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ADHD: Backlash to the Backlash

The views expressed are those of the author and are not necessarily those of Scientific American.


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ADHD isn’t just “kids being kids.”

Attention Deficit–Hyperactivity Disorder (ADHD) had a star turn in the recent, high-profile murder trial of University of Virginia lacrosse star George Huguely. Lawyers for the defense aren’t using the condition to explain away their client’s presumed violent behavior; rather, they’re saying that the woman he’s accused of killing may have died from her own, personal battle with ADHD. Amidst their exculpatory evidence was the victim’s prescription for Adderall, and they offered that she could have died from a mix of the drug (which is prescribed to treat ADHD) and alcohol. The medical examiner has discounted that notion, calling the very low levels of Adderall in the victim’s blood “within therapeutic range.” The cause of her death rather seems to have been a blunt force trauma to the head.

The idea that ADHD drugs might be killing us—and in ways that resemble being bashed in the head—represents just one of several ominous storylines associated with the disorder. In recent years, we’ve also heard speculation about whether ADHD is real, and if it is real, whether it’s being grossly overdiagnosed. And then there are the drugs. A recent opinion piece in the New York Times by psychology professor L. Alan Sroufe argues at great length that attention-deficit drugs do more harm than good over the long term, a conclusion other professionals in his field dispute. The backlash against ADHD—which often targets the drugs used to treat it, the people who have it, and the therapists and parents who make treatment decisions—has again reached a fever pitch.

Mental disorders can accompany ADHD/ADHD

These backlashes against childhood developmental diagnoses seems to rise and fall every few years, but lately it’s burgeoning. Part of the reason is a controversy over the DSM-5, a proposed update of the mental illness manual for health professionals. Professionals are publicly squabbling over the tome’s validity, and some of those who have been labeled under the existing criteria may suddenly be facing limbo. Overlooked in the noise is the fact that the symptoms underlying the still-current diagnosis of “ADHD” compose a real and often disabling disorder with limited but effective treatment options.

Probably the most persistent myth about ADHD is that it has become a catchall label for rowdy children, and one that’s a godsend for parents who are too lazy or incompetent to keep their kids under control. Yet there’s no reason to think that anyone with diagnosed ADHD merely has “ants in his pants,” as some have suggested. Rather, the label refers to a set of behavioral excesses that go beyond developmental norms. In the last 20 years, I’ve taught languages and science to thousands of people from kindergarten to college age, and those with ADHD shared a suite of behaviors and aptitudes that distinguished them from their peers in positive and negative ways, depending on the environment. The disorder often has the company of learning disabilities and mental health problems, too.

Ritalin

In fact, the science suggests that ADHD is not “systemically” overdiagnosed in the U.S. A 2007 review of ADHD prevalence studies found no “sufficient justification” for assertions that ADHD is overdiagnosed, but the authors noted that public perception and news media coverage often don’t reflect that. Furthermore, according to a 2012 publication from the U.S. Agency for Healthcare Research and Quality, the real prevalence of ADHD hasn’t changed since the 1980s, and changes in diagnostic rates are “consistent with changes in clinical guidelines.” In spite of all this, psychologists like Sroufe have sought to reduce ADHD to simple “problems in focusing” and “difficulty with concentration,” one that we’re too quick to use medications to address.

Sroufe asks, “Are these drugs really helping children?” Citing a 2009 study of the outcomes of using these drugs, Sroufe says that the medications have no benefits in the long term. But he’s off the mark. That study of 600 children ages 7 to 9 compared the safety and effectiveness of medication alone, behavioral treatment alone, the two in combination, and “routine community care,” which was essentially the placebo. Children using medication had reduced ADHD symptoms compared to behavioral treatment or placebo after 14 months, and combined medication and behavioral interventions resulted in even greater improvement. Responses to the different therapies varied, emphasizing how personal any therapeutic effectiveness can be.

Adderall

After 14 months, the children continued on for six years having whatever care their families chose for them, including no interventions at all. At eight years, the benefits the researchers found at 14 months had faded, but 64% of the children taking medications at 14 months weren’t taking them at 8 years. The authors also looked at safety of the drug and found that 4% of children discontinued for adverse effects such as loss of appetite and sleep problems but cited no more dire effects.

Sroufe points out that there aren’t any long-term randomized studies lasting longer than two years that examine the influence of ADHD meds on various outcomes such as academic performance. These studies randomize participants into either a real medication group or a placebo or “dummy pill” group, and the 2009 study Sroufe cites did randomize children for 14 months of the different interventions. Because these drugs are medically indicated for a diagnosis of ADHD and show benefits, however, an ethics committee is unlikely to approve a study that involves withholding them long-term. As child and adolescent psychiatrist Harold S. Koplewicz noted in the Huffington Post in a response to Sroufe, “you can’t put a child on a placebo for his entire adolescence for the purpose of a study.” Koplewicz also points out that many therapies, including insulin therapy for diabetes, haven’t gone through long-term randomized studies for the same reason.

Baby having a bath, by Georgios Jakobides.

As the parent of a child with ADHD, I want to point out something else. In his early schooling, our nine-year-old son experienced daily and persistent public humiliation for his ADHD-related behaviors. In one class in particular, his teacher embarrassed him several times a day by sending him to sit alone in the public hallway as a sort of “in the stocks” punishment for his behavior. Parents and teachers would walk by and stare, and other students would softly taunt him. His motor tics and compulsive behaviors of handwashing to the point of cracked, bleeding hands, nonstop “confessing” of every worrying thought, and expressed self-repulsion worsened throughout that school year and then decreased abruptly when the year ended. Only then did we learn the truth about his experiences.

Because we couldn’t magically change his behavior, we decided to home-school him, opting to change his environment instead of medicating him. His neurologist told us that most ADHD medications would exacerbate his tics, and we were already home-schooling his brother. For us, this choice was preferable to leaving him that environment and attempting medications that might worsen his tics and OCD.

Baby crying in bath. This does not cause ADHD.

Not every family has that luxury, and not every child with ADHD has tics and OCD that may preclude medication. Because of impulsive and inattentive behaviors, people with ADHD usually find themselves absorbing incessant blows to their self esteem and personal achievement as our son did. Medications can reduce the behaviors that bring on these blows, and thus improve a child’s life. They may also help in other ways. According to the 2009 study that Sroufe cites, ADHD symptoms may interfere with a child’s ability to learn social skills, and the study results suggested that medication can reduce the symptoms sufficiently to allow children to acquire these skills.

Do meds “cure” ADHD? No. They ease symptoms only when a person is taking them and, as noted, may allow for deeper improvements in behavior. And in environments that require a specific behavioral conformity, they also may offer some real protection. As the study Sroufe cites noted, children experienced a benefit from the medications at 14 months, months that can translate into a break from constant negative inputs. One thing Sroufe glosses over in mentioning that study is that behavioral therapy combined with medication produced even greater benefits. The research doesn’t support not using medications, but it does support combination therapies as providing the best outcome.

