Doctor - ADHD does not exist

[ndfi78]

ADHD Does Not Exist Writes Dr. Richard Saul - TIME

This Wednesday, an article in the New York Times reported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about.

Agree completely, my in-laws make fun of how strict I am with the kids bedtimes. I honestly could care less though, sleep is SO important to kids.

 

[woolybug25]

I get blasted all of the time for this, so i'm guessing I will here too. But frankly, I agree with the doctor.

Don't get me wrong, I think that much of the ADHD medicine can be beneficial for people wih axiety/hyperactivity issues. That being said, most people with these issues just use those drugs as a crutch. They don't change their eating/excercise/schedule structure, which is usually the root of the problem.

Nothing pisses me off more than a kid on ADHD drugs that gets to drink soda, has no definitive structure to their day and sits around playing video games.

No one took ADHD drugs for centuries, but now almost half of kids in the US are plagued by the "disease" of ADHD? Give me a break.

 

[Irishnuke]

I'm not saying it doesn't exist but I do think it's over-diagnosed. I also think it's a convenient excuse for parents who can't (won't) control their children.

 

[Irishnuke]

I get blasted all of the time for this, so i'm guessing I will here too. But frankly, I agree with the doctor.

Don't get me wrong, I think that much of the ADHD medicine can be beneficial for people wih axiety/hyperactivity issues. That being said, most people with these issues just use those drugs as a crutch. They don't change their eating/excercise/schedule structure, which is usually the root of the problem.

Nothing pisses me off more than a kid on ADHD drugs that gets to drink soda, has no definitive structure to their day and sits around playing video games.

No one took ADHD drugs for centuries, but now almost half of kids in the US are plagued by the "disease" of ADHD? Give me a break.

Exactly how I feel. Let's hear what our message board psychologist has to say now.

 

[gkIrish]

I definitely believe that, at a minimum, it is severely over-diagnosed.

 

[gkIrish]

I'm not saying it doesn't exist but I do think it's over-diagnosed. I also think it's a convenient excuse for parents who can't (won't) control their children.

The funny thing is that so many people claim to have it that it isn't really even an excuse anymore.

 

[ulukinatme]

Definitely over diagnosed, but I've heard that doctor's were getting kick backs from drug companies back in the day to push Ritalin. I can see where anxiety and/or hyperactivity could be part of the problem. Some of this is behavioral though and can be curbed, its just easier for some parents to dole out pills.

 

[Cali_domer]

Too much sugar in kids diets= ADHD

 

[Ndaccountant]

Always believed ADHD was an easy out and still do.

 

[ACamp1900]

I'm not saying it doesn't exist but I do think it's over-diagnosed. I also think it's a convenient excuse for parents who can't (won't) control their children.

I definitely believe that, at a minimum, it is severely over-diagnosed.

I think there is something to it, but from a teachers perspective... This.

A lot of the cases I saw were just parents wanting the extra support checks.

 

[IrishLion]

I'm not saying it doesn't exist but I do think it's over-diagnosed. I also think it's a convenient excuse for parents who can't (won't) control their children.

I couldn't agree more.

Kids get spoiled, and when they stop getting what they want, they start acting out.

Oh, that child is misbehaving, can't be controlled? Must be ADHD.

 

[dublinirish]

Anyone ever seen that Louis Theroux episode where he spends a week or so with families with kids who are heavily medicated due to their ADHD diagnosis? Every one of the families had parents who just were terrible parents and had lost control of their children and needed their kids medicated so the parents could "relax". The downside of this of course was that the kids were 8/9 years old and were already having suicidal thoughts and that their lives were worthless and just a burden on their parents. Terrible stuff altogether.

Here's the episode on youtube, part 1 of 4: Louis Theroux - America's Medicated Kids - 1 of 4 - YouTube

 

[ACamp1900]

As an educator it's hard for me to speak for doctors... So I've never been able to say it doesn't exist. I have had students that definitely had something going on. From a common sense pov it's strange that we went from this never being known/diagnosed/an issue/whatever to what seems like one out of every four students ( never counted, just a fair round from my last classes) having it. Seems we changed something major in our diets or child rearing practices or its not what it is made to be... Idk. They do over diagnose though, I've seen parents go ape shit for a positive diagnosis... Dolla dolla bill yall.

