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Wednesday, April 2, 2014

What is ADHD (ADD)?

What is ADHD?

ADHD is a syndrome, not a disease (see end of post for more information about this distinction). A syndrome is a set of symptoms where the cause of any one or all of the symptoms is not known. Irritable Bowel Syndrome (IBS) is one example of a medical syndrome; the cause of IBS is not known, but there are many factors that are related (correlated) to any one or all of the symptoms.

Academic demands have dramatically increased since
the 1950's as American society has moved from a low-skilled
labor force to one that is based in Science, Technology, and Math.**

     All of the diagnosis in the DSM classification book are syndromes. Many people are told to believe that the cause of these syndromes are biological, such as genetic or "chemical." However, this is not true. Genes and neurotransmitters underlie all thoughts, feelings and behaviors, however, there is no such things as a chemical imbalance that could be said to cause ADHD, depression, anxiety, Bipolar disorder or other disorders. Also, genes work in a reciprocal manner; they play a role, but genetic correlations for mental illness are too weak to be considered "the cause" or mental illness.

Certainly biology plays a role in ADHD, but it is only one factor, 
and the degree to which biological factors contribute to any 
one child's behavior problems cannot be determined
by modern scientific methods.

     Many psychiatrists make the claim that stories from the 1800's and early 1900's like "fidgety Phillip," by German physician, Heinrich Hoffmannor, or "mental restlessness," by Sir Alexander Crichton, or the presentations on moral deficiency by Dr. George Still are evidence and confirmation that ADHD is a disease that was discovered and elucidated by modern medicine. However, these old medical anecdotes are completely unreliable with regards to ADHD, because, we have no biological markers to look at; even if there were preserved specimens for research, there's no bio-markers to measure. All we have are vague reports of various behavior problems. Prior to 1980, evaluations of children were rudimentary and scientific knowledge of child development was non-existent prior to the 1950's.

So, ADHD is a syndrome, but what kind of syndrome?

ADHD is a behavioral syndrome. Although the syndrome is named "Attention Deficit," the symptoms of ADHD have no direct connection to a child's (or adult's) ability to pay attention. In fact, there is absolutely no available method to measure a person's attention span. Behaviors like, "fails to pay attention," or "seems like he is driven by a motor," or "fails to give close attention to details," are nothing more than observations that people can make about a child's behavior, and the big assumption is that, if a child has these behaviors, it means their attention-span or ability to "pay attention" is somehow disabled. However, this is a false assumption considering it is not possible to directly measure attention span in order to confirm that the cause of the behavior problems has anything at all to do with attention span.

Why is ADHD so controversial?

ADHD is probably the most controversial mental health diagnosis. What sets ADHD apart from other DSM diagnosis is that it is one most common diagnosis used by psychiatrists, and it is applies to children. However, all of the diagnosis in the DSM are controversial because they are non-scientific syndromes. They are non-scientific for several reasons: 1) they are very subjective, 2) the symptoms for each diagnosis are arbitrary and vague, and 3) the process to determine what constitutes a mental illness is non-scientific. 

There is no test for ADHD. For example, there are no scans, no blood tests, 
or other biological markers to determine if someone has ADHD or any other 
mental health problem, including Bipolar disorder or Schizophrenia. 
There are screening forms, but these are very subjective.

     The influence of pharmaceutical corporations on the process of developing and treating mental illness is immense and inappropriate. You can now see how much individual psychiatrists accept from pharmaceutical corporations at, under Dollars for Doctors.
     Some doctors like Daniel Amen and organizations like CHADD (which has been funded countless millions by Shire Pharmaceutical corporation, maker of ritalin) conduct extensive marketing to promote the diagnosis and medicating of ADHD. Dr. Amen promotes the use of SPECT scans to diagnose what he believes are many different types of ADHD (see post regarding SPECT scans).
    They are allowed to "raise awareness" of disorders and promote one treatment over another, even when the science behind a treatment is questionable or where one drug is no better than another or no better than a sugar pill. For example, all anti-depressants work about as well as a sugar pill, but these drugs remain one of the most prescribed drugs in the US. You can read more about the selling of ADHD in the New York Times, here:
     Doctors in the US are allowed to accept "speaking fees" from pharmaceutical corporations; There's just way too much bogus information out there about ADHD, and it continues to spread. Adult ADHD is the latest expansion of the ADHD syndrome, and pharmaceutical corporations and physician profit from this expansion. 