Some experts, like psychiatrist Peter Breggin, also writing in the New York Times, drive the current backlash by accusing parents of using these drugs for children who are just badly or lazily parented, whose parents have “parent attention disorder.” This idea that parents of children with ADHD turn willy nilly to drugs ignores the real complex and painful calculation of costs and benefits parents do–and the outcome is often not to choose medications. According to the U.S. Centers for Disease Control and Prevention, at least one-third of children diagnosed with ADHD are not on any medication at all (and that number could be closer to one-half).

Parents may be reluctant to turn to medications because of what they’ve heard about the related risks and the seeming impossibility of teasing out what the risks really are. ADHD medications do carry risks, as all medical interventions do. A recent controversy about one ADHD medication, Focalin, associates it with suicidal thoughts in four children, even though the Food and Drug Administration says clinical trials don’t support a link. Strattera, another ADHD medication, has been associated with a risk of suicidal thinking in the first months of therapy in an average of every 4 children of 1000 taking it. But at least one study has found that early treatment can reduce the risk of suicide attempts among teenagers with ADHD. Other research finds that that drug therapy for children can help to stave off substance abuse down the road. Again, as with any therapy, effects vary from individual to individual, one probable reason these risks and benefits are so hard to pin down.

Adderall

The FDA also warns that people with pre-existing heart problems could be at risk taking Focalin. A 2011 study, however, identified no increased risk of cardiac-related deaths among children and young adults taking various ADHD medications. A just-released study in adults found that increasing drug dose of methylphenidate (e.g., Ritalin) was actually associated with decreasing risk of cardiovascular events, such as stroke or death. Finally, while it’s true that these medications may stunt growth for the first year that a child is taking them, patients appear to catch up with growth curves a few years later. As with any intervention, considerations of the risks of the medication must be balanced against consideration of the benefits of using it.

In his piece, Sroufe also encompasses parents in blame, saying that parents may be responsible for ADHD and that drugs get everyone, including parents, “off the hook.” He has a point: Research indicates that drugs combined with behavioral therapy may be the best route for ADHD treatment. But Sroufe asserts that early childhood environment is the real cause of ADHD. In addition to stressors like domestic violence, lack of social support, and frequent moves, he cites “parental intrusiveness”—and gives the improbable-seeming examples of a parent who ridicules her three-year-old for poor problem-solving or suddenly grabs an infant for a plunge into a bath.

Psychiatrist Breggin also writes that “the idea that American children are somehow genetically or even culturally predisposed has no scientific or common sense basis.” Yet, as seven board members of the American Professional Society of ADHD and Related Disorders noted in response to Sroufe’s commentary, research indicates that ADHD is “highly heritable” (about 60 to 80% inheritable [PDF]) and environment is thus only part of the equation. Indeed, thanks to the identification of gene variants and chemical signaling differences related to ADHD, researchers have developed mice that either lack an identified gene or carry mutations of it. These mice show behaviors that look like the rodent version of ADHD, without any history of “parental intrusiveness.”

This latest backlash against ADHD relies on recycled “diagnosis du jour” tropes of subpar parenting and doped-up, misbehaving kids, but it makes no mention of the abundant science showing what really underlies and helps with this disorder. Worse, the perpetuation of myths about ADHD encourages the perception that children like mine, with their very real disabilities, might be diagnostic frauds. That’s a potential harm that deserves a backlash of its own.

Images:

Adderall, by Twirligig; More adderall, by Patrick Mallahan III; Ritalin, by Sponge; Baby crying in bath – This does not cause ADHD, by Kyle Flood; Baby having a bath, by Georgios Jakobides; Baby vs. Bathwater, by Richfife; Mental disorders can accompany ADHD/ADHD, by Ezagren; ADHD isn’t just “kids being kids.”, by Bjoertvedt.

Emily Willingham About the Author: Emily Willingham, author of The Complete Idiot’s Guide to College Biology, has a B.A. in English and a Ph.D. in biology, and she’s not afraid to use them, often together. She blogs for EarthSky and at The Biology Files and tweets her interests, random thoughts and cool stuff from other people as @ejwillingham. In a previous life, Emily was an assistant professor of biology and an actual practicing researcher. Follow on Twitter @ejwillingham.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 28 Comments

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  1. 1. sauIt 11:23 am 02/23/2012

    ADHD is clearly a real and growing phenomenon. The modification and reduction of what “qualifies” is solely due to right-wing Republican greediness.

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  2. 2. smoore35 1:34 pm 02/23/2012

    What ADHD drugs can do is allow a child to gain a greater sense of self-control and it can also make boring things more interesting; it is not a cure by any means but more of an aid. The backlash is because Parents are using the diagnoses and drug as a form of behavior modification or therapy. But the desire to maintain self-control and focus in a productive manner must be internal and not forced upon. The dopamine pleasure centers are going to seek novelty in what it can’t have if force to act right.

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  3. 3. ruthhughes 2:16 pm 02/23/2012

    Thank you for a breath of sanity and a reasonable and accurate description of ADHD. It is mind boggling to me that so much bad and scientfically inaccurate information gets published in main stream media. ADHD is a very real brain disorder, with 50 years of research behind the diagnosis. To vilify parents and children for an illness is beyond the pale. CHADD works with thousands of parents and I can honestly say that I don’t know a single family that uses medication because they can’t be bothered with parenting. It is the exception, not the rule. The decision is usually made only after a lot of consultation with the physician, and trying other behavioral alternatives first. Thank you for standing up for all of us.

    Ruth Hughes, PhD
    CEO, Children and Adults with Attention-Deficit/Hyperactivity Disorder

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  4. 4. smoore35 2:32 pm 02/23/2012

    Yeah before anyone dismisses ADHD they should ponder how some kids can have sub-par grades; but when you ask them about a subject that they are interested in they all of a sudden become an expert. And the only reason their grades are lacking is because their classes just aren’t getting the adrenaline going.

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  5. 5. bestofnothing 3:12 pm 02/23/2012

    Per the author’s description of her child’s symptoms:

    “His motor tics and compulsive behaviors of handwashing to the point of cracked, bleeding hands, nonstop “confessing” of every worrying thought”

    The child has OCD and perhaps Tourette’s or Generalized Anxiety Disorder. Her child may have ADHD as well, but the symptoms she describes are primarily in the anxiety spectrum. There is a tendency for many psychiatrists and parents to label all ‘unfocused energy’ as ADHD, when typically there are more justified explanations with a little more investigation. Poor attention is associated with drug use, depression, PTSD, bipolar disorder, cognitive disorders, schizophrenia, pain, and other disorders. For instance, substance abusers typically report poor attention and goal completion because they are so preoccupied with getting high or in a state of withdrawal–should we call that ADHD? PTSD victims are preoccupied with past traumas, uncomfortable in public settings, hyper-vigilant about surroundings and thus have difficulty concentrating.