 

[woolybug25]

As an educator it's hard for me to speak for doctors... So I've never been able to say it doesn't exist. I have had students that definitely had something going on. From a common sense pov it's strange that we went from this never being known to what seems like one out of every four students ( never counted, just a fair round from my last classes) having it. Seems we changed something major in our diets or child rearing practices or its not what it is made to be... Idk. They do over diagnose though, I've seen parents go ape shit for a positive diagnosis... Dolla dolla bill yall.

Bingo!

Kids started consuming more complex sugars, caffiene and "energy drinks". Pair that with the invention of the internet and prolification of video games... bam!... you have ADHD.

Think of a puppy. What would happen if you raised one eating table scraps, no set schedule and no consequences for bad behavior? You would end up with a crazy dog that barks at everything, chews everything, shits on the floor, etc (kinda like Acamp on the weekends). Same concept for raising kids.

 

[ACamp1900]

Bingo!

Kids started consuming more complex sugars, caffiene and "energy drinks". Pair that with the invention of the internet and prolification of video games... bam!... you have ADHD.

Think of a puppy. What would happen if you raised one eating table scraps, no set schedule and no consequences for bad behavior? You would end up with a crazy dog that barks at everything, chews everything, shits on the floor, etc (kinda like Acamp on the weekends). Same concept for raising kids.

I am NOT a freaking dog.... Lets get that straight right now.

 

[Bogtrotter07]

At risk of entering a sort of oversimplistic conversation about a complex topic, did anyone actually read the whole article?

As I don't have a whole lot of axes to grind, I don't have any particular place to store my angst.

Here is what I know. There is a mental disorder called ADHD. [One can debate the ADHD-H and ADHD-PI sub-diagnoses all day.] How do I know this?

• There is a code for the disorder; it has stood up to 60 years of science.
• Brain scans always show specific (mis)function in a specific place (pre-frontal cortex) for ADHD.
• Medicine works, stimulant medication has the same "contraindicated" effect for those who need it.

Ritalin or any of the other stimulants in either of the two common classes used to treat ADHD does not have a calming affect on someone who does not have ADHD. It has a stimulating effect. That stimulating effect may be good for a student studying for an exam, but it is basically different than the effect Ritalin has for a child that cannot concentrate (inattentive) or calms immeasurably (hyperactive).

This guy is right, there are many things getting lumped together and that in it self is dangerous. But if diagnosis and treatment are pursued correctly, a result is never awry.

Many times it appears parents are at fault with their parenting. But good parenting can be perverted by a serious condition, or other factors.

And to make the point of the doctor, ADHD is divided into two major categories today, hyperactive (-H) and inattentive, (-PI) or primarily inattentive. Of the ADHD-PI, it is estimate 30 to 50 percent can be fit into a series of symptoms (called a cluster) known as SCT, or Sluggish Cognitive Tempo. Please note, it is not "lazy" cognitive tempo. It is real, and a hot topic. Much of the debate is should it be offered its own diagnosis or be kept under the ADHD umbrella.

There are many reasons for the conversation, practical, ethical and technical within the field. Do you drill down to specificity of a disorder to the point that so few suffer from it you lose all hope of funding for research? Or do you stay general enough risking finding a more specific treatment (along the lines of the argument of the author)? I don't know.

I know that if you look at SCT, you find that most of the problem lies along the midline of the brain in the back, but if you look at true ADHD-PI it lies in the prefrontal cortex. Ritalin works with both.

I know someone with what I suspect is SCT, though it is diagnosed as ADHD-PI. This person could not memorize simple math facts. SCT symptoms affect memory storage and retrieval. They also affect certain complex math and language related functions. People that have SCT often report that they feel like a different person, or think differently, when on a low dose of Ritalin. This child is scoring an average of 35 points (of 100) higher after finding a good balance of meds and other treatment. Which is another important point. Meds alone are not a solution.

Here is the important point in all this : the comorbidity of any of these disorders with other disorders. MDD and other disorders follow any of these ADHD or SCT disorders. More specifically, early correct diagnosis and treatment of these disorders is indicating a lower effect of depressive episodes. Correct the kids learning problems, so that they can build confidence, and they are less likely to have depressive episodes.

So in conclusion, by all means weed out the people that don't need it. But there is a working mechanism in the medical and mental health community to deal with this issue. Get the people what they really need. But don't deny a whole group of people who are demonstrably better off because there have been a number of missed diagnosed cases.

