New ADHD study leaves some wiggle room

@High Seas,

A friend of mine is a paediatric neuropsychologist. She also feels that there's no such thing as ADHD, however she blames it on lazy parenting and a greedy pharmaceutical industry.

She quit a job at a good U.S. hospital a few years ago as the clinic head wanted her to make the dx's parents were requesting and then to refer the kids to someone who could prescribe meds. The clinic head didn't like her recommendations that the parents become more involved in terms of doing things with their children and being taught how to provide appropriate discipline to children (you know, all that good rights and responsibilities stuff).

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I have mixed feelings about genetic testing. I'm not sure what I would gain by knowing. I can see circumstances where I might consider it, and circumstances where he might consider it when he's an adult.

Even if there was something I could do to change it I don't know if I would. I like Mo the way he is. I worry because the way he is sometimes causes problems for him but I really think he'll be okay.

He didn't completely freak out and melt down on the last day of school this year and wake up crying and upset about life the next day. I think that shows he's learning how to regulate his behavior a lot better.

I believe that there probably is such a thing as ADHD/ASD but it has become such an industry that many people are willing to throw kids to the wolves rather than fight back.

You would not believe the things that have been said to me. That I'm a negligent parent for not medicating Mo. That he's going to grow up miserable, depressed and suicidal because I won't medicate him. That my life would be rainbows and unicorns if I would only medicate him.

The fact that he doesn't have ADHD doesn't seem to matter.

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What they really mean is: "You're a negligent parent for not making our job easier...We're going to be miserable, depressed and suicidal because we don't want to work that hard...Our lives would be rainbows and unicorns if you would only medicate him."

They've just twisted the truth around to make it look like YOUR problem so you'll solve it for them.

Mo is a challenge in the classroom, but teaching him is their job. Keep holding their feet to the fire, boomer.

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@ehBeth,

The parents most caught up in the whole industry actually believe anyone suggesting changes in how the child is dealt with is a personal attack on them, and, at least here have, or had, (the ADD industry appears to be losing power at present...I guess because the drugs do so little for so many kids and have such nasty side effects for many, and because some kids and their parents end up selling the damn things on the streets, and because of the appalling practices of some paediatricians who would have kids on a cocktail of drugs BEFORE THEY WERE THREE, some of whom have been forced out of business because of these and other practices...like diagnosing ON THE PHONE etc.) formed a powerful lobby group demonising any practitioner who did not immediately give them drugs on demand. Never mind proper assessment, double blind trials etc!!!

I don't take the position that some kids don't have something we now call ADD, whatever the hell it might turn out to be...but the ADD industry has been an almost demonic force in the hands of the weak and incompetent and the drug companies.

Also, so much else exists to explain the behaviour of so many of these kids.
Nonetheless, I think it a bit premature to absolutely deny the existence of ADD/ADHD...though we certainly have some very active psychiatrists here strongly involved in advocating that view.

But, I am a pragmatist....eg I am co-working a case now where a very traumatised little fella has been drugged. I see his sibling. The drugged kid's therapist is aghast, and fought unsuccessfully against the paediatrician's decision. Thing is:

1. Most of us would function a bit better on a mild dose of speed, and these kids often do, at least for a while (unless they are one of the percentage of kids who react very negatively to the drug.) This particular kid reacted well.

2. The carer was overwhelmed, and had become fixated on getting the kid drugged.

3. In my experience, if the carer has become obsessed by drugging said child, and the prescriber is not one of the mad doctors who prescribe really dangerously (we've had a couple of kids nearly killed by mad paediatricians and their bizarre and ignorant potions) fighting the carer results in a destroyed relationship with you, the therapist, and the kid will be drugged willy nilly.

4. Whereas, if you keep the relationship, you can often guide the carer away from the truly dangerous doctors....also, you can continue working with the kid and the family on dealing with the issues...and, if the drugs stop working, you still have a client who has a good relationship with you, and can happily relinquish the meds without feeling this means they have lost a battle, and refusing to move on....they often just try a madder doctor with more drugs. There are actually drugs that help very traumatised kids better than speed....but they have to be used with extreme caution, monitored with great care, and in my view should never be prescribed except by a very experienced child psychiatrist.

5. In keeping the relationship, you also get to be able to explain to the kid about the drugs without them going on with life believing their brain is wrong and therefore they cannot have any control over their behaviour and they are just fucked for life (a common belief with drugged kids.)

So, I try not to get into big fights about this stuff....my colleague in the case I just described has succeeded in alienating the carer I mentioned from our service, and I am kind of mad about it.