    There is no evidence that use of stimulants over a period of >2 years improves a child’s functioning; in fact, it appears they are as well or worse off than when they started on stimulants. Here are the papers: http://www.madinamerica.com/2011/11/children/

    There is no debate that stimulants help some children in the short-term. There is no evidence children should be on these medications for >3 years.

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  6. 6. ejwillingham 3:44 pm 02/23/2012

    @bestofnothing I knew it would be only a matter of time before someone tried to (un) or (re)diagnose my child based on a single paragraph of information in an online article. Yes, he has OCD and tics, both diagnosed. Even in the absence of these, he has ADHD, not GAD, and professionals–three independent professionals, in fact–who have seen him in person and examined him over a period of four years agree on these specific diagnoses. It is important to avoid diagnosing people whom you have never met or evaluated in any way, wouldn’t you agree–especially as you assert that “a little more investigation” would lead to “more justified explanations”? Your “investigation” of my son is very limited. What you’ve done here is to imply exactly what I talk about in the article: that “unfocused energy” is really what my son has, rather than ADHD. My son, by the way, was diagnosed with ADHD at age 4, and has no history of “drug use, depression, PTSD, bipolar disorder, cognitive disorders, schizophrenia, or ‘pain.’” He still has none of these, all of which have clear criteria and manifestations that distinguish them from ADHD. My son is on no medications and never has been.

    The article I wrote links directly to the MTA study papers included at the link you provide (which appears to be an anti-medication site) and breaks down the real implications of those studies. The authors themselves draw the conclusions I cite. Readers can go read these results for themselves, as the 2009 paper is open access.

    My article also addresses why “there is no evidence” for a period of >2 years…because it has not been tracked in randomized trials beyond the 14 months in the MTA study (which is not an 8-year controlled study but a 14-month controlled study, after which participants were not controlled at all for the remaining six years). Conducting long-term randomized, placebo-controlled trials through adolescence and involving a drug that shows effectiveness would not be considered ethical practice.

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  7. 7. Sammka 6:18 pm 02/23/2012

    @bestofnothing: Many of us with ADHD eventually develop anxiety and OCD symptoms. If you kept getting punished for behaviors you couldn’t control and kept feeling overwhelmed by the world around you, you might develop them as well. Compulsive behavior imposes order on a world that’s very confusing.

    I also have ADHD, OCD, and tics. I was treated for anxiety for years before I started on ADHD meds (I have to take the atypical ones not the amphetamine-like ones, because of the OCD/tics). The anxiety meds were semi-effective but not nearly as effective as when they were combined with ADHD meds. Until I started on ADHD meds I’d have near-death experiences with some regularity due to not looking where I was going. That sort of thing can make you anxious!

    It’s “just” OCD when you check whether you’ve locked the door four times despite the fact that you always lock it. It’s ADHD with OCD symptoms when you check whether you’ve locked the door four times because you actually forget to lock the door a lot and don’t actually remember having checked it three times already, or when you actually can’t anchor your thoughts in one place without engaging in repetitive behaviors.

    Kudos to Emily for doing right by her kid and not just assuming he’s being obstinate whiny.

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  8. 8. Sammka 6:31 pm 02/23/2012

    Another thing to note: it’s very rare for brains to be “different” in only one way. If you have one issue – seizures, attentional issues, sensory integration issues, compulsive and repetitive behaviors, or motor tics – you probably have others as well. As a result, it’s not uncommon for kids to carry two or three different diagnoses, and sometimes professionals do disagree over whether a kid’s “primary” diagnosis is ADHD, Asperger’s/Autism Spectrum Disorder, Tourette’s (or Tic-NOS), OCD, Sensory Integration Disorder, or whatever. But in practice the “primary” diagnosis should be whatever the child and family thinks is the most salient, or what appears to be the “root” of the other issues. In this case, that’s the attention issues.

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  9. 9. p,deth 9:49 pm 02/23/2012

    It is hard not to dismiss the suspicion that ADHD is more of a marketable diagnosis. My brother and I were both diagnosed with ADHD as kids.
    I was just plain lazy in school and preoccupied with my social life and after-school projects. My brother, however, had legitimate anger issues.
    My mom, who was overbearing at the time, (wrongly) suspected that we were both on drugs and took us to see psychologist and then a psychiatrist. While my brother’s anger issues were immediately recognized, they could offer nothing so well-defined to explain my indifference in school. We were both, however, diagnosed with ADHD and prescribed Ritalin.

    My brother’s behavior changed. He was calmer and had time to process and learn to communicate what made him angry before he had an outburst. After a year or so, he was taken off Ritalin, continued therapy, and is now a functional, non-violent adult without medication.

    As for myself, I was confused about how my diagnosis was determined with little more than a 15 minute session. I was told that taking Ritalin would make me “focus” in class. But I didn’t think that my problem was focusing. My problem was that class work was not my priority
    When I took Ritalin, I did not focus or find the class more interesting. I became disconnected. My grades did not improve, in fact, they dropped as I became inattentive in the few classes I was actively interested in. I asked my mom and the doctors why I needed this medication. what was it supposed to be doing? How was I supposed to be feeling? What is so wrong with me that I need to stay on it despite the lack of improvement? How was my diagnosis determined?

    As a teen, my questions were scoffed at and dismissed as rebellious nonsense. I was not included in/informed of any decision made on my behalf.

    So I started flushing my daily dosage down the toilet. Only when my doctor and mom pointed out the sudden (although moderate) improvement in my grades, crediting the Ritalin, did I finally tell them I stopped taking the medication months ago.

    During that same year, a friend of mine was diagnosed with ADD. He was a relatively good student but was oddly distant, forgetful, and incredibly quiet. He was told he had a learning disorder and, for a while, believed it and his self esteem suffered for it. No matter what medication he was given, nothing seemed to improve. Doctors suspected that he was building up a tolerance for the medication so they upped his dosage. On and on, for two years, until his parents sought a second and third and fourth opinion….finally coming across a doctor who asked “Well…does he have a hearing problem?”
    Yes. He did.

    I have seen ADHD be the go-to diagnosis that parents are too eager to accept and medicate.

    So I have to ask how many other children have been treated for a disorder they did not have? What questions should parents be asking when they are told their child has ADD/ADHD? What kind of behavior does one look for when diagnosing the disorder or prescribing medication? What sets ADHD behavior apart from laziness? Anger issues? Anxiety? Perhaps some subtle phobia?
    I believe ADHD is a real disorder and that there are people out there who can benefit from medication and therapy. I do not feel that I can speculate how many people with ADHD truly have/don’t have it…but I’m not quite convinced everyone is given a correct (or honest?) diagnosis.

