders go untreated and end up in the ditch?

 

Don't know if he's been to the conferences or read the articles on the dopamine differences.

Oh well, he musn't have anything worthy to say on the subject then.

 

Well, if all he knows is outdated information, then that's exactly right. He can blather on about there being no brain differences, but there are studies which prove that's simply not true. Physicians of all professions need to remain current with the newest discoveries in medicine. If that dude isn't, then he's not worth listening to. Or maybe you'd like to take up smoking for your health since doctors used to recommend that before science learned differently.

 

 

Oh well, 3 Universities looked at data from 72 different studies & you find it hard to believe.

and again from one of your links:

 

Stimulant medications may improve excessive physical activity, inattention, impulsivity and poor self-control, physical and verbal aggression, and low academic productivity.

 

Treatment with these agents may not improve antisocial behavior, reading skills or academic achievement.

 

Well you have to admit that the two bolded sections appear contradictory. Anyway, again, that misses the point entirely. People do not succeed in life if they are impulsive, have poor self-control, and are aggressive, now do they? So you think people should just be left alone to be as troubled as all that because somehow not giving them a medication which corrects their dopamine levels is evil but allowing them to disintegrate into non-productive dysfunctional lives is kind?

 

You're trying to jump on the bandwagon that AD/HD is over-diagnosed and over-drugged. There's a ton of research saying that the opposite is true. I urge you, no I BEG you to go spend some time on some AD/HD boards or else meet some actual humans rather than chewing up statistics. Talk to people like my ex who, his entire life, has felt bad and wrong because he couldn't behave the way he was supposed to. Talk to people I've met in their forties and older who say being on meds has given them their lives back. Talk to kids who had nothing but trouble in school until they got help. Don't just park yourself in your study and yatter about these people as though they are only statistics.

 

People like you are only doing harm in your anti-drug zealotry.

[bluechocolate]

I posted a ton of links saying differently and you chose not to believe so go ahead.

 

Your links are better than mine & what you provide could only be the absolute truth on the matter.

 

Oh really. And where's your proof of that?

 

Lies, damn lies!!

 

You're just spouting stats over a concern about something that's not touched you, aren't you?

 

That is really very rich. "spouting stats" You know someone with ADHD therefore you know more than anyone else (btw - those 3 boys I mentioned - they're family & gosh yes there is more but that doesn't make me any kind of expert on that matter & I would never presume to imply that it does).

 

And let's not play 'quote only a tiny bit of the study', shall we.

 

oh dear

 

What is it with men and name-calling? No, I have something against one-liner stats being used out of context.

 

What is it with women know-it-alls? Oh please. "And now you're being hysterical". Perhaps I truly was laughing?

So prove the stats wrong then. You can quote a study which shows that prescription rates HAVE NOT gone up? That drug production HAS NOT gone up? That the majority of children and adolescents who receive stimulants for ADHD FULLY meet the criteria for ADHD? That 80 percent of 11 million prescriptions for methylphenidate (Ritalin) are NOT written for children each year. That the United States DOES NOT produce and consume about 85% of the world's production of methylphenidate according to United Nations data?

 

I still am not about to consider a single study to be definitive.

 

Um no. Actually I've read it more than once & a single study conducted by 3 universities that looked at 72 other studies?? I'm not going to provide links - it's out there & not difficult to find. And I've no doubt that if you did come across it you would dismiss out-of-hand because you seem to have reached a pre-determined conclusion on something that not even the "experts" are in full agreement over. Oh wait, I get it. Those experts who don't support your conclusions are not as "up" on the topic as you are - that is the only possible explanation.

 

And it is just that now more kids with AD/HD are being diagnosed

 

Being diagnosed correctly? One more time:

 

Despite broad endorsement for using ADHD-specific behavior rating scales and DSM-IV criteria to diagnose and monitor ADHD, most primary care physicians use neither.

I lifted that from your link: http://www.aafp.org/afp/20010901/817.html

How many of these children are being diagnosed & prescribed drugs from their primary care physicians?

 

Physicians of all professions need to remain current with the newest discoveries in medicine. If that dude isn't, then he's not worth listening to.

 

What you really mean to say is that dude, who happens to be a working psychiatrist in a large NHS Trust, is saying something that you don't agree with therefore he must be wrong.

 

Or maybe you'd like to take up smoking for your health since doctors used to recommend that before science learned differently.

 

Thank you for illustrating my point for me once again.

 

People like you are only doing harm in your anti-drug zealotry.

 

oh dear, "people like me..." "only doing harm......."

 

Don't just park yourself in your study and yatter about these people as though they are only statistics.

 

I am really curious to know what exactly it is that makes you the only sole authority figure on the subject - (not really actually)

 

The last word is all yours - this is really boring now.

[moimeme]

Your links are better than mine & what you provide could only be the absolute truth on the matter.

 

Now you're getting it

 

That is really very rich. "spouting stats" You know someone with ADHD therefore you know more than anyone else

 

No. I lived with someone with it and, because of that, am now part of an association that advocates for people with AD/HD. In an attempt to figure out how to make our relationship work, I researched the topic extensively for six months. And I mean 'extensively'. As in daily, all day, reading everything I could get my hands on, communicating with experts and with people with AD/HD and their partners. Like I said, I have hundreds of articles and websites on the topic.