But a new and better NLP is here! (NLD = new and lucrative diagnosis).

Behold, the US brings us Childhood onset bipolar!!!

This is a better cash-cow even than ADD.

The diagnostic criteria are even fuzzier!!

The range of drugs recommended is HUGE!!!

The proponents state that one may spend YEARS finding the right combo of drugs!!! Think of the multiple paediatric visits! They are endless!!! Think of the masses of drugs that can be poured down young throats!!!!!

It's a goldmine!!!!

We are alerted over here this time, and have medical etc. folk already attempting to educate GP's and paediatricians about the new madness.

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@boomerang,

You guys have it harder re the education system, I think.

We have the odd teacher/school that tries the "drug your damn kid" thing, but nothing like as much as appears to happen in the US.

And I have not heard of the emotional blackmail thing.

Personally, after making nice and doing my best to assist, I'd tear a teacher putting such pressure on a parent a new one if nothing else helped.

We do a lot of teaching re trauma and attachment issues in schools about these little folk, and try our best to assist schools with figuring out what works with them.

I also, with my bamboo vs oak philosophy, have no problem with getting a kid assessed (as you did) by competent people to give an informed opinion re medication, if the parent is happy with this.

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@dlowan,

Is childhood-onset bi-polar even in the DSM?

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@DrewDad,

Haven't looked.

There's a newer than DSM IVR out, don't have a work copy yet.

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I just wanted to say, Miss Wabbit, that i always enjoy reading your professional opinions.

And that's about the last time i'll ever say anything nice to you, so don't come over all gushy and friendly on me.

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Yes, dlowan's posts are always so helpful!

Absolutely the parents or carers are a huge part of the problem!

We saw one doctor (when our regular doctor was out) who I think thought that I was there to try to get Mo on drugs -- and he was perfectly willing to give them to me. I too Mo to the doctor for some allergy problems which the "new" doctor diagnosed as ADHD (in 5 minutes, having just met Mo, who was actually behaving very, very well). He was surprised when I balked. I wanted to ask him which pharmacutical company lined his pockets.

"Emotional blackmail" is the perfect term for what happens. A lot of parents are really proud of the "help" they give their kids with drugs following a 5 minute office visit and a 10 point "survey" of the child's behavior.

But for some kids, drugs do help. I know one young girl who is on a mild anti-psychotic and for the first time in her life she is able to relax enough to be happy. (Note: this child's mother is a child psychiatrist and the meds were prescribed by a neurologist after serious evaluation.)

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I knew a boy (he'd be about 16 or 17 now), who was diagnosed and put on a course of drugs, and his mother completely lacked the knowledge or perspective to know if this was the right thing. I strongly suspect that he was "acting out" in response to a messy and acrimonious divorce, and the subsequently revealed sexual abuse of the paternal grandfather. (My friend and i actually had to bully the woman into going to Child and Family Services with the allegation, which, after investigation, was confirmed by them, and then she was able to get an order that the father could only see the children at her home once a week, unless and until he moved out of his father's house and undertook never to leave the children in his father's custody.)

Things went from bad to worse with "John," and his behavior at school and toward his mother and siblings deteriorated to the point that they basically "jailed" him in a group home. My friend, who came from a good family but ended up on the street on drugs when he was in his late teens, began going to see him alone, and talked and talked to him. John cleaned up his act, and they eventually released him from the group home. He got off the drugs, got "clean," and the fear of being dragged back into the unreality of the drugs was enough to make him aware of the need to govern his temper and control his behavior. His mother moved, and he was put into another school where he had no "history," and the last i knew, he was drug free and behaving well. The turn-around was like night and day. It apparently never occurred to the clowns in the public school system that you can expect trouble from a boy who has just experienced a messy divorce and been sexually molested by a middle-aged man. As you put it Boom, a ten minute evaluation followed by a prescription, and it quickly escalated to the point at which the school got an order from Children's Services to keep him drugged up.

It's an appalling thing, and i don't frankly know what ought to be done about it.

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@Setanta,

Last week the FDA approved even stronger drugs for use in children; they could be prescribed before, of course, but now it's official. There's just too much money in it, and too many teachers, parents, doctors are just caught up in the system. This is from last year - one of many warnings that were ignored in that decision:

Quote:

WASHINGTON " Powerful antipsychotic medicines are being used far too cavalierly in children, and federal drug regulators must do more to warn doctors of their substantial risks, a panel of federal drug experts said Tuesday.

