Recognition of the False Epidemic of ADHD by a Major Newspaper Its About Time

Finally, there has been recognition by at least one major metropolitan newspaper, the New York Times, about the phony “epidemic” of ADHD diagnoses among both adults and children. Not that doctors pushing the disorder would ever admit to it. (News to some: a high percentage of these diagnoses are made by non-psychiatrist physicians such as pediatricians).

An e-mail newsletter from the American Psychiatric Association contained the following story on 12/10/2013:

 “The Centers for Disease and Control and Prevention (CDC) reports that there has been a 42% increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses in children aged 4 to 17 from 2003 to 2011. Data were published in the Journal of the American Academy of Child and Adolescent Psychiatry. The study included 2011 data from a randomized, cross-sectional national survey of more than 95,000 U.S. households known as the National Survey of Children's Health. …The results showed by 2011, 11% of children—or 6.4 million children nationwide—had received a diagnosis of ADHD. Among those with a diagnosis for ADHD, approximately 70% were currently taking medication for the disorder—increasing by 28% from 2007 to 2011. Nearly 1 in 5 high school boys was diagnosed with ADHD, compared with 1 in 11 high school girls. ADHD-diagnosis frequency was most prevalent in Kentucky, at 15 percent, and least prevalent in Nevada, at 4.2 percent.

"The authors [of the study] speculate that 'better detection of underlying ADHD, due to increased health education and awareness efforts' may be the reason for the increase of ADHD diagnoses among American children."

BETTER RECOGNITION?? REALLY?!?  A story in the New York Times by Alan Schwarz on December 14, 2013 had a far more reasonable explanation.  It said that even the person most responsible for recognition of ADHD in children, Keith Conners, questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

Keith Connors, Ph.D.

The Times story continues:

“The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

… The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.”

The story was followed by an editorial on 12/18/13, An Epidemic of Attention Deficit Disorder.  Hooray for the New York Times!!  Some of what it said:

“The hard-sell campaign by drug companies to drive up diagnoses of attention deficit hyperactivity disorder, or A.D.H.D., and sales of drugs to treat it is disturbing. The campaign focused initially on children but is now turning toward adults, who provide a potentially larger market…Many of these children, it appears, had been diagnosed by unskilled doctors based on dubious symptoms…

“Shire, an Irish company that makes Adderall and other A.D.H.D. medications, recently subsidized 50,000 copies of a comic book in which superheroes tell children that “Medicines may make it easier to pay attention and control your behavior!” Advertising on television and in popular magazines has sought to persuade mothers that Adderall cannot only unleash a child’s innate intelligence but make the child more amenable to chores like taking out the garbage…

“The potential dangers should not be ignored. The drugs can lead to addiction, and, in rare cases, psychosis, suicidal thoughts and hallucinations, as well as anxiety, difficulty sleeping and loss of appetite…So many medical professionals benefit from overprescribing that it is difficult to find a neutral source of information. Prominent doctors get paid by drug companies to deliver upbeat messages to their colleagues at forums where they typically exaggerate the effectiveness of the drugs and downplay their side effects. Organizations that advocate on behalf of patients often do so with money supplied by drug companies…

“Curbing the upsurge in diagnoses and unwarranted drug treatments will require more aggressive action by the F.D.A. and the Federal Trade Commission, which share duties in this area. It will also require that doctors and patients recognize that the pills have downsides and should not be prescribed or used routinely to alleviate every case of carelessness, poor grades in school or impulsive behavior.”

Talking Adult ADHD Blues

Despite popular demand that I shut the hell up, here at last is the music to my song, Another Dubious Hyped Disorder. Click the link to see.  In case you can't make them out, the lyrics are here.

ADHD More Misleading Propaganda

In the never ending effort to con the world in general, and physicians in particular, into thinking that most inattentive and rambunctious children and adults have a neurobiological disease, a Dr. Samuele Cortese and his colleagues presented yet another MRI study that they allege shows that children and adults who have been diagnosed with ADHD have abnormalities in their brains. 

