Ritalin Debate: Some Experts Doubt Existence of ADHD

Cybercast News Service (CNSNews.com) ^ | April 18, 2003 | Patrick Goodenough

[FreeRadical]

Pacific Rim Bureau (CNSNews.com) - The debate over attention deficit hyperactivity disorder (ADHD) and the drugging of children diagnosed with it has been rekindled in Australia, one of several countries to have followed the U.S. trend over recent decades.

A youth conference in the eastern city of Brisbane this week was told that no proof has been found that ADHD exists at all.

U.S. psychologist Dr. Bob Jacobs told the Youth Affairs Network Queensland conference that doctors and pharmaceutical companies had turned behavioral problems in children into a disorder.

He voiced concern that misdiagnoses resulted in youngsters being prescribed powerful drugs like Ritalin, which may affect their long-term mental and physical development.

In a radio interview afterwards, Jacobs - who is on the advisory board of the International Center for the Study of Psychiatry and Psychology - said his conclusions had been made as a result of his own observations during many years in practice, working with children and families.

He cited cases where parents reported that their ADHD-diagnosed children could not pay attention - but then those same children could play video games for hours without being distracted.

Sometimes where parents made changes in the way they were doing things, the symptoms would go away.

"A real disease doesn't go away when somebody else does something," he argued.

Jacobs said experts had put labels on different behaviors and called them a disease.

"There's no proof. Nobody has ever presented any evidence of a condition called ADHD, except to say all these children are hyperactive; all these children are inattentive, and therefore they all have the disease. It's the 'and therefore' that I'm concerned about."

Jacobs acknowledged that many parents would disagree with him. Parents tend to believe what has become the mainstream view, in part because the drugs prescribed for ADHD do work in that they make the child more docile and more compliant.

"The child's not getting into trouble at school any more. The child's easier to manage at home, so we say, well this is great, it works."

Also, parents struggling with a behavior problem were made to feel better. Instead of feeling inadequate as parents, they felt they were now struggling with a sick child and doing the best they could.

Money trail

In the United States in 2001, pharmaceutical companies made more than $600 million in profits just on stimulant drugs used for attention deficit disorders.

"If ADHD doesn't exist, those hundreds of millions of dollars in profits go away."

"You have to follow the money," agreed Peyton Knight, legislative director at the American Policy Center, a Virginia-based think tank.

"It's big money," he said by phone late Thursday. "The more diagnoses there are every year the more Ritalin and other mind-altering drugs they are going to be able to market and sell."

Many would vehemently disagree with the arguments against the existence of ADHD, he said.

"But it's never been validated as a disease," Knight said. "It's arbitrary."

"The number of diagnoses has risen exponentially over the past decade. It's not like some epidemic is sweeping the nation like a flu virus. It's just a matter of diagnoses going up because of the popularity of diagnosing children with ADHD," he said.

"In today's society, parents look for the easy way out. If their kids are unruly, we give them a pill and it sedates them. That becomes a very easy thing to do and if a doctor tells them to do this, they feel good about it."

Knight said there was a fairly sizeable grassroots citizens' movement in the United States questioning these issues, and more parents and teachers were becoming aware of the problems.

Unfortunately a similar movement had yet to take hold in the scientific community, although there were some bold specialists who disagreed with the wider-held views.

One of them is neurologist Dr. Fred Baughman Jr., who in a 1998 letter to the then Attorney General Janet Reno, called the representation of ADHD as a disease and the drugging of millions of normal children "the single, biggest heath care fraud in U.S. history."

Massive increase in drug use

According to Baughman, 500,000 children were diagnosed ADHD in 1985 and between 5 and 7 million were today.

Substantial growth has also been reported in Australia, a country of just 19 million people, where it's estimated that at least 50,000 children are now on drugs prescribed for ADHD.

A report in the Medical Journal of Australia last November said Australia and New Zealand have the third-highest rate in the world of the drug use, after the United States and Canada.

