There is an epidemic of over-diagnoses of ADHD

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JIM CURRAN
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There is an epidemic of over-diagnoses of ADHD

Post by JIM CURRAN » Mon Aug 20, 2012 8:14 pm

There is an epidemic of over-diagnoses of ADHD

There is not an epidemic of ADHD in the country, there is an epidemic of fraudulent diagnoses of this disorder. Fred A. Baughman Jr., M. D., a Pediatric Neurologist, has elucidated upon this problem very effectively in his paper “Attention-Deficit Hyperactivity Disorder (ADHD) As Fraud.” Dr Baughman has noted that with absolutely no proof that ADHD is a disease with a confirmatory, physical abnormality, the ADHD “epidemic,” grew from 150,000 in 1970, to five million in 1997. According to the Drug Enforcement Administration, Ritalin production, in the United States , rose 700%, between 1990 and 1997.

http://educationviews.org/there-is-an-e ... s-of-adhd/

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Re: There is an epidemic of over-diagnoses of ADHD

Post by volunteer » Mon Aug 20, 2012 8:32 pm

I read an article recently about the male gymnastic team that won a medal at the Olympic games this year making history for GB. It was surprising how many of their mothers sent them off to do gymnastics because they thought they were hyperactive, lacking attention etc etc. Good job they had mothers who chose gymnastics and not a statement --- they could have been on Ritalin in their teens otherwise and that would have been a lost medal.

I know a boy at my children's school who was put on Ritalin at 6 or 7. I could never understand why. Interestingly, he runs like the wind, but thanks to Ritalin we will probably be one medal down in the future if they continue to medicate him long-term. The side effects look so scary I could never put a child of mine on it, even if they really did have ADHD, whatever it is. He now has high blood pressure at 9.

Having said that, one of the gymnasts gets up in pain every morning; maybe Ritalin would be better than gymnastics.

elsiep
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Re: There is an epidemic of over-diagnoses of ADHD

Post by elsiep » Mon Aug 20, 2012 10:03 pm

ADHD, like many other so-called 'mental disorders', is a rather vague group of symptoms. There is little doubt that some children with ADHD symptoms have low dopamine levels, resulting in serious problems with attention, which is why Ritalin and similar stimulants make their lives tolerable.

There's also no doubt that many other children with ADHD-type symptoms are reacting to an inappropriate diet and environmental conditions, and don't have a 'disorder' at all.

elsie

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maizie
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Re: There is an epidemic of over-diagnoses of ADHD

Post by maizie » Mon Aug 20, 2012 10:23 pm

elsiep wrote:There is little doubt that some children with ADHD symptoms have low dopamine levels, resulting in serious problems with attention,
Can low dopamine levels be tested for (I'd be quite surprised if they couldn't) and if so, are they tested for in an investigation into possible ADHD? I've only ever known of the Connor's Scale being used.

elsiep
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Re: There is an epidemic of over-diagnoses of ADHD

Post by elsiep » Tue Aug 21, 2012 4:50 am

There are several different types of dopamine receptor in the brain, distributed across different locations, and they all work slightly differently. Testing for levels of neurotransmitters is difficult enough, never mind looking for the distribution of different types of receptor - although one day we might be able to do that easily. It's individual differences in physiology that result in 'side effects'. In other words, the Ritalin might have the desired effect on dopamine levels and attention, but has knock-on effects elsewhere.

Because of individual variations and the difficulty of testing, doctors have to use a 'suck it and see' approach. I think there's a good argument for using Ritalin and related drugs in children with extreme ADHD characteristics where other causes (such as responses to food additives) have been ruled out. This is because in extreme cases, the children have such difficulty with monitoring, control and attention their lives are intolerable. I don't think it should be used in cases where children are just having difficulty concentrating at school because the side effects can cause problems and we're not clear about the long-term effects on development.

Until then, we're stuck with behavioural measures like the Connor's scale. What bothers me, as the article Jim linked to pointed out, is that ADHD isn't a medical condition like measles where there's a clear single cause that results in very similar symptoms in everybody. It's a label for a bunch of symptoms that might have different causes in different individuals. Like many developmental conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), in fact. ADHD is exactly like 'dyslexia' - except that there is evidence that in some cases, all the characteristics do appear to stem from a single cause. But that's not the impression people get when teachers, doctors and researchers refer to ADHD (or dyslexia) as a 'disorder' or a 'condition' that can be 'treated' (in the case of ADHD) with a drug.