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  10. 10. ejwillingham 10:16 pm 02/23/2012

    @pdeth Your questions at the end are good ones. Our son was diagnosed very early– at age 4–by a neurologist and that diagnosis confirmed later and separately by a neuropsychologist and a pediatric psychiatrist. He is neither lazy nor preoccupied with a social life. He also is not remotely oppositional or poorly behaved–in fact, he is courteous, thoughtful, funny, smart, and extraordinarily creative. His manifestations of what we call “ADHD” consist of (a) an incapacity to hold his body still under any circumstances–he has trouble staying in a seat, sitting on a floor during a “circle time,” sitting while eating–he is in constant motion; (b) blurting without thought in situations that most people are well aware aren’t appropriate, such as movie theaters, in class during quiet periods, in the middle of conversations, etc. The movie theater is the most noticeable; (c) an attention span that clocks in at about 20 seconds at a time–the family joke is that he’s on “Planet D” (his initial) because he spends so much time completely checked out; (d) other issues with impulse control that can be unsafe, such as darting, jumping at the wrong time (he broke his arm at age 3 because of this), and other impulsive behaviors. He also has learning differences and auditory processing delay but tests as gifted. His creativity in art and related activities is through the roof.

    He doesn’t seem to have anger issues, although he’s emotionally labile–easily revved up to near (happy) hysteria in play. He’s not lazy and is a hard worker but requires constant reminders about where he is and what he’s doing. He’s had great and understanding teachers since preschool (with a couple of exceptions) who’ve made all kinds of classroom modifications to help him function. One of these included allowing him to draw during circle time or reading time, which kept him focused and quiet and able to listen simultaneously.

    His differences from his ADHD can be debilitating in a classroom environment, but they’re also advantages in other environments. I’ve written about that on my personal blog: http://daisymayfattypants.blogspot.com/2011/10/when-it-comes-to-development.html . So our goal is to keep him educated without crushing his spirit and while promoting his obvious talents in pursuits he also enjoys.

    As I noted in the piece, I’ve taught thousands of people. The students I’ve had who’ve had an ADHD diagnosis (of which I was aware) have all presented with a very similar suite of behaviors and abilities, much of which I’ve just described above about my son. I can’t recall that I ever thought of them as lazy or angry or anxious or phobic. Just struggling all the time with impulse control and attention. Honestly, many of them have been among my favorite students because they were such kind and interesting people with unique capacities but who needed academic supports because of their problems with attention and impulse control.

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  11. 11. GinaPera 11:01 pm 02/23/2012

    Dear Dr. Willingham,

    You are my newest heroine. Thank you for this clear-headed column.

    The only thing I would quibble with is calling professional crank Peter Breggin an “expert.” He is nothing more than a rogue attention-seeker.

    I would never suggest that treatment for ADHD, as it is currently dispensed, is anywhere close to what it should be. I’ve just now come from talking with a university class on Adult ADHD, and the ones who are being treated medically are receiving sub-par treatment, sometimes causing as many problems as it solves (or more).

    Poor medical practices, however, should not be an indictment against the diagnosis or the evidence-based strategies for it. It should be reason for doubling down our efforts to educate the public so that they can demand better from the medical and therapeutic establishment.

    Thank you,
    Gina Pera, author-advocate
    Is It You. Me, or Adult A.D.D.?
    http://www.ADHDRollerCoaster.org

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  12. 12. GinaPera 11:06 pm 02/23/2012

    Bestofnothing wrote:
    There is no evidence that use of stimulants over a period of >2 years improves a child’s functioning; in fact, it appears they are as well or worse off than when they started on stimulants. Here are the papers: http://www.madinamerica.com/2011/11/children/

    There is no debate that stimulants help some children in the short-term. There is no evidence children should be on these medications for >3 years.

    ——————-

    With all due respect, did you actually read Dr. Willingham’s clearly written explanation of the MTA’s common misinterpretation or are you just quoting from “Mad in America.” It’s obviously the latter. I suggest that you pursue better documentation for your conclusions about ADHD, because you are sorely off the mark.,

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  13. 13. balklanningaronline 3:11 am 02/24/2012

    Hey kids are very cute!Drugs still can not mess with sympathy!Laly Mary http://www.balklanningaronline.com/category-111-b0-%C3%84lskling+Halskant+Kl%C3%A4nningar.html

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  14. 14. ejwillingham 10:22 am 02/24/2012

    @GinaPera Thanks for commenting. I agree that treatment is a rough spot–in part because the findings about interventions are confusing and sometimes contradictory and results can be extremely individualized.

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  15. 15. GinaPera 12:08 pm 02/24/2012

    Yes, Dr. Willingham. People with ADHD are individuals, with individual neurochemistries and compounding challenges (anxiety, etc.).

    But I attribute the backlash against ADHD treatment primarily to physicians (including psychiatrists who consider themselves ADHD experts) not taking the time to follow a protocol. Too often, titration is slipshod and selection of Rx is too often based on a pharma rep’s spiel. It’s deplorable.

    This is why I spend so much time educating patients and parents, because they cannot count on their physicians’ knowledge or skill in this area.

    Moreover, the basics of good nutrition and healthy habits can go a long way towards mitigating ADHD symptoms and can maximize Rx efficacy. Yet, this is another area where most allopathic physicians are failing us, despite the well-publicized information on national epidemics in certain vitamin/mineral deficiencies. Parents and adults must pursue this information on their own.

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  16. 16. joshua.cullick 1:38 pm 02/24/2012

    The disorder is in the educational system(s) and not in these individuals, myself included, who have been diagnosed with this ‘disorder’.
    (briefly) Some Deleuze, Chomsky or Lacan needs to analyse and explain the power relations here.
    The psychology/psychiatry establishment needs to have its ethical integrity cross-checked by an ethically, socially and politically interested academic community, especially the law schools.

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  17. 17. ejwillingham 3:23 pm 02/24/2012

    Joshua– While it’s true that a traditional classroom is typically a poor environment for someone with ADHD, the criteria for diagnosis state that the symptoms of it must be present in all environments. While my son has positive attributes related to what we call “ADHD,” he also experiences negative outcomes (e.g., see “broken arm,” above) that require our consistent attention to head off and vigilance over ourselves to avoid constantly barraging our son with negative correctives.

    E.M. Forster wrote passionately in *Maurice*, particularly, about the freedom to be one’s natural self, and we believe in that for our son, as well. However, some of the negatives are significant enough–a danger to life and limb–that we also have to recognize that efforts at some modifications are also worthwhile. He is, in these respects, disordered in ways that bother even himself, and we work to help him with that. I share some of these features with him, and he and I talk about what has worked for me in terms of a modified environment or behaviors for enhanced function. We do that for all of our children, of course, ADHD or not; this particular grouping of symptoms just happens to have this name.