Dr. Cortese is listed as a consultant for Shire Pharmacueticals, a major manufacturer of stimulant drugs for “ADHD.” Or as some might say in ordinary language, Shire is a drug dealing syndicate. One of the most egregious examples of same, at that. Shire’s interests are served by having the largest number of people taking their “legal” amphetamines as possible, while also spreading the word that their competition, “illegal” amphetamines, are dangerous and highly abused drugs.

I use the word “diagnosed” with ADHD in the first paragraph above rather than “have” ADHD because, as I have demonstrated in previous posts, the evaluation of patients who seem to have these problems leaves out an entire and absolutely essential part of their lives – the behavior of their families that provides a context for the child’s “symptoms.” 

No effort, or only a half-baked one, is made in these studies to differentiate acting out from other possible causes for the patient’s hyperactive behavior or difficulties in maintaining focus.

The new study, published in the issue of the American Journal of Psychiatry, proves the following point beyond a shadow of a doubt: people who are not paying good attention to a particular task in which they are engaged exhibit less activity in those brain centers involved in paying attention to tasks than people who are paying strong attention.  Wow. Who’d’a thunk it?

And as we all know, any difference simply must be an abnormality.

In fact, the study says absolutely nothing about whether these research subjects cannot pay attention or simply are not paying attention.

The study in question (Cortese et al, “Toward Systems Neuroscience of ADHD: A Meta-Analysis of 55 fMRI Studies,” Am J Psychiatry 2012; 169:1038-1055) combines statistics from 55 different studies of ADHD, many of which use very different diagnostic “tests” which are merely symptom report lists and pay little attention to the pervasiveness of the symptoms, let alone the psychosocial context in which the symptoms take place.

Here are the results. Hypoactivation is a term meaning that the affected part of the brain is less active, on average, than it might be in a comparison subject. Of course, how active such a brain part might depends strongly on the motivations of the particular subjects. (This is analogous to the results of IQ tests, which are biased against those people who don’t give a damn about how well they do on the test).  Hyperactivation means the opposite.  

Surely, whether more or less activity in a region of the brain is pathological is entirely pre-supposed by the authors without any valid justification. It is basically a value judgment.

“Fifty-five studies were included (39 for children and 16 for adults). In children, hypoactivation in ADHD relative to comparison subjects was observed mostly in systems involved in executive function (frontoparietal network) and at­tention (ventral attentional network). Sig­nificant hyperactivation in ADHD relative to comparison subjects was observed predominantly in the default, ventral at­tention, and somatomotor networks. In adults, ADHD-related hypoactivation was predominant in the frontoparietal system, while ADHD-related hyperactivation was present in the visual, dorsal attention, and default networks. SignificantADHD-related dysfunction largely reflected task features and was detected even in the absence of comorbid mental disorders or a history of stimulant treatment.

Conclusions: A growing literature pro­vides evidence of ADHD-related dysfunc­tion in multiple neuronal systems involved in higher-level cognitive functions but also in sensorimotor processes, including the visual system, and in the default net­work. This meta-analytic evidence extends early models of ADHD pathophysiology that were focused on prefrontal-striatal circuits.”

The studies being "meta-analyzed" are designed on purpose to make it appear that normal differences mean something other than their just being normal differences.

Let us look at the distribution of how strongly people “pay attention” to boring tasks to which they have no particular motivation to do well (other than their desire to be co-operative with an experimenter). Most of the tasks during which brain activity is measured are, let’s face it, at least somewhat uninteresting.

This distribution, like almost everything else in nature, will look like a bell-shaped curve, or what is called normal distribution. We don’t even have to invoke the fact that some people may habituallypay less attention to most activities because they might be compulsively and habitually playing a role ["unambitious"] within their family of origin that allows them to get labeled as having ADHD.

The self report instruments and diagnostic interviews through which a diagnosis of ADHD is made will, in effect, sort the patients so that those labeled with ADHD will fall, on average, at point A on the bell shaped curve in the figure above. Since those individuals will then be taken out of the pool of study subjects, those that remain will have an above average tendency to pay attention to boring tasks – their average will be at point B in the diagram.