Is it over diagnosed? Yes, and missed in some cases, too! Is it made worse by our habits and environment? Undoubtedly! In fact there is some interesting research on changes in hormonal balances of pregnant women, post WWII and how that may have an effect on the number of cases diagnosed. Has it always been around? Yes. Just like diabetes. First it was unknown. Then it was a death sentence. Now we are understanding some much in treating it, that it is almost always caught early, and treatable.

 

[Emcee77]

My mother in law is a special ed teacher, and let's just say I'm certain that there are plenty of kids with serious psychological problems who benefit from Ritalin or similar drugs. Whether the real problem is not ADHD but some underlying disorder I won't claim to know.

But I don't think anybody doubts that ADHD is over-diagnosed and ADHD drugs are over-prescribed. Honestly, sometimes people like my mother in law are part of the problem ... over decades she has seen her kids benefit from Ritalin and at this point she may be a little too quick to counsel someone to talk to a doctor about getting a prescription. There are plenty of people out there who have no real learning disability and are just looking for a quick fix.

 

[irish1958]

At risk of entering a sort of oversimplistic conversation about a complex topic, did anyone actually read the whole article?

As I don't have a whole lot of axes to grind, I don't have any particular place to store my angst.

Here is what I know. There is a mental disorder called ADHD. [One can debate the ADHD-H and ADHD-PI sub-diagnoses all day.] How do I know this?

• There is a code for the disorder; it has stood up to 60 years of science.
• Brain scans always show specific (mis)function in a specific place (pre-frontal cortex) for ADHD.
• Medicine works, stimulant medication has the same "contraindicated" effect for those who need it.

Ritalin or any of the other stimulants in either of the two common classes used to treat ADHD does not have a calming affect on someone who does not have ADHD. It has a stimulating effect. That stimulating effect may be good for a student studying for an exam, but it is basically different than the effect Ritalin has for a child that cannot concentrate (inattentive) or calms immeasurably (hyperactive).

This guy is right, there are many things getting lumped together and that in it self is dangerous. But if diagnosis and treatment are pursued correctly, a result is never awry.

Many times it appears parents are at fault with their parenting. But good parenting can be perverted by a serious condition, or other factors.

And to make the point of the doctor, ADHD is divided into two major categories today, hyperactive (-H) and inattentive, (-PI) or primarily inattentive. Of the ADHD-PI, it is estimate 30 to 50 percent can be fit into a series of symptoms (called a cluster) known as SCT, or Sluggish Cognitive Tempo. Please note, it is not "lazy" cognitive tempo. It is real, and a hot topic. Much of the debate is should it be offered its own diagnosis or be kept under the ADHD umbrella.

There are many reasons for the conversation, practical, ethical and technical within the field. Do you drill down to specificity of a disorder to the point that so few suffer from it you lose all hope of funding for research? Or do you stay general enough risking finding a more specific treatment (along the lines of the argument of the author)? I don't know.

I know that if you look at SCT, you find that most of the problem lies along the midline of the brain in the back, but if you look at true ADHD-PI it lies in the prefrontal cortex. Ritalin works with both.

I know someone with what I suspect is SCT, though it is diagnosed as ADHD-PI. This person could not memorize simple math facts. SCT symptoms affect memory storage and retrieval. They also affect certain complex math and language related functions. People that have SCT often report that they feel like a different person, or think differently, when on a low dose of Ritalin. This child is scoring an average of 35 points (of 100) higher after finding a good balance of meds and other treatment. Which is another important point. Meds alone are not a solution.

Here is the important point in all this : the comorbidity of any of these disorders with other disorders. MDD and other disorders follow any of these ADHD or SCT disorders. More specifically, early correct diagnosis and treatment of these disorders is indicating a lower effect of depressive episodes. Correct the kids learning problems, so that they can build confidence, and they are less likely to have depressive episodes.

So in conclusion, by all means weed out the people that don't need it. But there is a working mechanism in the medical and mental health community to deal with this issue. Get the people what they really need. But don't deny a whole group of people who are demonstrably better off because there have been a number of missed diagnosed cases.