And of course the situation will get worse next year because dyslexia is scheduled for inclusion in DSM 5.

http://www.dsm5.org/ProposedRevisions/P ... spx?rid=84

elsie

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Re: There is an epidemic of over-diagnoses of ADHD

Post by geraldinecarter » Tue Aug 21, 2012 7:30 am

Interesting link, Elsie, thanks. Thisse points were particularly relevant :

Reading fluency is included as a critical feature of reading acquisition: poor fluency is a key feature of dyslexia in adulthood; also poor fluency is a key feature of dyslexia in languages other than English (e.g., Bashir & Hook, 2009 Lang Speach Hear Services Sch; Share DL, 2008 Psychol Bull; Shaywitz,SE et al 2008 Annu Rev Psychol; Shaywitz et al. Biol Psychiatry 2003)

Recommend that reading comprehension per se be omitted from DSM-5, because individuals who have specific reading comprehension problems in the presence of good decoding skills, do not meet criteria for dyslexia. Such individuals typically are found to have poor oral language (as in communication disorders). However, specifc reading comprehension disorders could be coded under the newly proposed superordinate category of learning disability

Clarification of severity requirements and need for systematic assessmuperordinate category of learning disability

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Re: There is an epidemic of over-diagnoses of ADHD

Post by geraldinecarter » Tue Aug 21, 2012 7:41 am

A few years ago I had a 7 year old boy for one-to-one hour long tuition a week. On good days he was funny, charming, interested and progressed well. At other times he was impossible to engage - rude, surly and unco-operative. The same happened in class - if he didn't want to do his work, he wouldn't, and therefore spent much of the day standing outside the headteacher's office.

He had his lunch-box filled withstuff like chocolate, crisps, 'orange' drinks and he was frequently tired having watched too much telly in bed and staying up late to watch James Bond films.

These are the things I would have tried to tackle first if I'd had any influence.

When I went back to visit the school a few months later, this boy was on Ritalin. I later telephoned his mother to see how he was getting on and she said that he had had bad reactions to the Ritalin and was now on another drug which had helped a lot.

I found the whole approach of drugging a child before exploring other areas to be deeply depressing.

JIM CURRAN
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Re: There is an epidemic of over-diagnoses of ADHD

Post by JIM CURRAN » Tue Aug 21, 2012 8:44 am

Unscrupulous parents seek ADHD diagnosis for benefits

By Adrian Goldberg
Presenter, 5 live Investigates

Head teachers claim stimulants are being over-prescribed to young children, who they suspect are not sufferers of Attention Deficit Hyperactivity Disorder (ADHD). They say unscrupulous parents of troubled youngsters are pushing for an ADHD diagnosis to claim disability benefits.

http://www.bbc.co.uk/news/health-12359070

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Re: There is an epidemic of over-diagnoses of ADHD

Post by elsiep » Tue Aug 21, 2012 9:51 am

I find some of the assumptions made in this report quite worrying. Even if ADHD isn't a single medical condition, it can't be diagnosed by headteachers, GPs or parents. Many parents whose children clearly have significant attentional problems and quite likely should get a diagnosis, often have a long path to follow before that diagnosis is obtained.

Also, few doctors who are qualified to diagnose ADHD would prescribe medication unless the symptoms warranted it - in the UK at least.

In addition, getting DLA isn't easy and doesn't depend on a diagnosis, but on the level of disability. I'm sure there are some parents playing the system, but I feel articles like this exaggerate the 'scrounger' aspect and overlook the 'widespread ignorance, shoddy education system and poor deal for people with genuine disabilities' aspects of the situation.


elsie

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Re: There is an epidemic of over-diagnoses of ADHD

Post by volunteer » Tue Aug 21, 2012 7:48 pm

A 6 or 7 year old I used to help one - to - one told me one day he had been to see "a doctor" who was going to give him some medicine to "slow him down".

Who would this have been? I guessed it was Ritalin (possibly incorrectly but I'm pretty sure my guess is correct as I've seen ADHD down next to his name), but I was shocked at him receiving it at such a young age. He was a cute boy; he concentrated well if I gave him something interesting to do which was appropriate for him, but I never could understand what he was(n't) being taught in class on his "special needs" table with the TA.

I heard school phone the parents more than once to check he had taken his medication that day (so where was the pressure coming from I ask myself?).

Recently about two years on I heard his parent telling the office staff about his high blood pressure and the medication that he would need before going to an after school club. I start to make connections and feel terribly sad about the whole thing. I don't think the mother works (but they are not well-off). If I had been her I would have kept him out of school for several years. He is very much just like a much younger child in the wrong year group, and thrives on physical outdoor activities.

I know nothing of the "real situation" but a child of mine has been in his class before medication and she never came home with tales of anything untoward that another child had done (and believe me she would have done) so I do not know what merited such heavy handed prescribing at such a young age.