Unlike the United States, where Ritalin (methylphenidate) is most often prescribed, in Australia dexamphetamine is more widely used.

University of Queensland figures show that legal use of dexamphetamine in Australia has risen from 8.3 million tablets prescribed in 1984 to 38.4 million tablets in 2001. Over the same period Ritalin prescriptions rose from 1.5 million tablets to 19.3 million.

The federal government early this year approved use in Australia of long-acting Ritalin-LA, which is said to be effective for longer than the usual four-hour period for standard Ritalin.

Rosemary Boon, a child psychologist in Sydney for more than 20 years, acknowledged in a recent article that the drugs were effective in settling the child and this benefited teachers, parents and classmates. But there was little benefit to the afflicted child, she added.

Boon does not argue that ADHD doesn't exist, but says it can be managed with the help of diet, exercise, behavior modification, stress management, identification of "triggers" of the symptoms, and a supportive family environment.

Critics list among the problems with drugs like Ritalin the fact children on them tend not to grow as tall as they might otherwise. There are also concerns that a child's intelligence, creativity and spontaneity may be dampened.

The Royal Australian and New Zealand College of Psychiatrists says medication should not be the first line of intervention for the vast majority of children. Alternatives should be looked into first.

On its website, Novartis, the pharmaceutical company that manufactures Ritalin, describes ADHD as "a physical disorder caused by differences in how the child's brain works."

Novartis has an article in the April-May edition of its journal, Pathways, arguing for the existence of ADHD.

It quotes Prof. Russell Barkley of the Medical University of South Carolina as saying that ADHD is not overdiagnosed in the United States.

"We have more diagnosis now than before due to better public awareness and greater referrals," he said.

[tutstar]

though you might be interested in this Ritalin/ADHD article...

[tutstar]

http://www.breggin.com/ritalinconfirmingthehazards.html

excerpt-----

In my practice of psychiatry, I am frequently consulted about children who are taking three, four, and sometimes five psychiatric drugs, including medications that are FDA-approved only for the treatment of psychotic adults. The drug treatment typically began when the children developed conflicts with adults at home or at school. In retrospect, the conflicts could easily have been resolved by interventions such as family counseling or individualized educational approaches. Usually under pressure from a school, the parents instead acquiesced to put their child on stimulants prescribed by psychiatrists, family physicians, or pediatricians.

When these children developed depression, delusions, hallucinations, paranoid fears and other drug-induced reactions while taking stimulants, their physicians mistakenly concluded that the children suffered from "clinical depression," "schizophrenia" or "bipolar disorder" that has been "unmasked" by the medications. Instead of removing the child from the stimulants, these doctors mistakenly prescribed additional drugs, such as antidepressants, mood stabilizers, and neuroleptics. Children who were put on stimulants for "inattention" or "hyperactivity" ended up taking multiple adult psychiatric drugs that caused severe adverse effects, including psychoses and tardive dyskinesia.

[tutstar]

Methylphenidate (MPH) commonly known as Ritalin

...."Abuse of MPH can lead to marked tolerance and severe psychic dependence...."

...."Students are giving and selling their medication to classmates who are crushing and snorting the powder like cocaine. In March of 1995, two deaths in Mississippi and Virginia were associated with this activity...."

...."The U.S. manufactures and consumes 5-times more MPH than the rest of the world combined.....

