Tag Archives: ADHD

01/8/16

Academic Steroids

© ninto | stockfresh.com

© ninto | stockfresh.com

In response to the growing problem of the abuse of ADHD medications by college students, colleges and universities are instituting a variety of new campus rules. Some college clinicians are forbidden from diagnosing ADHD. Several now require students who bring ADHD medication from home to sign a contract that they will not divert their medications. Others require students to sign a release to have school officials confirm the truth of reported symptoms with parents. Duke University declared the nonmedical use of ADHD drugs to be a form of academic dishonesty. And Harvard is being sued for malpractice by the parents of a student who received an ADHD diagnosis and medication after one meeting with a clinical nurse specialist.

Mad in America pointed to an article by Watson et al., “The ADHD Drug Abuse Crisis on American College Campuses” and noted that ADHD drugs like Ritalin and Adderall have become so common on college campuses that there have been “exponential increases in emergency room visits, overdoses, and suicides by students taking these drugs.”

While ADHD meds are popularly known as “academic steroids,” there is no clear evidence that they facilitate cognitive functioning or scholarship. In fact, “compelling new evidence indicates that ADHD drug treatment is associated with deterioration in academic and social-emotional functioning.” Lower GPAs have been found to be associated with HIGHER rates of ADHD drug abuse in a couple of studies (Arria et al., 2008; McCabe et al., 2005). But this effect is not just limited to students with lower GPAs. ADHD drug abuse is a more common problem at competitive colleges and universities with high admission standards. “There is an emerging trend for medical students to abuse these drugs.”

There was a story in The New York Times about a student who died from prescribed ADHD medications. He never had ADHD, but used a classmate’s ADHD medications to cram for exams. Then he decided to get his own prescription to help him study for medical school entrance exams. He had been a presidential scholar with a high GPA. His academic performance plummeted AFTER he began to use ADHD drugs. This raises the possibility “that low GPAs may often follow—not always precede—use of the medication.” Eventually he became violently delusional and spent a week in a psychiatric hospital. Upon his release, his doctor gave him another prescription for 90 days of Adderall. He hung himself in his bedroom two weeks after he was out of Adderall.

The substantial risk associated with stimulant drug treatment might be best evaluated against associated academic and/or social emotional gains—namely, the reason that the drugs get prescribed in the first place. After 30 years of research on the topic, not a single study has linked ADHD drug treatment with improved academic outcomes. Hundreds of studies have documented that it is associated with short-term improvements in focus and performance on boring, repetitive tasks; nevertheless, these gains have not been shown to translate to improvements in higher order learning or scholarship.

ADHD drugs have a high addictive potential and as early as 1995, the DEA was warning about the potential for abuse with methylphenidate, the generic name for Ritalin, Concerta, and Daytrana. Although it is regularly described as benign, it has the same abuse potential as other Schedule II stimulants, like cocaine and methamphetamine.

It’s been long established that neither drug addicts nor lab rats can distinguish between cocaine and methylphenidate [Ritalin, Concerta, Daytrana]. Now, a growing body of evidence has actually linked methylphenidate treatment to an increase proclivity toward cocaine abuse in rats. These preclinical findings add to the cautionary note about lax attitudes toward ADHD diagnosis, which has the potential to become the gateway to more serious substance use and abuse.

The lead author of the article, “The ADHD Drug Abuse Crisis on American College Campuses,” Gretchen LeFever Watson, is no stranger to the ADHD wars. In the mid 1990s, she began a program of ADHD research. When LeFever et al. published their findings in the American Journal of Public Health, they concluded that the high prevalence rates found by their study suggested that “ADHD was overdiagnosed and overtreated in some groups of children.” They called for additional prevalence studies:

Further research is needed to clarify the long-term social, psychological, and biological consequences of ADHD drug therapy; to determine the prevalence of multimodal ADHD treatment; and to provide a framework for design and implementation of educational programs that ensure appropriate use of stimulant medications and nonpharmacologic interventions.

But in the course of her ongoing efforts to improve ADHD treatment in southeastern Virginia, the area where she did her research, “LeFever was repeatedly attacked for reporting high rates of ADHD diagnosis and treatment.” One of the attacks was an anonymous allegation of scientific misconduct. Although she was ultimately cleared of all allegations, the net effect of the attacks against her was that her research into psychosocial interventions that “raised questions about the effectiveness of ADHD drug treatment was terminated and study findings were suppressed.” You can read a detailed description of LeFever’ s research and the attacks on her here: “Shooting the Messenger: The Case of ADHD.”