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  18. 18. bestofnothing 6:49 pm 02/24/2012

    Here is another study on the long-term outcomes of stimulants in children for ADHD. The study authors offer an interpretation of the results in the beginning of the paper.

    http://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf

    Emily, I find your description of your son in the comment section far more enlightening than the label ADHD. Those of us critical of ADHD are often just critical of fixed-labels. Who can know what will become of these childhood symptoms as your son becomes a man? We worry that by focusing on labels, the child will become an adult who focuses on the label as well, seeing himself as flawed, rather than become the unique individual he would be without the label. Yes, I offered other labels to you, but only as a means to weaken the hold of the ADHD label.

    If a medication or therapy produces more benefit than harm, than we should consider it. But something that is beneficial for 6 months may be quite harmful if taken for 6 years. We don’t know without the evidence. And if it is unethical to do a 6-year randomized study, then we must leave it to parents to do the experiment with their children.

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  19. 19. EMW12 12:17 am 02/25/2012

    Dear Emily,

    Thank you for an article that is well-written and presents points that were obviously thoughtfully-considered. People are entitled to their opinions and I always learn something from interactions with people who hold opinions that are different than mine. However, while I think a healthy, respectful discussion of differences of opinion on a subject is productive, I feel that one of the risks of claiming that this disorder doesn’t exist or medication is unnecessary for those who have it is that someone who does have it will read the dissenting opinions and not pursue treatment that they need. Having said that, this has without a doubt been the most respectful discussion on this topic that I have read. Usually, the people who claim ADHD doesn’t exist or that people who have it just need more discipline and to pay more attention are quite rude about expressing their opinions. That isn’t the case here, and I appreciate the rational exchange of opinions.
    ADHD is a disorder involving neurotransmitters that do not function the way they should. I was diagnosed with ADHD at 38, and was relieved to finally have an explanation for the way the previous 37 years had gone. In the absence of a diagnosis, someone who has ADHD thinks that they are less than, which is a terrible way to go through life. The use of medication is a personal one, and has made it possible for me to take control of my life. It doesn’t make one a different person, and it doesn’t cure anything. It levels the playing field and enables people who take it to have the same chances as those who don’t need it.
    Thank you for writing this article and for the discussion that followed.

    Link to this
  20. 20. luannpierce 1:38 pm 02/25/2012

    As an adult with ADHD, and a therapist, I can tell you that the problems with my brain did not magically disappear after taking medication for a couple of years. Mind you, I was not diagnosed until college in my 30s; being one who hated school because I was always in trouble, college was never one of my goals. I fought the diagnosis, going on and off the medication, thinking I was ‘better now’ and tired of trying to hide the truth from the naysayers who appear to be growing exponentially. Being a mental health professional with a diagnosis as controversial as ADHD has been for decades is tough. As a profession, we can be absolutely as judgmental toward our own as the bullies on the playground.

    After a horrible experience in a new work environment (while taking my meds – they aren’t a cure all, believe me), I finally gave in and accepted. . . again. . .that I have a brain disorder. I can not control it anymore than someone who has seizures can control them without medication and good self care. Trying to hide my secret causes more problems for me than being honest and dealing with the backlash.

    The grief that comes with true acceptance that your are somehow impaired with an invisible illness is every bit as devastating as grieving a death. The relief of telling the secret publicly has been both freeing and frightening. I am now officially ‘one of those people’ everyone is talking about. People who know me now realize the reason for some of my quirks – if they believe ADHD truly exists. If not, I am relegated to the same category I started out in from first grade – “talks too much – can’t sit still – doesn’t pay attention – doesn’t use time wisely – disruptive – rebellious – delinquent.” Be glad I take my meds – we didn’t know about ADHD in the early 60s when I was ‘acting out’ and making average grades.

    For those who are concerned that people are giving stimulants to kids to manage their behavior because the parents are lazy and/or incompetent, not to worry. Stimulants usually make kids without ADHD more hyperactive and harder to control – the meds only have the paradoxical calming effect on brains that aren’t functioning properly. Kids who are labeled as lazy, unmotivated and dumb because their symptoms are the inattentive type (without hyperactivity) are very high-risk for developing emotional problems by internalizing these judgments that are based on a misunderstanding of this very real disorder. Others with the stereotypical hyperactive behavior are at-risk for ‘becoming’ the very things we say about them – delinquency is an all to common outcome.

    I can’t tell you how much damage people cause who don’t understand this disorder, yet insist on expressing their biases long and loud. Do us all a favor and ‘focus your attention’ on the people who are drug-seeking, as they are the problem here, not those of us who have a brain disorder and need medication to function in society. We are trying our best to work and contribute to society. We may all need to step up to help people with this and related disorders overcome the emotional damage inflicted by people who make broad judgments about a group of people who aren’t like them. It is no different than any other stereotype or discrimination based on race, gender or religious differences. The effect on the intended target is the same as any other hate crime – it needs to stop.

    LuAnn Pierce, LCSW
    http://adultadhdhelp.net

    Link to this
  21. 21. ejwillingham 8:12 pm 02/25/2012

    @bestofnothing Can’t say how much I appreciate your concern about my son’s well being as he gets older and your investment in “weakening” the ADHD label on his behalf.

    @EM12 and @luannpierce Thanks for your comments. The damage you describe is one of my concerns. @luannpierce While it is disordered to have a brain like that in some scenarios, in other situations–at least, as far as my experience being non-neurotypical and knowing many others who are goes–it can be a gift. I wonder how much of your experience informs your empathy with those with whom you work. @EM12 I know many adults who express the relief you feel with having discovered medications that give them some control. What a very, very personal decision it is, too.

    Link to this
  22. 22. luannpierce 3:56 pm 02/27/2012

    Indeed my ADHD has been instrumental in my becoming who I am today. There are many times when my ADHD-brain function is a gift – my best creative work comes during time of hyper-focus when it seems there is nobody else in the world. I just didn’t want to give the impression that it is anything other than a disorder in ‘mixed company’ lest it be misconstrued.

    In the past week, I have spoken with with a 59-year-old woman, a 61-year-old woman, a 39-year-old man and a 32-year-man who have ADHD. All of their lives might have been very different had they been diagnosed earlier. Like me, I think they would agree that the actual ADHD is much easier to live with than the backlash of having an invisible condition.

    Thanks for sharing your story – your son is very fortunate to have a mom who is ‘with it’.

    Link to this
  23. 23. peterpf 7:52 am 02/28/2012

    The following information is from a PBS Frontline report.

    According to the United Nations, the U.S. produces and consumes about 85 percent of the world’s methylphenidate.

    To view the stats go to the link below.