...."MPH aggregate production quota has increased almost 6-fold since 1990...."
http://www.breggin.com/dearelease.html

...."Every indicator available, including scientific abuse liability studies, actual abuse, paucity of scientific studies on possible adverse effects associated with long-term use of stimulants, divergent prescribing practices of U.S. physicians, and lack of concurrent medical treatment and follow-up, urge greater caution and more restrictive use of MPH...."

excerpts from DEA Press Release, October 20, 1995, "Methylphenidate"

[tutstar]

Psychiatrist Discloses Ritalin’s Hidden Dangers to Children

Warning Contradicts Claims that Drug is Helpful

Ritalin decreases blood flow to the brain, and routinely causes other gross malfunctions in the developing brain of the child, reveals Peter R. Breggin, M.D., Director of the International Center for the Study of Psychiatry and Psychology and associate faculty at The Johns Hopkins University Department of Counseling. In his new book, Talking Back to Ritalin (Common Courage Press, 1998), Dr. Breggin thoroughly documents the many scientific studies that have been ignored by Ritalin advocates.

America’s children are being exposed to a "prescription epidemic" of dangerous, addictive stimulant drugs such as Ritalin and Adderall, according to the psychiatrist, a leading critic of psychopharmaceutical practices.

"Ritalin does not correct biochemical imbalances—it causes them," Dr. Breggin says, adding that there is some evidence that it can cause permanent damage to the child’s brain and its function.

"Pediatricians, parents, and teachers are not aware of these hazards because a large body of research demonstrating the ill effects of this drug has been ignored and suppressed in order to encourage the sale of the drug," Dr. Breggin stated. Damaging effects of the drug can include:

* Decreased blood flow to the brain, an effect recently shown to be caused by cocaine where it is associated with impaired thinking ability and memory loss.
* Disruption of growth hormone, leading to suppression of growth in the body and brain of the child
* Permanent neurological tics, including Tourette’s Syndrome
* Addiction and abuse, including withdrawal reactions on a daily basis
* Psychosis (mania), depression, insomnia, agitation, and social withdrawal
* Possible shrinkage (atrophy) or other permanent physical abnormalities in the brain
* Worsening of the very symptoms the drug is supposed to improve including hyperactivity and inattention
* Decreased ability to learn

"Ritalin and other stimulants are currently prescribed to several million U.S. children in the hope of improving their supposed hyperactivity, inattention, and impulsivity," says Dr. Breggin. He presents evidence that these drugs "work" by producing robotic or zombie-like behavior in children. This enforced docility and obedience can produce a few weeks of subdued behavior but has no positive effect on academic achievement and no positive long-term effects at all. Contrary to claims by drug advocates, giving Ritalin to a child does not help to prevent future problems such as school failure or delinquency.

Ritalin’s lack of effectiveness has been proven by hundreds of studies but has not been revealed to doctors, teachers or parents. "Parents and teachers and even doctors have been badly misled by drug company marketing practices," Dr. Breggin says. "Drug companies have targeted children as a big market likely to boost profits—and children are suffering as a result."

Dr. Breggin describes the principles necessary to empower parents to help their children with their behavioral and school problems without resorting to drugs. He does not believe that mind-altering drugs are ever an appropriate approach to helping our children. Instead, he urges adults to learn to identify and meet the individual needs of the children in their care.

Most children receiving Ritalin have been identified for treatment by teachers who have been misled by drug company and government promotional campaigns for Ritalin and other stimulants. "Educate—don’t medicate," should be the motto of every parent or teacher who is tempted to resort to Ritalin, says Dr. Breggin.

The stimulant drugs include Ritalin (methylphenidate), Dexedrine and Dextrostat (dextroamphetamine or d-amphetamine), Adderall (D-amphetamine and amphetamine mixture), Desoxyn and Gradumet (methamphetamine), and Cylert (pemoline).

Additional information about the hazards of Ritalin and other stimulants can be found on Dr. Breggin’s web site at: http://www.breggin.com.

[webstersII]

"When our children were small my mother-in-law told me about this great stuff she had gotten from her Dr as a young mother. "Just one spoonful, and they'd all sleep for 10 hours straight! You've got to get some." I wonder what it was..."

Probably paragoric. It was used for a number of different things 40+ years ago. You wipe some on a baby's gums when they were having teething pain and they would be so happy and sleep for hours without bothering you. If they had an earache or any other thing keeping them from sleeping, give them a spoonful.