More than 389,000 children and teenagers were treated last year with Risperdal, one of five popular medicines known as atypical antipsychotics. Of those patients, 240,000 were 12 or younger, according to data presented to the committee. In many cases, the drug was prescribed to treat attention deficit disorders.

But Risperdal is not approved for attention deficit problems, and its risks " which include substantial weight gain, metabolic disorders and muscular tics that can be permanent " are too profound to justify its use in treating such disorders, panel members said.

http://www.nytimes.com/2008/11/19/health/policy/19fda.html
Children as young as 3 are put on these drugs - it seems monstrous.

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@High Seas,

PS (this case still sub judice) as of spring 2009, with Harvard University and Mass General doing their own investigations:

Quote:

Court documents show Dr. Biederman outlined plans to Johnson & Johnson company executives about a proposed trial of the antipsychotic drug risperidone (Risperdal). The trial “will support the safety and effectiveness of risperidone in this age group,” he promised before even conducting the drug trial.

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It is frightening.

I've been thinking a lot about this. I can see how it would be so easy to get sucked up into drugging your kid.

If it wasn't so sad, I'd laugh my ass off at all the people who told me that once Mo started school I'd get lots of help understanding what was going on from his teachers.

There have been times when I could have saved my own sanity by drugging Mo.

We're raised to trust doctors.

Seriously, it has been a full time job researching this stuff and advocating for Mo. Sorting through all of the misinformation and opinion masquerading as "evidence" for one side or the other is frustrating and time consuming. Trying to keep my own biases out of it makes it even more complicated. Having your insurance not pay for anything and even threaten to cancel your policy doesn't make help either. (Our policy wasn't canceled because Mo is adopted. There are some extra protections for adopted kids. (That's something they don't tell you and they hope you don't bother to research on your own.)) Being willing to put a lot of private information out into the world by asking and asking and asking and asking everyone who might know something and following those threads. Reading and rereading trying to make sense and learn something from articles that weren't written for laymen.

I know I'm lucky that I have the time and money to be a stubborn bitch.

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I have no problem with my students snoozing, stretching, yawning, going to the bathroom, etc.

They can be as physical as they please in class as long as they are not a distraction to either the material I must present, or to the other students.

Most of my students are male in the age range from 20 to 40 and are used to being physically active seeing that electrical is about evenly divided between mental skills and physical skills.

Mo might find this balance to his liking, albeit it is (arguably) the least physical and most math-intensive of the technical-trades.

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@boomerang,

boomerang wrote:

If it wasn't so sad, I'd laugh my ass off at all the people who told me that once Mo started school I'd get lots of help understanding what was going on from his teachers.

school - home - teachers, friends, family..

does your head in tho, doesn't it? Tiring. Wearing.

there's some good teachers out there, very good, good carers, very good - but whether it's mainstream or even in specialised settings - it's the system - medical and educational - in my opinion - that lacks the understanding. The system caters only to the "all" - not to our children as individuals.

keep advocating Boomer.

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@boomerang,

I've got some kids who have "going for a run" cards that they can use if they really need to move.

But they have to be able to be trusted to do just that......usually a run round the oval.

There's a duty of care issue involved for schools...you know, if they run off, or get kidnapped etc.

Also, if a pattern of needing a run whenever a certain subject comes up, and hence avoiding it, is detected, their running shoes are clipped for that subject!

I have also advocated that, for some kids, recess and lunch play is not something that is taken away as a consequence.

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@dlowan,

Or...they're allowed time to do an agreed upon physical activity when they have completed a piece of work well......or even a goddam computer game...(they're gradually expected to manage for a bit longer over time.)

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@boomerang,

boomerang wrote:

It is frightening............ Reading and rereading trying to make sense and learn something from articles that weren't written for laymen........

The risks of the medications have been obvious to the insurers for decades. But from the financial standpoint it's a whole lot cheaper to pay for pills than it is to pay for special teachers, extra medical exams and opinions, and so on. So nobody will say anything.

Here's another article, on which I have to warn you (from the purely statistical standpoint, not medical) that the numbers are too small to draw conclusions, mathematically speaking:
http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09050619v1.pdf

I'll be off public websites for a while due to an overseas trip, but can send you more articles by e-mail as and when I come across any. Good luck.

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@High Seas,

Oh my gosh!

Last week a 13 year old boy "in excellent health" dropped dead running on the school track. The teacher began CPR immediately. An abulance arrived in 3 minutes. The boy died.

I wonder if he was on Ritilan.

I hope you have a great trip. I always love the articles you send!