The reason her work was targeted is simple—it conflicted with drug industry interests. So ADHD experts with ties to the pharmaceutical industry repeatedly launched ad hominem attacks upon LeFever Watson and her work. “These attacks ultimately led to a decade of significant ADHD research and community-based interventions being mischaracterized in professional venues and media outlets.” The eventual suppression of her work contributed to the escalation and expansion of ADHD diagnosis and drug treatment among Americans of all ages.

The rate of ADHD diagnosis now exceeds all reasonable estimates of the true prevalence of the disorder. As a consequence, ADHD drugs are readily available on American high school and college campuses where they are increasingly abused with serious and sometimes lethal consequences.

10/1/14

The Rise of the Stimulation Junkie

image credit: iStock

image credit: iStock

Do you think your child has ADHD? Are they oppositional, petulant, prone to major tantrums when they don’t get their way? In school, are they inattentive, disruptive, unfocused? Does their teacher essentially have to stand over them to get their work finished? Do something radical—remove television and other electronics from their life!

In The Diseasing of America’s Children, Family psychologist John Rosemond indicated that in most cases, these kids will go through a “withdrawal period”—moodiness, irritability, obsessing about watching TV. “Typically, and depending on the age of the child and the strength of the addiction, after a withdrawal period of one to two weeks, parents begin seeing the signs of recovery.” Within two or three months, the child is better behaved at home and there can be evidence of academic improvement in school.

Rosemond related that within three months of taking his son off of TV and implementing a traditional model of parenting, Eric was one of the best-behaved children in his class; and his reading skills had improved one grade level. Today Eric is a corporate pilot with four boys of his own.

Without doubt, the most glaring difference between the environment of a young child fifty years ago and the environment of today’s child is the prominence of electronic media—television, video games, and computers.

Rosemond isn’t the only person reporting an association between TV and attention problems in children. In “A Generation of Stimulation Junkies,” Allen Hsu reported that according to Neilsen ratings, the average American watches 34 hours of television a week. Children 2 to 11 watch 24 hours a week, translating to 3.5 hours per day. Remember that these statistics don’t account for the time spent on smart phones, video games and computers. Both Hsu and Rosemond cited an important 2004 study in the journal Pediatrics.

In that study, Dimitri Christakis and others found that: “early exposure to television was associated with subsequent attentional problems.” The authors noted that their study did not prove a causative association between television and clinically diagnosed ADHD. Nevertheless, “Early television exposure is associated with attentional problems at age 7. Efforts to limit television viewing in early childhood may be warranted, and additional research is needed.” Hsu said the Christakis study reported that television increased the chances of a child developing attention problems by 28%.

Hsu also said the negative impact of television carried over to video games as well. The more time children spent playing video games and the more violent the video game was positively correlated with increased attention difficulties. A 2010 article by Edward Swing and others in the journal Pediatrics, reported that exposure to both television and video games was associated with attention problems in childhood. This continued in late adolescence and early adulthood: “It sees that a similar association among television, video games, and attention problems exists in late adolescence and early adulthood.”

The increased societal dependence on electronics is affecting how we do things. Hsu thought it was making us more stupid. This is not so outrageous of a thought. In a short story titled “A Feeling of Power,” Isaac Asimov described a future time where people were so reliant on pocket calculators, that they had forgot basic math skills. Then one of the scientists “reversed engineered” mathematics, and demonstrated to his fellow scientists that the same results could be done with paper and pencil.

Our society is becoming a generation of stimulation junkies. We click from website to website, change television channels as we please, while relying on an external stimulation. Viewing fast paced video games, fast paced movies, and addicting television is leading to a population who chooses to quit activities just because they are too hard or not entertaining enough and our need for instant gratification.

09/24/14

The Making of an American Tragedy

image credit: iStock

image credit: iStock

Psychiatrist Peter Breggin said that diagnosing millions of children with ADHD and then treating them with stimulants and other psychoactive chemicals is an American tragedy. “Never before in history has a society attempted to deal with its children by drugging a significant portion of them into conformity while failing to meet their needs in the home, school and society.” According to Dr.Breggin, the ethical scientist and physician, the concerned parent “must feel stricken with grief and dumbfounded” that our society has allowed this to happen to our children.

In October of 2011, the American Academy of Pediatrics (AAP) overrode the FDA and approved diagnosing children as young as four with ADHD and medicating them with Ritalin. The lead author of the report said: “Because of greater awareness about ADHD and better ways of diagnosing and treating this disorder, more children are being helped.” Dr. Breggin said this action was an outrage: “This endorsement of drugging younger children by the American Academy of Pediatrics is an outrage.”

According to Dr. Breggin, the scientific literature shows that 50 percent or more of children this young will become depressed, lethargic, weepy—along with being more manageable when given medications such as Ritalin, Adderall and other ADHD medications. Studies show that stimulants will permanently change brain chemistry in the children, cause shrinkage of brain tissue and predispose them to cocaine addiction in young adulthood. He also feared this endorsement by the AAP would open the door for every other psychiatric drug being prescribed to children that young.