Of course, it is actually a narcotic, so they don't sell it anymore. My, how times change.

[tutstar]

Table I summarizes many of the most salient adverse effects of all the commonly used stimulant drugs. It is important to note that the Drug Enforcement Administration, and all other drug enforcement agencies worldwide, classify methylphenidate (Ritalin) and amphetamine (Dexedrine and Adderall) in the same Schedule II category as methamphetamine, cocaine, and the most potent opiates and barbiturates. Schedule II includes only those drugs with the very highest potential for addiction and abuse.

Animals and humans cross-addict to methylphenidate, amphetamine and cocaine. These drugs affect the same three neurotransmitter systems and the same parts of the brain. It should have been no surprise when Nadine Lambert presented data at the Consensus Development Conference (attached) indicating that prescribed stimulant use in childhood predisposes the individual to cocaine abuse in young adulthood.

Furthermore, their addiction and abuse potential is based on the capacity of these drugs to drastically and permanently change brain chemistry. Studies of amphetamine show that short-term clinical doses produce brain cell death. Similar studies of methylphenidate show long-lasting and sometimes permanent changes in the biochemistry of the brain.

All stimulants impair growth not only by suppressing appetite but also by disrupting growth hormone production. This poses a threat to every organ of the body, including the brain, during the child's growth. The disruption of neurotransmitter systems adds to this threat.

These drugs also endanger the cardiovascular system and commonly produce many adverse mental effects, including depression.

Too often stimulants become gateway drugs to illicit drugs. As noted, the use of prescription stimulants predisposes children to cocaine and nicotine abuse in young adulthood.

Stimulants even more often become gateway drugs to additional psychiatric medications. Stimulant-induced over-stimulation, for example, is often treated with addictive or dangerous sedatives, while stimulant-induced depression is often treated with dangerous, unapproved antidepressants. As the child's emotional control breaks down due to medication effects, mood stabilizers may be added. Eventually, these children end up on four or five psychiatric drugs at once and a diagnosis of bipolar disorder by the age of eight or ten.

In my private practice, children can usually be taken off all psychiatric drugs with great improvement in their psychological life and behavior, provided that the parents or other interested adults are willing to learn new approaches to disciplining and caring for the children. Consultations with the school, a change of teachers or schools, and home schooling can also help to meet the needs of children without resort to medication.

http://www.breggin.com/classactionmore.html

[Corin Stormhands]

but my complaint is that waaay too many people use this "hook" as an excuse to duck their responsibility to be good parents.

I agree that ADHD and ADD are way overdiagnosed, and that there are many kids taking meds that shouldn't be. When my son's teacher first suspected it, we took him to our family doctor who literally looked at him (didn't examine him or anything) and said "Well, he looks well adjusted to me, but if the school thinks he needs Ritalin, I'll write the prescription." I took him out of there and we found a pediatrician who spent two hours with him on the first visit. We went to meds as a last resort.

And the first day he went to school with the meds, he came home and said "I did all my math, and it was easy." But by the end of 5th grade, it was no longer working so we took him off the meds. We struggle every night with homework issues.

If we had honestly thought there as another solution, of course we wouldn't have chosen the meds. But we're upper-middle income, suburbia living, church-attending, community supporting, conservative, boy scout den leader, pta board member and stay-at-home mom (then) parents. It was not environmental with him.

[tutstar]

That is absolutely criminal!

[brewer1516]

There is a new treatment that is not a stimulent. It's called Strattera. It's made by Lilly (full disclosure; this is the company I work for, though not on the Strattera product team).
It's interesting that people most always associate ADHD with children when that certainly isn't the case. Kids with ADHD grow up and become adults; untreated adults may have trouble keeping jobs, have higher average of substance abuse, etc.