    Read more: http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html#ixzz1ngEdZtxk

    Source: http://www.dea.gov/pubs/cngrtest/ct051600.htm
    Source: http://www.dea.gov/pubs/cngrtest/ct051600.htm
    The DEA also tracks Schedule II controlled substances from the point of manufacture to the point of distribution to the consumer. This data reveals that there is wide variation in the levels of use of methylphenidate and amphetamine from state to state, and even among communities within states. This implies that there may be both under-prescription and over-prescription of medication for ADHD across the U.S., depending on the community.

    The top five ranking states in 1999 for methylphenidate and amphetamine use were: New Hampshire (5,525 grams per 100,000 population); Vermont (5,005); Michigan (4,848); Iowa (4,638); and Delaware (4,439). The lowest ranking states for use of methylphenidate were California (1,748) and Hawaii (1,208). For amphetamine, the lowest ranking were New York (509) and Hawaii (305).

    The average per capita use of methylphenidate across the United State was 3,082 grams per 100,000 population; for amphetamine it was 1,060 per 100,000.

    Read more: http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html#ixzz1ngEQ7HkM

    Link to this
  24. 24. peterpf 11:15 am 02/28/2012

    Here is a clip of recent research, It is used under the permission of Creative Commons…see below.

    Research
    A three-country comparison of psychotropic medication prevalence in youth
    Julie M Zito1,2*, Daniel J Safer3, Lolkje TWJ Berg4, Katrin Janhsen5, Joerg M Fegert6, James F Gardner1, Gerd Glaeske5 and Satish C Valluri1
    * Corresponding author: Julie M Zito jzito@rx.umaryland.edu
    Author Affiliations
    1 Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
    2 Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA
    3 Departments of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
    4 Department of Social Pharmacy, Pharmacoepidemiology & Pharmacotherapy, Groningen University for Drug Exploration (GUIDE), Groningen, The Netherlands
    5 Arzneimittelepidemiologie und Public Health, University of Bremen, Bremen, Germany
    6 Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Germany
    For all author emails, please log on.
    Child and Adolescent Psychiatry and Mental Health 2008, 2:26 doi:10.1186/1753-2000-2-26

    The electronic version of this article is the complete one and can be found online at: http://www.capmh.com/content/2/1/26

    Received: 17 April 2008
    Accepted: 25 September 2008
    Published: 25 September 2008

    © 2008 Zito et al; licensee BioMed Central Ltd.
    This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    Abstract
    Background
    The study aims to compare cross-national prevalence of psychotropic medication use in youth.

    Methods
    A population-based analysis of psychotropic medication use based on administrative claims data for the year 2000 was undertaken for insured enrollees from 3 countries in relation to age group (0–4, 5–9, 10–14, and 15–19), gender, drug subclass pattern and concomitant use. The data include insured youth aged 0–19 in the year 2000 from the Netherlands (n = 110,944), Germany (n = 356,520) and the United States (n = 127,157).

    Results
    The annual prevalence of any psychotropic medication in youth was significantly greater in the US (6.7%) than in the Netherlands (2.9%) and in Germany (2.0%). Antidepressant and stimulant prevalence were 3 or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5–2.2 times greater. The atypical antipsychotic subclass represented only 5% of antipsychotic use in Germany, but 48% in the Netherlands and 66% in the US. The less commonly used drugs e.g. alpha agonists, lithium and antiparkinsonian agents generally followed the ranking of US>Dutch>German youth with very rare (less than 0.05%) use in Dutch and German youth. Though rarely used, anxiolytics were twice as common in Dutch as in US and German youth. Prescription hypnotics were half as common as anxiolytics in Dutch and US youth and were very uncommon in German youth. Concomitant drug use applied to 19.2% of US youth which was more than double the Dutch use and three times that of German youth.

    Conclusion
    Prominent differences in psychotropic medication treatment patterns exist between youth in the US and Western Europe and within Western Europe. Differences in policies regarding direct to consumer drug advertising, government regulatory restrictions, reimbursement policies, diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences.

    he major finding of this cross-national prevalence study of psychotropic medications prescribed for youth is that the US prevalence exceeds Western European prevalence for overall psychotropic use and that drug class rates differ cross-nationally. While US stimulant and antidepressant use far exceeded the rates in Western Europe, the rates between the countries for antipsychotic use were less disparate. Findings from published studies from various Western European countries generally match the prevalence reports for the 3 major psychotropic classes (stimulants, antidepressants and antipsychotics) in Germany and the Netherlands as detailed below.

    Broad cross-national trends
    In a review of 10 Medline reports of published studies of prevalence of psychotropic medications prescribed for youth in Western European countries during the period from 1999 to 2002, there was general agreement on their low rates of use of psychotropic medications in youth relative to published reports of US utilization [4,20-29]. Stimulant prevalence was particularly low in France (0.05%) [20], but relatively higher (1.0%) in the Netherlands. Consistent with previous findings, antidepressant use is more common in the US. In a four-country antidepressant analysis, use of more than one antidepressant during the year 2000 was approximately four times more frequent in US youth (21.3%) than in Dutch (5.9%), German (5.4%), and Danish (5.6%) youth [27]. The striking antidepressant subclass pattern of the present study shows SSRIs represent nearly two-thirds of antidepressant use in US and Dutch youth, but less than one-quarter of German antidepressant use. The prevalence of antipsychotics in youth aged 0–4 ranged from 0.13% in Italy [24] to 0.5% in the Netherlands [29]. Generally, these antipsychotic prevalence findings closely matched those of this study, indicating that US youth -compared to Western Europeans-have a far higher prevalence of stimulants and antidepressants, but a less disparate prevalence of antipsychotics. Patterns for less commonly used psychotropic medications were remarkably similar across the 3 countries for lithium, alpha-agonists and antiparkinsonian agents but Dutch usage led the other countries in anxiolytic and hypnotic use. In the following sections, several factors that influence the utilization of psychotropic drugs across countries are presented.

    Regulatory differences
    Amphetamines are seldom prescribed in Western Europe. In fact, they were not allowed to be prescribed in France [20,30], Spain [31], and Italy [30], at the time of this study. Government cost restrictions in Europe have also cut down on the use of expensive drugs, particularly with respect to patent-protected antipsychotics and antidepressants [1,32]. These year 2000 patterns may be expected to change as recent European data suggest [30].

    Diagnostic classification differences
    The International Classification of Diseases (ICD-10) is now generally used for diagnostic purposes in Western Europe. This fact can influence the frequency of diagnosis and through that to treatment. For example, the diagnosis of hyperkinetic disorder in the ICD is more stringent than that of attention deficit hyperactivity disorder (ADHD) in the US based on the Diagnostic and Statistical Manual (DSM) criteria [33,34]. However, there is evidence that conduct disorder is more readily diagnosed in the UK using the ICD than in the US with the DSM [35]. The US trend of increasing bipolar diagnosis in children and adolescents [36] does not reflect European practice [37].