Imagine if your doctor claimed that a bruise on your leg is cancer and that you should start chemotherapy immediately. Before doing anything, you would demand a test to confirm that it is in fact cancer. But when it comes to psychiatry, the standard of evidence is a couple forms and a conversation before diagnosing a child with ADHD and prescribing chemotherapy for behavior problems (yespsychotropic drugs are a form of chemotherapy). Take your child to a psychiatrist, and in 30 minutes, based on some vague classroom behavior problems, he'll tell you that your son has ADHD and needs "meds," even though there is no real test to confirm that a child has a real problem with their attention-span. Based on decades of scientific research, there is no known biological or genetic cause of ADHD.

     Pharmaceutical corporations have no code of ethics other than to maximize profits for their shareholders. So, it's their job to find loop-holes and manipulate the system for profit, and in psychiatry, they run the show; there's an abundance of evidence to support this conclusion. They have many front-groups, like NAMI, TeenScreen, CHADD, and MHA. They fund these organizations and seem to direct their activities. For example, CHADD is recruiting adults in a national contest to tell their story of adult ADHD. This "raising awareness" of the syndrome promotes self-diagnosis and meds. 
     This combined with direct advertising of ADHD drugs to adults and children encourages them to ask for the meds from their doctor. Meanwhile, 100,000 pharmaceutical sales reps travel the country giving out free samples to doctors. They have access to each doctor's prescribing records so that they can see if their drugs are being prescribed. The American Psychiatric Association receives tens of millions from pharmaceutical corporations in direct funding and more from advertising in it's journal. Much more needs to be done to curb the influence of the pharmaceutical corporation in psychiatry.

Why do parents and teachers think that ADHD drugs work? And, if they work, doesn't that mean their child has ADHD?

Well, not all teachers and parents think the drugs work. There are many parents, teachers, and parent groups advocating for alternatives to drug treatment for classroom behavior problems and poor academic performance. 
     ADHD drugs do three things. First, they will boost your mood and feelings of confidence; second, they will increase your energy level; and last, they enhance your performance on just about any activity. So, any individual, ADHD or not, will benefit from taking them. But, they come at a cost. They are addictive. You will need more of the drug to achieve the same result. Users of these drugs will often become mentally dependent on them and end up taking them for decades; if they try to stop, many will feel irritable and depressed for months or years until their brain recovers. There are social consequences, too. Users of these meds will usually be very moody and edgy as they come-off the drug in the afternoon. They are often prescribed an evening dose which can cause insomnia.  Chronic insomnia has many, very clear health affects, no less than increased mortality. Many kids will develop bad habits like skin picking, or suffer other side effects like weight loss, stunted growth, and binge eating. I'm amazed at how often these negative side effects are ignored or not addressed.

There's a larger context to the struggles of our children in the classroom. The demands for academic achievement are greater now than ever, and parents, teachers, and school systems have not had time to adapt. Quick-fixes like amphetamines and stimulants are appealing, but their not the long-term solutions answer. One idea is for school systems to start reaching-out to homes of parents with young children in order to develop and implement early education programs aimed at building-up reading, writing, and math skills. The idea that children can wait for Kindergarten to start their education has past. Pre -school is a necessity. Regardless, making young boys sit still for hours at a time will never be healthy or realistic - our pedagogy should favor more experiential learning, more frequent and regular physical activity, and supervised socializing.

** In recent US history, most students were in school for short periods of time, never graduated high school, couldn't read better than an 8th grade level, and in some States, homework was specifically outlawed in favor of children working on the farm after school. Academic demands continue to out-pace the capacity of more and more students. Many parents are not teaching their kids to read and write at a very young age, so they're behind in upon entering Kindergarten. Too many parents continue to focus on sports and entertainment activities over academic achievements, still referring to high-achievers as "try hards," or "nerds." The consequences of American anti-intellectualism will be a labor force with little or no economic opportunity beyond basic service sector jobs (Walmart, McDonalds, Kohls). The US will continue to fill Science, Technology,and Math-based careers with immigrants from China and India who are keeping pace with academic demands.

Syndrome, Disease, Illness...?

A disease is a "disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury."

An illness is a "disease or period of sickness affecting the body or mind."

A syndrome is a "group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms."  (definitions from Google).

   ADHD isn't even a good syndrome, because most of the behaviors do not "consistently occur together." They occur with many other symptoms of other syndromes, like ODD, CD, depression, or anxiety. 

Mental Health Advice Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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