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Scary statistics on ADD/ADHD

 
 
dlowan
 
  1  
Reply Wed 3 Apr, 2013 07:35 pm
@boomerang,
boomerang wrote:

Why do you think that is, dlowan?

Why would America be so much quicker to diagnose their kids as having a mental illness?

I really has to be money.


You guys just seem to be more medicalized. We stand between the UK and the US in this sort of thing, not just with ADD but a lot of things.

I can't see that it can be just the money. The money is there in the UK, Oz and Canada, too.

It appears to be something in the culture and in the medical culture.

0 Replies
 
dlowan
 
  2  
Reply Wed 3 Apr, 2013 07:46 pm
@ossobuco,
ossobuco wrote:

We've talked about this before, Deb - one of my cousins is a self described ADD/ADHD expert. Around the time she was qualified in all that, she became heavily pedantic re the conditions, and also saw it in lots of people around her, including herself. I'm sure she takes me as sine qua non. Well, to the extent I fit any of the criteria, it's been enjoyable.

I'll back off of making fun of the studies - since I haven't read them and won't - but I think at least some of the aspects that worry therapists are well with the range of normal human personalities.


Often it's the therapists that are attempting to get families to look at other factors and to modify their ways of dealing with the children. It is even clearer now than it was when I first began posting here that the neurobiology of trauma explains a lot of the behaviour.

We have some psychiatrists here who pooh pooh the whole ADD/ADHD construct. It is generally the paediatricians here who grossly over-prescribe.

Actually, I had an interesting discussion with one of our paediatric registrars a while back.

She has gone hook, line and sinker for the diagnosis, but is also semi-aware of how over-diagnosed it is. As we discussed it more, it emerged that a lot of her prescribing comes from knowing how scarce the resources are for assisting families to deal with other causes of the behaviour. She also said, quite rightly, that the families who are most likely to have kids really suffering from trauma and/or very unskilled parenting tend to be the ones most demanding pills.

She said that she gives the pills because she knows that there is a chance that the kid will be more able to focus at school and not be so challenging in their behaviour. She hopes that this will bring about a positive cascade of events...such as doing better in school, being more accepted by peers and less likely to have only negative interactions with their carers, that will make a real difference in their lives.

I could get that.

At least she will properly monitor the effects of the drug so that, hopefully, the poor kids aren't poisoned.

I don't deny the existence of something we currently call ADD/ADHD, as some do. However, the diagnosis is made grossly too often in some countries.
ossobuco
 
  1  
Reply Wed 3 Apr, 2013 08:01 pm
@dlowan,
Followed your thoughts on that, nods.
0 Replies
 
Setanta
 
  2  
Reply Thu 4 Apr, 2013 03:26 am
@boomerang,
It is exactly the way health care is delivered. Certainly prior to the election of Mr. Obama, but continuing after the passage of his health care act, insurance companies have schedules of procedures and diagnoses which they recognize and for which they will pay benefits. If any professional organization recognizes a new diagnosis, the insurance companies will soon add it to the schedule and authorize the payment of benefits. With new mental health diagnoses being added, pharma saw an opportunity for a whole new category of drugs which they could sell. It's easy as pie right on down the line. The doctor diagnoses a mental health disorder, or in the case of children, a behavioral disorder, and the insurance companies will pay for the treatment. If the drug companies come up with a pill, everyone (with the likely exception of the child, and possibly, the child's parents) can happily and easily prescribe the pill, and their problems ares solved. The insurance company pays the bill, after the payment of annual deductibles and co-pays, what's not to like? In many, perhaps most jurisdictions, counselors can diagnose and prescribe for mental health/behavioral conditions, which expands the scope of the use of prescription drugs, and also, significantly, means school board employees can get into the game. A school can't afford to have an MD on staff, but they can afford a counselor. Most states do not require that a counselor have anything more than a BS to qualify and therefore prescribe.

Drug companies have been in the business of courting customers for decade, pretty much from the end of the Second World War. The sales rep shows up at a clinic, quickly identifies decision makers (Not necessarily the doctors) and takes them out to lunch, brings little gifts, shmoozes them and then gets out his or her order pad. They only have to have a brief interview with the MD to convince him or her to try the product, and there is high probability of getting a repeat customer. How much easier when dealing with mental health counselors employed by a school board or a specific school, where they don't have to deal with an MD?

Since 1974, after i had gotten out of the army and was working in a hospital, i've seen their plays and even after no longer working in the medical field have read about them. So, for example, an employee of the drug company will come along with the sales rep, he will be introduced as a "phamacological consultant" and he will rent space from the clinic or the emergency service/out patient services corporation (the doctors) for which he will pay premium prices for office space based on local real estate rates. What they do is rent a closet and pay for an office. The next time the sales rep shows up, he's already the doctors' buddy. He will identify the real decision makers--administrative staff and nurses--and bring the flowers and candy, and take them out for expensive lunches on his tab. Gifts of golf clubs and health club memberships will materialize. Expensive you think? A drop in the bucket compared to the billions and billions of dollars at stake.