    Drug class preferences
    The common use of phenothiazine products in German youth aged 0–4 may be due to its medical usage for antihistaminic effects or to induce sleep, and not for psychiatric indications. In the US, several phenothiazines, e.g. promethazine, have antihistaminic properties which have been used to treat allergy and cold symptoms, but these drugs are classified separately and were not assessed as psychotropic uses. That may not be the case in Europe. Similarly, in Sweden during the late 1970s and early 1980s, 10% of youth had received prescriptions for neuroleptic drugs before their 5th birthday for sedative/hypnotic use [38]. The use of antidepressants varies by physician specialty depending on the setting and type of insurance. In year 2000, the prevalence of prescribed stimulant medication for 0–4 year-olds in Western Europe was quite low [UK (0%), Germany (0.02%), Netherlands (0.05%)] in relation to the US (0.49%) [39].

    Co-medication patterns
    Use of multiple medications, i.e., having two or more prescribed psychotropic medications during a one year period, was rare in the Netherlands in 1999 compared to the US [21]. In the current study, US concomitant use was 2 or 3 times more common than in Dutch and German youth, respectively.

    Access to physician specialties
    General practitioners prescribe most of the psychotropic drugs in Western Europe. In the US, pediatricians prescribe most of the stimulants for youth [40], whereas psychiatrists prescribe most of the antipsychotics [41]. In France, the first prescription of a stimulant must be written by a specialist. The general practitioner can continue stimulant prescribing, but only for a maximum period of one year [20]. The number of child psychiatrists per capita in Western Europe is low compared to the rate in the US [35], which presumably also accounts for some prescribing differences.

    Limitations
    Several limitations should be noted: 1) These data are cross-sectional in nature, covering one year, which do not permit time trend analyses. Future studies should address changing patterns over time. 2) Diagnostic information was not available so that it is unclear if antidepressants were prescribed for depression, anxiety, obsessive compulsive disorder or other indications. 3) US direct-to-consumer prescription drug advertising and professional journal advertising may contribute to increased awareness and utilization of medication to treat emotional and behavioral conditions in children. 4) There is no information on reimbursement patterns. 5) Access to medical specialists differs. 6) The US data were based on the s-CHIP Medicaid data from one state and have limitations as a representative US dataset, but adjustments were made to improve generalizability, e.g. prevalence of use rates were adjusted for the greater proportion of 0–4 year-olds in s-CHIP. 7) The analysis of the major psychotropic drug classes in this study did not include certain commonly used over the counter (OTC) drugs that are not generally recognized as important. Examples include St. John’s Wort–used prominently in Germany for the treatment of depression [1] and the extensive use of anxiolytics and hypnotics for adolescents in many European regions [22].

    Conclusion
    Prominent differences in psychotropic medication prevalence patterns for youth exist between the US and Western Europe and within Western Europe. Understanding these differences should help clarify and hopefully improve our understanding of the various influences on psychotropic drug treatment.

    Competing interests
    The authors declare that they have no competing interests.

    Link to this
  25. 25. SK15769 7:57 pm 03/1/2012

    Thank you, Emily, for your article about the New York Times opinion piece.

    My husband’s primary diagnosis is ADHD, but he also suffers from depression, anxiety and OCD and for us, medication was really a nightmare. Several of his practitioners have said to him, “I can’t treat you, you don’t change.” This is really frustrating – for him, the stimulants he has tried for ADHD make his OCD really bad (collecting all the dead birds on the beach and hanging them in our garage, for example, or not being able to leave the house until all the clutter was arranged at right angles even though no actual cleaning was getting done – something that took several hours of his time one day – not being able to choose what to pack for an overnight, and bringing all the clothes in the dresser and the dirty laundry in the back of the station wagon – taking 100 pictures and more of an indeterminate hybrid gull when late to an appointment…there was more). Antidepressants (Lexapro, Wellbutrin, and Paxil among others) seem to have had absolutely no effect. The anxiety medication made him really catatonic. He has had practitioners – at least four – say, “I can’t treat you; you don’t change.”

    The push in his family was to “do better than your father did” – and so I really think there was a mismatch between family expectations and individual strengths and weaknesses.

    The New York Times piece did talk about early childhood environment as being a potential cause for ADHD… and I wonder if that is never true – that is, I think it can be true. My mother-in-law had all her three children in three years; they are all about a year and a half apart. My husband is the middle child. His mother is a very overbearing person; when I first met her when I was nineteen, her only form of communication was yelling. I have absolutely no doubt that my husband, who is a very sensitive individual, was damaged by this. The model for communication in that family is constant fighting and bickering and disagreement. One time I said, sadly, because there was his constant nitpicking and general unhappiness, “I always thought of my home as the place where I was MOST comfortable, and where the people in your family were KIND to you and demonstrated that kindness by not interrupting with an order to empty the garbage if you were finishing your coffee and the newspaper on a Saturday morning.” He just stared at me and said, “Wow. It never occurred to me.” (Everyone in his house was constantly overtly and covertly bossing everyone else around.)

    He is 43. He had wanted to push himself to be a PhD in ecology, but he failed completing his master’s thesis. It was a slow-motion train wreck, and he has still not really recovered from it.

    So, for us, we are really in a quandary about what to do, and in what order and with whom. We live in a small, rural community. There is a LNP who can prescribe psych meds. She seems to diagnose everyone as Bipolar 2. There is a social worker who sends everyone over the hill to the psychiatrist who overmedicated my husband four years ago, and there is another social worker we went to for marriage counseling whom he is not willing to see again because he says to me, “That is YOUR social worker.”

    So, for four years, he has been an underemployed seasonal biologist, but every year improves a little bit more than the one where he was collecting all the dead birds.

    We have found that routine and structure really help, and having consistent household responsibilities… He grew up in a house with extremely rigid systems and rules. I didn’t. Bother our homes of origin were orderly, but if he doesn’t have consistent and prominent systems and rules, he falls apart and is unreliable, which for me is difficult. So, his job is dinner and dishes and mine is laundry and bills. Also, because he doesn’t attend to people or details, I have to be extremely clear about what the schedule is in numerous ways. He also has no sense of time, so I have to be a timekeeper (not really a strength of mine, either). We also find that routine and structure help with nutrition and sleep; he doesn’t exercise enough. I think that would help him order his brain somewhat, too.

    I teach middle school science. It is very clear to me that people with ADHD share similar behaviors. They are so extraordinarily observant and so curious. This is a real gift, actually. I think the key is to find a field where these work – I just wish he had been caught as early as you caught your son. I think it is extremely difficult to change at age 43. I said, “I think some of this anxiety is learned behavior.” His knee-jerk reaction was that it was not, but “just the way I’m wired” – but I honestly think that if someone had caught this when he was in elementary school or even middle school or high school or his first time through college – that he would have learned better coping skills.