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palisadesk
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Re: There is an epidemic of over-diagnoses of ADHD

Post by palisadesk » Tue Aug 21, 2012 8:40 pm

It must be remembered that "ADHD" behaviours and symptoms can be (and often are) caused by physical malfunctions or conditions, and that before being medicated for "ADHD" any child (or adult) should receive a thorough medical checkup including bloodwork, neurological examination, cardiac exam, and medical history. The hyperactivity, impulsivity, attention regulation problems and other symptoms can be a result of FAS (Fetal Alcohol Syndrome --affecting up to 10 % of children to some degree, and rarely diagnosed); ABI (acquired brain injury, often minimized or overlooked in children), various congenital heart defects, liver disease, stroke, seizure disorders and others.

For a good look at the medical conditions that can cause "ADHD" read "The Hyperactivity Hoax" by Sydney Walker, MD. He outlines the dangers of going for an "ADHD" diagnosis followed by Ritalin treatment when serious potential causes have not been ruled out.

http://www.amazon.com/The-Hyperactivity ... 0312970986

A student of mine was slated for "Ritalin" treatment but her mother, a nurse, insisted on a full examination by a specialist paediatrician. It turned out the child had liver disease. When this was successfully treated, her "ADHD" disappeared. Ritalin might have caused serious, even life-threatening, complications as well as delaying the proper diagnosis.

While Dr. Baughmann presents a needed counterpoint to the over-prescription of psychotropic drugs today (the issue is similar in treatment of depression), he is not quite a reliable source. He has been away from practice for 20 years and does not address findings that question his position. I'm all for contrarians myself -- they keep discussions going -- but am wary when I read the position of any extremist. There is always more than one side to the story.

The other side on this issue is that, when properly prescribed and monitored, and when families are given additional supports (particularly in behaviour management skills), use of stimulant drugs for ADHD children (given that they have been properly assessed by medical professionals) can be life-saving. I have seen such cases too, where use of the drug (along with other strategies) prevented the child from being institutionalized or surrendered to foster care. A longitudinal study --I believe it was done here in Ontario, but would have to look it up -- found that neither drugs in isolation nor management and counseling protocols alone were effective long term, but that a combination was most successful, allowing the child to gain self-regulation over time and decrease and eventually stop use of the medication.

It's a serious issue for parents, but those who find themselves in such a dire situation need support and the best medical advice they can get, along with regular monitoring of the child's health. "Wiggly" kids are not the issue -- chair-throwing, assaultive, screaming hysterical tantruming kids are. Frequently they have multiple issues.

Susan S.

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Re: There is an epidemic of over-diagnoses of ADHD

Post by volunteer » Tue Aug 21, 2012 9:04 pm

So how does it get presribed in the UK today to children whose symptoms are nothing like you describe, or is the situation I have seen at school very unusual - I do hope so.

elsiep
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Re: There is an epidemic of over-diagnoses of ADHD

Post by elsiep » Tue Aug 21, 2012 9:13 pm

palisadesk wrote:It must be remembered that "ADHD" behaviours and symptoms can be (and often are) caused by physical malfunctions or conditions, and that before being medicated for "ADHD" any child (or adult) should receive a thorough medical checkup including bloodwork, neurological examination, cardiac exam, and medical history. The hyperactivity, impulsivity, attention regulation problems and other symptoms can be a result of FAS (Fetal Alcohol Syndrome --affecting up to 10 % of children to some degree, and rarely diagnosed); ABI (acquired brain injury, often minimized or overlooked in children), various congenital heart defects, liver disease, stroke, seizure disorders and others.
Yes!!!

Have you read Mary Coleman and Christopher Gilberg's book "The Biology of the Autistic Syndromes"? Isn't about ADHD, obviously, but the principle is the same. The authors aren't as explicit as you've been, but reading between the lines make it quite clear that 'autism' can be caused by anything from a wide range of genetic causes, through brain damage to viral infections. My son's paediatrician did a battery of blood and urine tests prior to making her diagnosis and the only reason she didn't do DNA testing or an MRI scan was that even if they had revealed an anomaly there was no treatment available anyway. But her approach seems to be something of a rarity.

elsie

elsiep
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Re: There is an epidemic of over-diagnoses of ADHD

Post by elsiep » Tue Aug 21, 2012 9:15 pm

volunteer wrote:So how does it get presribed in the UK today to children whose symptoms are nothing like you describe, or is the situation I have seen at school very unusual - I do hope so.
The situation varies widely and depends to a large extent on the views of local CAMHS or paediatricians.

elsie

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Re: There is an epidemic of over-diagnoses of ADHD

Post by volunteer » Wed Aug 22, 2012 12:43 pm

My best guess is that this would have been local CAMSH. So you are saying that a psychiatrist at CAMSH could prescribe Ritalin to such a young child for some pretty "mild symptoms". Makes mental note to myself to make sure my children never go anywhere near them!

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