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@boomerang,

Here's some stuff by a local psychiatrist (local to me):

Quote:

Medical experts expose ADHD misdiagnoses

By Janet Fyfe-Yeomans and Kate Sikora

August 21, 2008 12:00am

TWO of Australia's most senior medical experts have blown the whistle on the misdiagnosis of ADHD, with at least one in three children wrongly diagnosed with the condition.

The alarming figure comes as a leading psychologist warned there was no evidence of the long-term benefits of medication such as Ritalin.

Dr Jon Jureidini told The Daily Telegraph yesterday that the misdiagnosis figure could even be higher, with some children with learning difficulties wrongly prescribed drugs for Attention Deficit Hyperactive Disorder. Dr Jureidini is among a group of experts who have made powerful submissions to the Federal Government's ADHD review panel, which will rewrite guidelines for the diagnosis of the condition.

His warning comes at the same time as a push to ban GPs from diagnosing attention deficit hyperactivity disorder.

Some child education experts are concerned doctors are "too readily" labelling children with ADHD and prescribing Ritalin, potentially putting them at risk of dangerous side effects.

In their submission, a group of 14 academics has called for multi-disciplinary teams of psychologists, doctors and experts to replace GPs and have sole responsibility for diagnosing the condition.

The influential group, from seven universities, including the University of Sydney and the University of Wollongong, has also urged the Federal Government not to declare ADHD a "disability" and allocate special funding for schools based on the number of students suffering it.

A similar move in the US led to an explosion of 600 per cent in the diagnosis, or misdiagnosis, of ADHD as schools competed for the extra grants, the group said.

"It is a diagnosis that should not be used in anything other than a tiny fraction of cases in which it is made," Dr Jureidini, head of the Department of Psychological Medicine at Adelaide's Women's and Children's Hospital, said.

The Royal Australasian College of Physicians, which is reviewing the outdated guidelines at the request of the National Health and Medical Research Council, has been accused of taking too narrow a view.

Dr Jureidini said that about 30 per cent of boys and girls diagnosed with ADHD do not even meet the current diagnostic criteria, which includes being inattentive and easily distracted.

He said up to 90 per cent of those diagnosed would be better off with other treatment.

Two of the RACP's controversial draft recommendations include education programs for teachers on dealing with ADHD pupils and special funding for schools with ADHD students.

The group of academics said this would mean children with significant disabilities, including cerebral palsy and autism, would miss out on funding and teaching time.

One of the group, Trevor Parmenter, foundation professor in developmental disability studies in the faculties of education and medicine at Sydney University, said ADHD was too complex to be diagnosed in a GP's office.

"It is a very complex issue that goes beyond the symptomology," he said. "If a child has been diagnosed with ADHD, a teacher may think they should be put in a special class. They could be disadvantaged."

He said too many children were being diagnosed with ADHD by lazy doctors who did not properly investigate the child's problems.

(I thought only paediatricians and shrinks could diagnose and medicate anyway? Mayve only here in SA, but not nationally?)

http://www.news.com.au/dailytelegraph/story/0,22049,24213952-5001021,00.html

A precis of Jon's interests:

http://health.adelaide.edu.au/psychiatry/clstaff/jureidini_jon.html

http://www.healthyskepticism.org/Jureidini.htm

https://www.researchgate.net/author/Jon+Jureidini

Some interesting articles here!

He's an...er...interesting fella...but I asmire his speaking out and the researcg he does, by gum I do!!!

(He is also prominent in speaking out re detention of illegal immigrants seeking refugee status)

You can only get a free preview of this...but its kinfd of interesting:

http://www.springerlink.com/content/c3bkwqnh0yv1ly1g/

http://www.gnews.net.au/news/pbs-ignores-adhd-pill-warnings/

Here's some general articles, with a range of different views.
http://news.surfwax.com/general-news/files/Adhd_Medication.html

A lay discussion site, withan interesting doctor perspective
http://forum.dadsontheair.com/viewtopic.php?p=38797&sid=bf7606bf3309fabad3df37136c938fc6

http://www.ablechild.org/newsarchive/generation_ritalin.html

http://www.bmj.com/cgi/eletters/337/sep24_1/a1239

Interesting radio show on the new craze....bi-polar in kids.

http://www.abc.net.au/rn/backgroundbriefing/stories/2007/2012718.htm

Halleluljah...the drug people sit in review of drugs!

http://www.zielenknijper.nl/wp-content/uploads/2008/11/australie-schandaal-commissie-banden-farmaceuten.pdf

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New ADHD study leaves some wiggle room

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