    We have two daughters. I confess I watch them like hawks because of the apparent heritability of ADHD, but it doesn’t seem to be there.

    Link to this
  26. 26. ABlack 12:32 pm 12/13/2012

    seems very odd that when i was of school age nobody suffered from adhd. perhaps those suffering were self medicating with uppers but i doubt it.

    Logged in via Twitter.com/buysteroidsuk

    Link to this
  27. 27. sselby 1:12 am 06/15/2013

    Thank you for taking the time to write this. I am a geneticist with ADHD, married to a man with a PhD in genomics and lucky enough to have gotten a postdoc doing clinical studies in cardiovascular medicine, also an ADHDer. I strongly believe he would not have been able to accomplish the work, the writing, nor have the focus to finish without being properly medicated. People who meet him, may not have “believed” in ADHD prior to meeting him, but after spending a few hours with him medicated and unmedicated, they usually come out as believers, or see him as an eccentric, off-the-wall genius, quite atypical, and as an unprofessional PhD that would by no means be invited to a wedding, perhaps the bachelor party, but not the wedding. It’s tough to live in that light. It’s tough to be seen as that person despite being brilliant. (And prior to meeting him, my friends always described me as “hyper” or “weird,” saying I had met my match finding someone more hyper than me.)

    I’m quite frustrated with the lack of support, yet autism, bipolar, depression anything BESIDES ADHD is seen as real, is understood, well funded, and receives support from our communities, both medical and at home. Within the medical community, it’s harder and harder to find a supportive physician. (We’ve moved a lot due to postdoc training and career). Peterpf brought in publications demonstrating the current & accepted critique of diagnosis rates in the US vs over-seas. However, where he, and the authors, may see this as the US over-producing, over-diagnosing, I see it as lack of support, complete disregard, and discrimination of a real debilitating disorder/ disability over-seas. Maybe overseas our eclectic nature is more supported in the workplace, however, that doesn’t stop the run around, the extra steps we take, often too many to be able to perform as well as someone without the disorder. Without medication, it’s like a simple task gets fumbled all the way through, an A to B, seems to have 10 offshoots before B is eventually achieved. We struggle. On medication the path to B is seen clearly and is much more able to be efficiently & effectively accomplished. I watch other people, moving slowly, more calculated, less jumbled, less frantic, less rushed finishing a task, seems so effortless, while I am the running rabbit to their turtle, running back and forth getting little done. On medication, I slow down, I relax, I can accomplish and it’s so simple. Even the act of driving, simple to most adults, off medication is taxing, I look at the speedometer, I look at the road, I look at other cars, concentrating as hard as I can, it feels hard. On medication all those steps aren’t deliberate, they just happen and I don’t feel strain. The 10 offshoots, do have a perk, in that we may see something someone else misses. Obviously in science this is an asset, on medication, however, these offshoots are still there (we don’t change who we are) they are just stored for later use and not lost to sea as they often are without medication. (Often our impulsiveness is acted upon because we are afraid we will loose the thought/ idea, medication helps us store those great ideas). What isn’t an asset is starting to do the dishes, seeing a piece of laundry, running to put the laundry into the washer(because if it isn’t done right then it’ll be forgotten), realizing you have to pee, seeing that the toilet needs to be cleaned, scrubbing the toilet and forgetting to start the washer, and forgetting the dishes altogether.

    I don’t know how to explain the debilitating feelings, how overwhelming even shopping can be. This isn’t an easy thing to have. We honestly forget you asked us to stop talking, the instant a new thought comes in, and believe me thoughts are what our brains do; we will blurt out the thought. Usually in hindsight, we regret speaking. I can’t tell you how much I now avoid meeting new people, because of how many times I just say the wrong things, only later realizing I seem like a buffoon. I was fun as a teenager, funny, bright, happy, the kid other teens like, but other adults, well they grew up. They learned how to refrain from saying things. I didn’t and even medication can’t help my lack of social skills, I didn’t pick up in my wild, mad dash development. (Diagnosed in college when my smarts didn’t match my ability to go to class, I didn’t drink or do drugs-nerdy type, but I would feel like sleeping in so I did. Or I’d procrastinate too long, college isn’t as forgiving as easy AP high school) Many of us are brilliant, so I guess because we seem OK, it should be scrutinized? I wish they’d make a drug that could mimic the effects so for once the naysayers would finally understand.

    18 years after meeting and beginning this crazy journey together, my husband and I now have 3 homeschooled children, one diagnosed by Dr. Brown himself, the next is highly suspect and our youngest is way too young (though our children are often already noted as being “different” in infancy). They are testing above their age and are doing fantastic. Discrimination is a very real reason we chose to homeschool.

    As ADDers need jobs with flexible hours, that rely on us to use our strengths. We need bosses that understand we are a bit different and allow us to shine. Or we end up sad, depressed, not living up to potential, and not finishing our master’s thesis, ever living, and knowing we could have accomplished more.

    In the US, we need the credentials, we don’t have apprenticeships, so it can be lifelong devastation when we are unable to get our proper certifications, especially as scientists.

    This medication issue, lack of proper diagnosis and life skills coaching is damaging a small percentage of the population that could do great things.

    Dear world against ADHD,
    Stop dismissing us, stop telling us that we’re just lazy, we’ve heard it our entire lives. Stop punishing us, hiding us, or putting us on display as the bad kid. Lazy implies just not getting up, not caring, we get up, we run around and we just don’t perform the way others want us to. And it hurts who we are that we cannot do the things we know we can. Though we can do it with support, with diagnosis, with medication and/or with life skills coaching. (But see that’s an awful lot of accommodations just to be able to do what the average functioning person is able to do with finesse. We need accommodations, it really is a disability to live up to average standards, even though we might be above average in other areas.) Either realize this is real, or stop expecting us to finish tasks, we get so excited about, and get your hopes up. Stop expecting us to contribute the way an average person does. We’ll get to the lawn, eventually, when it has become full of ticks and it isn’t fun to play in anymore. It will be unsightly, and growing weeds, you’ll want to call the community overlords to fine us, but without support, without realizing this is a real thing, this is what you can expect from us. Meanwhile, whilst the lawn grows, we’ll be working on a medical miracle, only we won’t even get to the breakthrough, running out of clean dishes will distract us. And see now we’ve done nothing beneficial and you can continue to see us as lazy, can’t even take care of the lawn, nor complete a brilliant idea.

    Link to this
  28. 28. sselby 1:31 am 06/15/2013

    @ABlack: the best example of a famous ADDer is Albert Einstein. The kids you went to school with who were “troublemakers, ” the smart ones that never finished their homework, the day dreamers, they all had ADHD. This has been recognized since 1902, yet little support was there.

    Link to this

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