[tutstar]

There is info on shock treatment at breggin.com

[BJungNan]

DeathFrom Ritalin
The Truth Behind ADHD
www.RitalinDeath.com

[Doctor Stochastic]

Some of these problems (along with high blood pressure for example) are due to chemical imbalances. No trauma is seen, but the chemistry just isn't right.

[Doctor Stochastic]

..."highly visually oriented"...

I've never heard this. As one who has been dysletic for decades (past tense sedaced), the main problems seem to be the reversal of letters and numbers along with a (slight in my case) disconnect of words with their referents. (The map really isn't the territory.)

I do know of people considered dysletic who see numbers in arbitrary geometric patterns. Like:

44 477 34 8....
12 743 16 194....
2 45 466 744....
..............

Theses people have trouble with math; I had to teach them algorithmic rather than intuitive methods of computation. Fortunately I see the numbers in a line (ordered by magnetude). (I do see days of the year in a circle, Christmas on top and July 4 on the bottom. I know one person who sees a year as a horshoe with November connecting the ends.)

Studying music does seem to help with dyslexia. Perhaps it's because music uses different brain circuits or because one just learns more discipline.

[Doctor Stochastic]

Map reading and music reading seem related to each other. Neither is much related to math or reading ability.

Students as you describe sometimes can be helped by teaching a rote algorithmic method of arithmetic. It's not easy but balancing a checking book is good motivation.

[Maximum Leader]

Thank you for sharing your story. You may be interested in a book by a psychiatrist named Daniel Amen (his website is amenclinic.com)called Change Your Brain Change Your Life.

Dr. Amen discusses in his book cases of people suffering brain injuries to their left temporal lobe and becoming more irritable and aggressive as a result. Injuries or abnormalities to the prefrontal cortex can cause issues with impulse control (as well as ADHD in some cases). Dr. Amen has photographs of SPECT scans that show abnormal blood flows to these areas.

His thesis is that many pyschiatric disorders are as a result of abnormal blood flow patterns. Very interesting book.

[tutstar]

thanks for postin this site, I heard about the boy's death but didn't realize they had a website.....such a tragedy.

[AnAmericanMother]

Music appears to "put you together". Pre-medication, the only time my son could concentrate was in the church choir. The neurologist (and popular writer) Oliver Saks found that music helped a lot of his patients.

FWIW, I see the years as an uneven horseshoe, January on the top right and about two months higher than December on the far left. Against a plain white background -- they look like sheets torn from an old-fashioned wall calendar.

[Lazamataz]

Does an athiest, dyslexic, who suffers from insomia stay awake at night pondering if there is a DOG?

I know about a teenaged dyslexic who was a very religious, Dog-fearing boy.

But then he fell in with the a devil-worshipping crowd and started praying to Santa.

[Lazamataz]

Does ADHD medication have it's uses? Sure, for an incredibly small number of kids who have genuine neurologically-initated problems.

And adults. Don't forget the adults.

I agree with what you say about overdiagnosis of ADD and the subsequent overprescription of ADD medicines.

[Lazamataz]

Laz, good for you. I was in denial and then guilt over medicating my kid, but it makes a HUGE difference in his life. I don't let the ideologues bother me about this. No doubt some are needlessly medicated or it doesn't help. That doesn't mean that it's always a bad idea.

Thanks. I'm a little surprised about the vehemence of the ideologues on this topic. I'm sure the same vehement ideology goes on in the Prozac/Xanex/etc. community.

Those people want to see a physically damaged spot in the brain, or they will not buy that ADD exists at all. I like to ask them if clinical depression exists, and if they agree it does, to show me the physically-damaged spot in the brain which is the cause of said depression.

Face it, there is a lot we simply don't know about the human brain. We will, someday. In the meantime, if a small number of people get great healing from certain medications, why would the ideologues want to deny us the medications? What is going on in their brain?

Disclaimer: I agree that ADD is overdiagnosed and ADD medication is overprescribed to today's youth.