 

What is it with women know-it-alls?

 

And what is it with men who throw that lame phrase at women who are extensively read and who make every effort to ensure that they don't post information on topics without researching them? If I were a 'know-it-all', I would post on every single topic but I don't. I am very interested in *many* subjects, I love to learn, and I am constantly reading and learning. Plus, I'm a researcher by trade so I am, if anything, a 'research-it-all'. And I have no idea why someone would get in a snit about that. Did you spend six straight months researching AD/HD?

 

Oh please. "And now you're being hysterical". Perhaps I truly was laughing?

 

A stock male phrase to denigrate women. Shoulda chosen something else.

 

So prove the stats wrong then. You can quote a study which shows that prescription rates HAVE NOT gone up?

 

That is not the point. Gawd.

 

Lumpectomies have gone up. Medications for all conditions have gone up. Physicians were not knowledgeable about AD/HD and nobody was recognizing it for a long time. Now they are. So of course there are many more diagnoses and prescriptions. Did you actually read the stats??? The estimates are that four to ten per cent of all kids have AD/HD. They are all saying it is the *most common childhood condition*. So of course there will be a lot of diagnoses and subsequent treatments. And thank god for it. Those kids will no more be considered 'behaviour problems' and will be treated properly.

 

That drug production HAS NOT gone up? That the majority of children and adolescents who receive stimulants for ADHD FULLY meet the criteria for ADHD? That 80 percent of 11 million prescriptions for methylphenidate (Ritalin) are NOT written for children each year. That the United States DOES NOT produce and consume about 85% of the world's production of methylphenidate according to United Nations data?

 

None of those issues are a problem. 11 million prescriptions in a nation of 300 million people when the incidence of AD/HD is four per cent or higher is not excessive. As people say, do the math. That the US is using more meds has entirely to do with the fact that the US is ahead of everybody else now they've finally figured out that this is a problem and how to treat it. Stories from sufferers in Britain and their families show a very different picture. There are many fewer resources and many fewer knowledgable physicians. So, duh. That's what I mean about statistics - taken out of context they look all scary - ooooo - but when you analyze them, you realize that the big scary statistics are no big deal after all.

 

Um no. Actually I've read it more than once & a single study conducted by 3 universities that looked at 72 other studies??

 

There have been 5000 studies on Ritalin alone. And, again, even if so, so what? Really. A HUGE percentage of people with AD/HD have comorbid learning disorders so of course they may not do that much better in school academically and they will need treatment for the comorbidities. However they will succeed in their relationships and they will feel better about themselves which, as I also pointed out, is critical. Much more so, surely you realize, than what marks you get in grade school.

 

Being diagnosed correctly? One more time:

 

Despite broad endorsement for using ADHD-specific behavior rating scales and DSM-IV criteria to diagnose and monitor ADHD, most primary care physicians use neither.

 

And that's why all parents need to be knowledgable about AD/HD and the diagnosis guidelines and demand their physicians use them. However, again, most kids put on the wrong drugs will not improve. The study I have been questioning is the single study you said showed that 'normal' kids do better on the meds, too. I'd be surprised if that were true.

 

However, if parents are too lazy to educate themselves about how their kids' illnesses should be diagnosed and if they are not reporting complaints to medical associations, what's to be done? Not denying kids who do have AD/HD treatment, for sure. The cure for your complaints is that parents take the trouble to educate themselves. I've provided links to two diagnostic guidelines which are freely available on the 'net. Most people have the internet and, according to you, people like myself who know how to research are as common as dirt so there is NO excuse for parents who can't find this stuff out, is there?

 

How many of these children are being diagnosed & prescribed drugs from their primary care physicians?

 

I don't know. Used to be that only psychiatrists could do that but the rules changed. If you think it's a problem, complain to the medical associations and medical schools. If you are going to get exercised over physician skills, then take your complaint to the people who can solve the problems. Don't take it out on kids. And, as I said:

 

Physicians of all professions need to remain current with the newest discoveries in medicine. If that dude isn't, then he's not worth listening to.

 

What you really mean to say is that dude, who happens to be a working psychiatrist in a large NHS Trust, is saying something that you don't agree with therefore he must be wrong.

 

You bet your butt he is. One of the biggest problems for people who have AD/HD is finding psychiatrists and other professionals who have been trained in diagnosing and treating AD/HD. Big surprise, Blue - not all physicians know everything about everything. There is too much knowledge coming out too fast about all ailments. These days, patients need to be their own health advocates and to get their own information together about conditions they have - and pass that on to their physicians.

 

I repeat - any parent who is satisfied with a physician who does not do a full differential diagnosis of a child is to blame. In the end, the parents are the guardians of their childrens' well-being. If there is a problem with misdiagnoses, then you need to aim your proselytizing at telling parents to ensure their caregivers are doing their jobs properly, but then back off and accept a diagnosis of AD/HD if it's been done properly. Of course they have to then observe the efficacy of the treatment, but to flat out refuse meds or to deny the kids have AD/HD or that it is a real condition will only prolong people's suffering.

 

And if you haven't spoken to adults who had to deal with being undiagnosed and untreated for lifetimes, you might have a little more concern over the UNtreated people than over the myth that kids are over-diagnosed.