These new guidelines will encourage prescribers to throw caution to the wind with toddlers, opening a Pandora’s box of drug intervention for children. Many young children will have their brains bathed with powerful and often toxic chemicals in the early years of their central nervous system development.

But the problems didn’t stop there. Susanna Visser, who oversees the CDC research on ADHD, presented a report at the Georgia Mental Health Forum in May of 2014 that suggested at least 10,000 2 and 3 year-olds were being medicated for ADHD. “It puts these children and their developing minds at risk, and their health is at risk.” Effective non-drug treatments were often ignored.

Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they are getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child.

As liberal as the AAP guidelines for ADHD are, they do not even address diagnosis in children 3 and younger—let alone the use of stimulant medications—with that age group. Children under 4 are not covered in the guidelines because “hyperactivity and impulsivity are developmentally appropriate for toddlers.” Dr. Lawrence Diller, a pediatrician, said: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Sheila Matthews attempted to put “the insanity of drugging 2-3 year olds” in perspective. She noted that the average weight for male toddlers at three years was 29.5 pounds; female toddlers averaged 28.4 pounds. “By this age, only 80 percent of the child’s brain has fully developed.” Kids at this age are learning to arrange things in groups, to put things in size order, remembering what they did yesterday, learning to say please and thank you, and recognizing themselves in the mirror. “In a nutshell, 2-3 year old toddlers are being labeled with an alleged mental illness that is not based in science or medicine and then “treated” with extremely addictive, mind-altering drugs before their brains are even fully formed.”

Psychiatrist Allen Frances said: “Treating babies with stimulants is based on no research, is reckless, and takes no account of the possible harmful long-term effects of bathing baby brains with powerful neurotransmitter drugs.” He hoped that the CDC report would fuel a backlash of parental and professional protest as it becomes clearer how absurdly overused is the ADHD diagnosis and stimulant medication. “It is also particularly outrageous that so many of the thought leaders promoting the excessive use of stimulants have such close ties with pharmaceutical companies.”

Dr Breggin lamented that instead of meeting the normal needs of our children, we are suppressing them with drugs. The average parent or teacher has no idea that what is presented as medical treatment “is actually a form of medical child abuse.” What they see is a more manageable child and assumes this is for the best. Instead, it is the making of an American tragedy.

08/13/14

The Dumbest “Diagnosis” Ever

Is your child drowsy/sleepy at times? Do you see signs of daydreaming, mental confusion, slowed thinking or behavior, lethargy or apathy? Don’t worry; it may just be the early signs of Sluggish Cognitive Tempo (SCT)! By some estimates, SCT is present in two million children. While still not acknowledged as an official psychiatric disorder, the January 2014 issue of The Journal of Abnormal Child Psychology devoted the entire issue to SCT. Be patient, it will eventually become an official childhood psychiatric disorder, if its advocates have their way. And then you will have a brand new reason to give your son or daughter stimulant medications.

If you think this satire is too off-the-wall, read the April 11, 2014 article in the NYT by Alan Schwartz, “Idea of New Attention Disorder Spurs Research, and Debate.” Schwartz said that “Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder—and as such, a candidate for pharmacological treatment.” He added that some of the identified symptoms so far in the research “have helped Eli Lily investigate how its flagship A.D.H.D. drug might treat it.” The psychiatric drug industry has excelled at expanding the market for its drugs, generating tremendous wealth for many.

Becker, Marshall and McBurnett did a search of journal articles (for their own article in January 2014 issue of The Journal of Abnormal Child Psychology) and found that “very few papers explicitly examined or even mentioned SCT between 1985 and 1999.” Since then there has been a steady increase in the articles that either focused on SCT or mentioned it in the body of the paper. They observed that while symptoms of under-arousal and low levels of mental energy were noticed to be part of attention deficit as early as 1798, it wasn’t until the 1970s that inattention was seen as causing even more impairment than hyperactivity. By the mid-1980s, “empirical support for the SCT dimension separate from inattention emerged.”

Russell Barkley, one of the most influential advocates for ADHD, noted in his article for the special issue of The Journal of Abnormal Child Psychology that there was a dearth of studies on SCT. Students now entering the profession could make a successful research career specializing in the research of SCT. He felt there would surely be an increased demand for such empirically-based research in view of the clinical referrals already occurring; and the anticipated increase in the near future as the general public becomes aware of SCT. “The fact that SCT is not is not recognized as yet in any official taxonomy of psychiatric disorders will not alter this circumstance given the growing presence of information on SCT at various widely visited internet sites such as YouTube and Wikipedia, among others.”