Is it over diagnosed? Yes, and missed in some cases, too! Is it made worse by our habits and environment? Undoubtedly! In fact there is some interesting research on changes in hormonal balances of pregnant women, post WWII and how that may have an effect on the number of cases diagnosed. Has it always been around? Yes. Just like diabetes. First it was unknown. Then it was a death sentence. Now we are understanding some much in treating it, that it is almost always caught early, and treatable.

100% correct
This is an extremely complex and real problem.
I wish there were an easy solution but there is not, for social, religious, economic and scientific reasons.

 

[IrishinTN]

I am NOT a freaking dog.... Lets get that straight right now.

Obviously you are a cat.

Yeah, I was never a big believer in this. Parents are too busy trying to be their kids best friend any more.

 

[Cackalacky]

Pull your brain chemistry up by the boot straps.

 

[wizards8507]

I wish IrishPat were here...

 

[Bogtrotter07]

So it isn't that ADHD doesn't exist, maybe that it is other things, and misdiagnosed, and over-diagnosed. So maybe we can change the headline from "ADHD doesn't exist" is not well understood, or something more appropriate.

I remember talking about ADHD with Pat, and a few others, and we came to a rather elegant and sophisticated meeting of the minds on the topic.

I miss Pat, by the way. I always have. And I didn't get into the hullabaloo because it wouldn't have contributed anything positive to the situation.

 

[RDU Irish]

My wife worked in a child development clinic for quite a few years. One time she comes home honked off. She realized one teacher had referred her entire class to the clinic after she connected the dots of so many kids from the same town, same age coming in over a few months. Literally the entire freaking kindergarten class was referred in by this new teacher who obviously had no clue how 5 year olds are supposed to act.

We are very regimented with our kids on bedtime and schedule. People think we are militant and mean but then are quick to compliment our kids' behavior. Then complain about their own in the next breath and how they stay up late, eat pure junk 24/7 and haven't taken a nap since they were 2.

 

[irishff1014]

I'm not saying it doesn't exist but I do think it's over-diagnosed. I also think it's a convenient excuse for parents who can't (won't) control their children.

100 % correct. I honestly believe that some kids do have it but to would venture to say that is under 20%.

I believe you hit the nail on the head with the second part as well.

 

[Cackalacky]

I will just post this anecdotal item and that is it for me.

A family member who is relatively young was largely unfocused and had trouble even maintaining vigilance enough to pay attention to little things like walking in the middle of the road or a busy parking lot. This person was treated with methamphetamine salts and is night and day when they take the medicine as prescribed. When they do not, I can tell within a few minutes that they have not.

The same can be said for another of my family members who went undiagnosed their entire life until a few years ago and they survived. Also, I can tell when they have missed taking their meds too. Anyway, it is likely these two individuals have inherited the disrupted brain activity. Its not even really anything to do with structure or discipline as far as these two individuals go. It is more of them being unaware how distracted they really are. Its amazing to watch and frustrating to deal with as well. I have to finish projects they start or tell them things over and over again. No amount of discipline or parenting can correct for that except a large does of understanding and an ability to adapt.

 

[Bogtrotter07]

My wife worked in a child development clinic for quite a few years. One time she comes home honked off. She realized one teacher had referred her entire class to the clinic after she connected the dots of so many kids from the same town, same age coming in over a few months. Literally the entire freaking kindergarten class was referred in by this new teacher who obviously had no clue how 5 year olds are supposed to act.

We are very regimented with our kids on bedtime and schedule. People think we are militant and mean but then are quick to compliment our kids' behavior. Then complain about their own in the next breath and how they stay up late, eat pure junk 24/7 and haven't taken a nap since they were 2.

I have a social acquaintance who is a therapist, on top of her game, and in demand. She is a cognitive therapist. She would appreciate you. She would say what kids and puppy's have in common is that they are both to be trained. That is step one. For her step two is logical consequences for behavior, so they both learn from their training and behavior. Then you can teach a kid the difference between thoughts, feelings, and actions. Then, that they can stop their thoughts, modify their actions and change their feelings. Voila!

 

[Te'o4Heisman]

I used to be in the group that would say ADHD is completely made up...before I became the step father of a young boy who has it badly.
I do believe it is used completely as a copout by many however, and abused in the over diagnosis of it to make excused for generally misbehaved and undisciplined children.