Everything else being equal, the “ADHD” subjects and the control control subjects could all be completely normal, and the study result would be identical to a study in which a real disease were being studied! The authors have no way of knowing which of these possibilities their study is demonstrating. They do not clearly acknowledge the above considerations as a weakness of the study, although they do concede, “fMRI data cannot define an absolute or quantitative baseline of activation…” (p. 1053).

That disclaimer is added to give the authors plausible deniability, and will of course be completely ignored by readers if it is noticed at all.

The authors start their discussion of their results with the sentence, “ADHD is increasingly being conceived of as a disorder underpinned by dysfunctions in multiple large scale brain networks.” Yeah, because of pseudo-scientific conclusions made from a multiplicity of studies done the way this one was.

Adult ADHD Another Dubious Hyped Disorder

Here's a song I wrote for some of my symptom-obsessed fellow psychiatrists who are - what's the word? - oh, yes - incompetent:


Take some of these and you’ll feel better
Forget about those hippies who claimed, “speed kills”
You’ve got ADHD and just a touch of bipolar
Things are always better when you’re taking pills

Your family life’s a mess but that we won’t mention
What’s crucial is your trouble paying attention
You say bad memories make you a sad girl
If your ma drank too much, that’s ‘cause you were a bad girl

[chorus:]
So what if your husband’s out chasing booty?
So what if your brother’s coming on to your kids?
If you find that you’re feeling moody
Your brain’s miswired, that’s all that is!


Those things you remember, they’re all distorted
Your stepfather couldn’t have fondled you
If he had he would have been reported
Others must have been there, not just you two

[repeat chorus]
[repeat first verse]
[repeat chorus]


(Anyone who wants the chords, please feel free to contact me).

UNVEILING THE TRUTH ABOUT ADD ADHD

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

There are many myths that exist concerning ADHD. According to www.helpguide.org, the following are some of the myths that exist about ADHD and some of its positive effects:

Myths about Attention Deficit Disorder
Myth #1: All kids with ADD/ADHD are hyperactive.
Fact: Some children with ADD/ADHD are hyperactive, but many others with attention problems are not. Children with ADD/ADHD who are inattentive, but not overly active, may appear to be spacey and unmotivated.
Myth #2: Kids with ADD/ADHD can never pay attention.
Fact: Children with ADD/ADHD are often able to concentrate on activities they enjoy. But no matter how hard they try, they have trouble maintaining focus when the task at hand is boring or repetitive.
Myth #3: Kids with ADD/ADHD could behave better if they wanted to.
Fact: Children with ADD/ADHD may do their best to be good, but still be unable to sit still, stay quiet, or pay attention. They may appear disobedient, but that doesn’t mean they’re acting out on purpose.
Myth #4: Kids will eventually grow out of ADD/ADHD.
Fact: ADD/ADHD often continues into adulthood, so don’t wait for your child to outgrow the problem. Treatment can help your child learn to manage and minimize the symptoms.
Myth #5: Medication is the best treatment option for ADD/ADHD.
Fact: Medication is often prescribed for attention deficit disorder, but it might not be the best option for your child. Effective treatment for ADD/ADHD also includes education, behavior therapy, support at home and school, exercise, and proper nutrition.

Positive effects of ADD / ADHD in children

In addition to the challenges, there are also positive traits associated with people who have attention deficit disorder:

• Creativity – Children who have ADD/ADHD can be marvelously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADD/ADHD may be easily distracted, but sometimes they notice what others don’t see.
• Flexibility – Because children with ADD/ADHD consider a lot of options at once, they don’t become set on one alternative early on and are more open to different ideas.
• Enthusiasm and spontaneity – Children with ADD/ADHD are rarely boring! They’re interested in a lot of different things and have lively personalities. In short, if they’re not exasperating you (and sometimes even when they are), they’re a lot of fun to be with.
• Energy and drive – When kids with ADD/ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on.

Keep in mind, too, that ADD/ADHD has nothing to do with intelligence or talent. Many children with ADD/ADHD are intellectually or artistically gifted.

Sources:

http://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-in-children.htm