Alan Schwartz reported in his NYT article that Barkley has said that SCT “has become the new attention disorder.” Barkley also has financial ties to Eli Lily, receiving $118,000 from 2009 to 2012 for consulting and speaking engagements. He has also published a symptom checklist to identify adults with the condition. The forms are available for $131.75 apiece from Guilford Press. Oh, and Barkley also edits sluggish cognitive tempo’s Wikipedia page. The SCT Wikipedia page carried the following note at the top of the page on June 20th, 2014: “A major contributor to this article appears to have a close connection with its subject. It may require cleanup to comply with Wikipedia’s content policies.”

One of the SCT researchers, David McBurnett, said a scientific consensus on SCT could be many years in the future. “We haven’t even agreed on the symptom list—that’s how early on we are in the process.” And yet, Dr. McBurnett recently conducted a clinical trial funded and overseen by Eli Lilly to see if the proposed SCT diagnosis could be treated with Straterra, the company’s primary ADHD drug. Published in The Journal of Child and Adolescent Psychopharmacology in November of 2013,his study concluded: “This is the first study to report significant effects of any medication on SCT.”

This process with SCT reminded me of what Robert Whitaker depicted in Anatomy of an Epidemic. He showed that in order to sell our society on the benefits of psychiatric drugs, “Psychiatry has had to grossly exaggerate the value of its new drugs, silence its critics, and keep the story of poor long-term outcomes hidden.” This has meant telling a false story to the American public, and then actively hiding research results that reveal the poor long-term outcomes with a drug-centered paradigm of care. Whitaker said it was a conscious, willful process that exacts a horrible toll on our society.

The number of people disabled by mental illness during the past twenty years has soared, and now this epidemic is spreading to our children. Millions of children and adolescents are being groomed to be lifelong users of these drugs. This grooming happens by twisting childhood behaviors like daydreaming, slowed thinking or behavior, and lethargy into symptoms of a new so-called childhood psychiatric disorder.

Allen Frances, chair of the fourth edition of the DSM, said that “’Sluggish Cognitive Tempo’ may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered . . . .The risk that it could do great harm is real . . . .The last thing our kids need is to be misdiagnosed with ‘Sluggish Cognitive Tempo’ and bathe in even more stimulants.”

Still not convinced? Listen to this pod cast by Peter Breggin where he interviews psychologist Fred Ernst about Sluggish Cognitive Tempo and the “psychiatric assault” on children through psychiatric medication.

05/21/14

Is ADHD Simply a Case of the Fidgets?

At a conference, I heard Bose Ravenel (a great name) describe how the “science” behind ADHD and other childhood behavioral disorders wasn’t truly scientific. I bought and read The Diseasing of America’s Children, which he co-authored with John Rosemond. I collected additional critiques of ADHD treatment by Peter Breggin and Fred Baughman, intending to write an article for my web site. But other interests came along, and I didn’t get around to it for a few years.

As an abstinence-oriented addictions counselor, I have a built-in bias against using stimulant medication to treat behavior problems. According to the U.S. Department of Justice, most ADHD medications have “a high potential for abuse”, leading to possible psychological or physical dependence. In other words, Adderall and Ritalin have the same abuse potential as morphine or OxyContin. It didn’t make sense to me that this “treatment” for ADHD would reverse a biochemical or neurological deficit as claimed. The calming effect of stimulants had to have another explanation.

In the summer of 2012 I finally sat down and did the reading and research to first write: “ADHD: An Imbalance of Fire Over Water or A Case of the Fidgets?” Although I read several studies supporting the use of ADHD medications, I still concluded that the negatives far outweighed the positives.

I don’t think I simply found what I already “knew” to be true because of my built-in bias against stimulant medications. The research convincingly showed that stimulant medications do not really “treat” ADHD. And I think you will too after watching the presentation by Robert Whitaker in: “Medicating ADHD: Diagnosis and the Long-Term Effects of the Medications.”

Here is just one teaser mentioned in the video. William Pelham, a researcher with the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA Study), a long term study of the treatment of ADHD funded by the NIMH said: “We thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There were no beneficial effects; none. In the short term [medication] will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Viewing ADHD as a simply a neurological disorder that is treated with medication seems to make the mistake of viewing human beings as simply “bodies run amuck” (to use Dave Powlison’s phrase). This reductionistic understanding of human nature neglects a biblical understanding that we are a “psycho-somatic unity” of soul (psyche) and body (soma).

There is nothing morally wrong in using ADHD medications. But given the problems with them, I certainly think it is unwise to use them long-term—particularly since they have the same risk of drug dependency as morphine and OxyContin.