My step son is the poster child for ADHD though. He is 10, will be 11 in April. He does not drink soda, juice, or anything but milk and water. He does not get candy, sugary snacks, or junk food except on very rare occasions...I'm talking like maybe once a week we will let him have a tiny bowl of ice cream after dinner. We monitor his school lunch account to make sure he is not going and just eating junk there...his bedtime is 8:30, lights out at 9, every night, and we wake him up for school at 6:15 every morning. On the weekends we let him stay up until midnight and sleep in, unless he has baseball in which case he is bed by 9:30.
He gets to play playstation 2 days a week, for no longer than 90 minutes each time. We do not allow him to sit around watching TV or doing nothing all night when he gets home from school..the first thing he does is his homework then runs out to play outside with the boys in the neighborhood. We have strict rules in our house, and they come with consequences and loss of privileges, which happens often. That being said, if our son is not on his concerta, he literally just can not get out of his own way. He struggles to pay attention and make eye contact when you are speaking with him, often distracted by just about anything going on in the environment around him. He wakes up at 6:15 in the morning completely hyperactive, moving 1000 miles an hour, talking nonstop, unable to stay focused on tasks like getting dressed and getting ready for school, and he literally cannot control his mouth no matter the consequences. We waited as long as we possibly could prior to taking him to the Dr's for what we knew would end up being either vyvance or concerta...however it got to the point where his inability to focus and stay on task became an issue for him at school and was impacting his ability to learn and retain teachings. He is generally a well behaved young boy, and as soon as he has his medicine, is all "yes sir" "no sir", accomplishes his tasks, displays improved learning, and makes eye contact constantly while being spoken to. We have taught him well, and he knows better...he just literally, despite any consequences there are, including whoopings, groundings, loss of privileges, writing 100's of sentences, timeouts and anything else you can think of, just simply cannot control his impulsivity or focus without his medicine. We, as a family however, DO NOT allow this to be a crutch for him...instead we constantly preach to him that it is up to him to do the work and control his behavior..that his medicine cannot "fix" the problems for him, it just helps him slow his brain down enough that he can figure out how to organize his thoughts and actions to make the right choices and behave appropriately.

Fine line..I do believe ADHD is real, we as a society just need to do a better job identifying when it is real and not just excusing our inability to discipline our children, and their inability to behave appropriately as ADHD.

 

[RDU Irish]

I don't think it is BS, just grossly overprescribed as an easy out for a pill popping culture. Why change your lifestyle if you can fix your problems with a pill. My dad is the same way with his smorgasboard of drugs he takes. Diet and exercise would have him off half in no time but he has no interest in that. Easier to say you have some affliction and need meds than take responsibility.

I don't doubt that one of my kids in particular might benefit from some medication to help him focus and pay attention in school. However, I would rather he learns to deal with it and control himself. We get off schedule and he is a train wreck. If he doesn't have sports going on, he loses focus. Not unusual for 10 year old boys since the beginning of time though.

 

[Emcee77]

Man, these last two posts tell the story, don't they? This is the trick, knowing the difference between Teo's stepson and RDU's son.

I know from my mother in law's experience that there are plenty of kids out there like Teo's stepson who are great kids who just need the medicine.

I also know that there are many kids like RDU's son who seem to need the medicine but actually don't. I was one such kid. My mom read something about ADD, realized that I basically had all the symptoms, and took me in to be evaluated. Thankfully, the doctor correctly determined that I didn't need any medicine (I have no idea how he did so, and my mom doesn't remember what he said). I am really thankful now that they didn't just give it to me anyway. As the author of the Time piece points out, if you take the medicine for too long then your brain stops producing the neurotransmitters you need and you really DO need the medicine.

I suppose I disagree with RDU's implicit assertion that his son could benefit from the medicine, but doesn't need it. I'm far from an expert, and anyone with expertise please correct me if I'm wrong, but I had the impression that you either need the medicine because your brain chemistry is such that you can't regulate your behavior, or you don't and the medicine won't help you. If you don't need the medicine, i.e. if you don't have the chemical imbalance that the medicine corrects, then the medicine will just have a stimulating, speed-like effect, and will actually be counter-productive.

 

[greyhammer90]

Too much sugar in kids diets= ADHD

Actually that's another psychological fallacy. Sugar does not make children hyper. But the myth is so ingrained that kids act hyper when they think they've had sugar, and parents actually think their kid is being hyper when the parent is told their child has had sugar.