Whether it's a mental health/behavioral drug or any other type of drug, pharma has a trick to keep their product the current drug of choice. When their exclusive patent rights expire, and other companies can make the drug, including cheaper generic versions, they tweak the formula. They add a molecule to the formulation, and now they have a "new" drug. One hopes that it's just an inert molecule they've added, but pharma has not been known to be reliable about that.

In Canada, as an example, they're not dealing with the office manager or head nurse, they're dealing with government employees, whether provincial or Federal. Those boys have their own expert employees and the sales reps' tricks won't work there. Provincial and Federal medicare agencies negotiate price schedules. Canadians pay far less for their drugs than Americans do, so much so that Americans who live close to the border will cross the border in order to pay a doctor to prescribe for them, based on their American physician's medical history, and then buy their drugs in Canada. I don't know if it still goes on, but at one time there was a regular revolving door operation going on for American customers. In the United States, it's very easy for big pharma to manipulate the system when all anyone cares about is whether or not the insurance company will pay. It doesn't work that way with health care managed by the governments. This can be seen when, during the flap about Mr. Obama's proposed health care system, people started ranting about insurance companies rights of access. You could see conservatives here ranting about this, too. Basically, insurers were trying to do an end-run around the requirements of state insurance regulatory agencies. The conservative mantra was that the Feds were not letting all insurance companies compete on a level playing field. In fact, what insurance companies can operate in any state is determined by a state agency, not a Federal agency. What some of the shadier insurance providers wanted was to get Federal legislation which freed them from the necessity of meeting state insurance commission regulations.

It's about money, big money, tens of billions of dollars of money, and under the old system, as well as largely under the new system, all that matters is whether or not the insurance companies will pay. The American medical establishment is now hooked on the idea that almost all morbid conditions, including mental health/behavioral conditions, can be dealt with by prescribing.
Mame
 
  1  
Reply Thu 4 Apr, 2013 07:50 am
Boomer, I think prescribing pills is an easy and lazy way out. There are many children whose behaviour can be improved with a child behaviouralist. My soon to be daughter-in-law is one such who works in the education system with 'problem children'.

I also worked in a psychiatrist's office (5 psych's) and the amount of drugs they prescribed was ridiculous. Some people do need pharmaceuticals to operate at a functioning level, but some of the patients were on so many drugs, it's a wonder they were able to walk around.

I believe drugs should be a last resort. The side effects are often longer that the benefits. Listen to their commercials, for Pete's sake - they can be dangerous!
boomerang
 
  2  
Reply Thu 4 Apr, 2013 10:45 am
@dlowan,
That sounds like a compassionate approach to the issue. The "positive cascade of events" sounds like it might work. School issues can cause a lot of stress and family problems. I know it has made a huge difference in our lives that Mo is going to a school he loves now. We are all less stressed now that he is less stressed.

But I think sometimes it might backfire -- like if the home is really awful or the school is really awful. I dragged up an article I read sometime back about stimulant use and PTSD: http://www.nytimes.com/2012/04/22/opinion/sunday/why-are-we-drugging-our-soldiers.html?pagewanted=all&_r=0

Some choice quotes:

Quote:
Additional data provided by Tricare Management Activity, the arm of the Department of Defense that manages health care services for the military, reveals that the number of Ritalin and Adderall prescriptions written for active-duty service members increased by nearly 1,000 percent in five years, to 32,000 from 3,000.

... the military almost certainly uses the stimulants to help fatigued and sleep-deprived troops stay alert and awake...

Stimulants do much more than keep troops awake. They can also strengthen learning. By causing the direct release of norepinephrine — a close chemical relative of adrenaline — in the brain, stimulants facilitate memory formation.

...Since PTSD is basically a pathological form of learning known as fear conditioning, stimulants could plausibly increase the risk of getting the disorder.

...Because norepinephrine enhances emotional memory, a soldier taking a stimulant medication, which releases norepinephrine in the brain, could be at higher risk of becoming fear-conditioned and getting PTSD in the setting of trauma.


(The article goes on to say that there is no proof of correlation but suggests further studies should be done.)

It's really sort of a chicken or egg question.
0 Replies
 
boomerang
 
  1  
Reply Thu 4 Apr, 2013 11:01 am
@Setanta,
I think we've created a perfect storm for this diagnosis.

Dlowan mentions unskilled parents in her post and I was one. Everyone told me "the doctors will know" and "the teachers will know" (but lucky for me I had A2K where Deb and others put me on the proper path).

So first parents get paranoid listening to their peers tales of perfect kids, then the teachers feed this fear by telling you your kid doesn't measure up, then the doctor offers pills because they've been seduced by the pharma companies.

So we narrow and narrow and narrow down the definition of normal behavior.

I visit one parenting forum pretty regularly and "get him/her tested" is the answer for everything. Tilted his head funny yesterday? Probably autism. Get him tested. Pet the dog in an ungentle manner? ODD, obviously? Get her tested. Jumped on the bed and didn't sit through Sponge Bob? Clearly ADD. Get him tested.

Yep. There's a drug for that.

It's crazy making!
Setanta
 
  1  
Reply Thu 4 Apr, 2013 11:07 am
@boomerang,
Quote:
So we narrow and narrow and narrow down the definition of normal behavior.


An astute and poignant observation. I know of at least one person who left the country and moved to Canada so they would stop doping her child. I knew a woman in Ohio whose son had been "diagnosed" and was kept doped up by order of the school district. Eventually, they took him away and put him in a group home. When he got out, Mom transferred him to a new school district a few days before the end of term. She had a friend who cooperated by providing her address as a mail drop. They spent the summer helping the kid come down from drugs. He was so anxious not to be doped up again, he became the model student. I don't think, though, that terrifying children by doping them up is not a very good method to get them to behave.
boomerang
 
  1  
Reply Thu 4 Apr, 2013 11:09 am
@Mame,
I agree that other types of therapy are a better place to start but I do know that patients (or their caregivers) demand drugs for nearly everything.

Mo's ADD "symptoms" completely disappeared once he changed schools.

0 Replies
 
boomerang
 
  1  
Reply Thu 4 Apr, 2013 11:21 am
@Setanta,
The school district can order a child to be drugged?

I'd be gone to Canada too.

It's really scary when the schools start hinting that they think you're being medically negligent and wondering aloud about their duty to report.

We are so lucky that we have an excellent doctor who made sure Mo got the testing done independent of the school (who kept insisting they were going to do it with or without our permission. I wonder what those test results would have shown.)
0 Replies
 
Setanta
 
  1  
Reply Thu 4 Apr, 2013 11:23 am
Obviously that you're a vile Luddite who isn't fit to raise a child.
boomerang
 
  1  
Reply Thu 4 Apr, 2013 11:35 am
@Setanta,
Obviously.
0 Replies
 
ossobuco
 
  1  
Reply Thu 4 Apr, 2013 12:11 pm
@Setanta,
I've run into the sales reps lunch stuff in both the med lab world and landscape architecture. By the time I got to the second (or was it third, as I had three going for a while) career, I was recalcitrant re provided luncheon and went for a stroll later (this was in Marina del Rey area, wonderful food within 2 blocks) on my own. I could do that, as I was high on the chain and billed hours could be 24/7 - so I could and did work some long days and take occasional long lunches.

I was, of course, the only one who listened to the sometimes long spiel (christ, irrigation and all its bypaths) without gnawing on deli foodstuffs. I was also wooed by a rep in the med field. I did go out for a drink with him. Part of a longtime lesson in watch out.

On the other hand again, a friend of mine married a sales rep, een dating being a major hospital system no-no. That was a long time ago. They're still married.
0 Replies
 
boomerang
 
  1  
Reply Thu 4 Apr, 2013 03:58 pm
I was just thinking -- didn't Montana have some ordeal where the school tried to drug her kid?
ossobuco
 
  1  
Reply Thu 4 Apr, 2013 03:59 pm
@boomerang,
Yes, but I don't remember the details.
0 Replies
 
FOUND SOUL
 
  1  
Reply Thu 4 Apr, 2013 04:07 pm
@ehBeth,
Quote:
I think if there weren't a big bag of $$ in ADD/ADHD pharmaceuticals (and therefore drug lobbyists) in the U.S., you wouldn't be seeing this.


I totally agree with that statement, somewhere, here in Australia a couple of years ago there was a report that Doctors were being "paid" to promote the drug and diagnose a child ..... as ADHD.

A physcologist however, reported that in alot of the cases, it's kids going wild, rebelling or the bringing up of the children, whilst some off course were in fact suffering from ADHD.

What is sad, is who the heck can one trust these days.

0 Replies
 
dlowan
 
  1  
Reply Thu 4 Apr, 2013 05:33 pm
@boomerang,
boomerang wrote:

I was just thinking -- didn't Montana have some ordeal where the school tried to drug her kid?


Yes. And she went to Canada to escape.
dlowan
 
  1  
Reply Thu 4 Apr, 2013 06:20 pm
@dlowan,
First post on this topic has an interesting video re this discussion

http://able2know.org/topic/211905-1#post-5295560
boomerang
 
  1  
Reply Thu 4 Apr, 2013 06:23 pm
@dlowan,
I was just posting there! Ken Robinson is one of my heros.
dlowan
 
  2  
Reply Thu 4 Apr, 2013 06:35 pm
@boomerang,




For anyone interested who doesn't want to go to the topic.
0 Replies
 
 

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