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Attention deficit hyperactivity disorder controversies

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Ritalin 10mg Pill (Ciba/Novartis)

Attention-deficit hyperactivity disorder (ADHD) is one of the most controversial psychiatric disorders despite being a well validated clinical diagnosis. ADHD and its treatment has been considered controversial at least since the 1970s. The controversy has involving clinicians, teachers, policymakers, parents, and the media with opinions regarding ADHD ranging from those who do not believe it exists to those who believe that there is genetic and physiological basis for the condition.

Researchers from McMaster identified five features of ADHD that contribute to its controversial nature: 1) it is a clinical diagnosis for which there are no laboratory or radiological confirmatory tests or specific physical features; 2) diagnostic criteria have changed frequently; 3) there is no curative treatment, so long-term therapies are required; 4) therapy often includes stimulant drugs that are thought to have abuse potential; and 5) the rates of diagnosis and of treatment substantially differ across countries.

Lack of clarity on exactly what qualifies as ADHD and changes in diagnostic criteria have caused confusion. Ethical and legal issues with regard to treatment have been key areas of concern, particularly the use of psychostimulant medication and the promotion of stimulants to treat ADHD by groups and individuals who receive money from drug companies. Medical professionals and news sources have stated that the diagnosis and treatment of the disorder deserve greater scrutiny.

Alternative theories to explain the symptoms of ADHD have been proposed,. These views include the Hunter vs. farmer theory, Neurodiversity, and the Social construct theory of ADHD.

Some individuals and groups reject the existence of ADHD entirely and claim it was invented to sell pharmaceuticals. They include Thomas Szasz, Michel Foucault and groups such as CCHR . This view has been rejected by medical authorities and US courts (see the Ritalin class action lawsuits).

Status as a disorder

Concerns about methods of diagnosis

ADHD and stimulant use are controversial in part because most children are diagnosed and treated based on decisions made by their parents and clinicians with teachers being the primary source of diagnostic information. Most children who end up with a diagnosis of ADHD have normal behavior in the physicians office.

The number of people diagnosed with ADHD in the U.S. and UK has grown dramatically over a short period of time. Critics of the diagnosis, such as Dan P. Hallahan and James M. Kauffman in their book Exceptional Learners: Introduction to Special Education, have argued that this increase is due to the ADHD diagnostic criteria being sufficiently general or vague to allow virtually anybody with persistent unwanted behaviors to be classified as having ADHD of one type or another, and that the symptoms are not supported by sufficient empirical data.

Publications that are designed to analyze a person's behavior, such as the Brown scale or the Conners scale, for example, attempt to assist parents and providers in making a diagnosis by evaluating an individual on typical behaviors such as "Hums or makes other odd noises", "Daydreams" and "Acts 'smart'"; the scales rating the pervasiveness of these behaviors range from "never" to "very often". Connors states that, based on the scale, a valid diagnosis can be achieved; critics, however, counter Connors' proposition by pointing out the breadth with which these behaviors may be interpreted. This becomes especially relevant when family and cultural norms are taken into consideration; this premise leads to the assumption that a diagnosis based on such a scale may actually be more subjective than objective (see cultural subjectivism).

Some of the criticism does not reject the concept of ADHD as a valid disorder, but alleges that children with problematic behaviour are often diagnosed with ADHD when the cause of the behaviour may result from other causes. They state that some children diagnosed with ADHD, or labeled ADHD by parents or teachers, are normal but do not behave in the way that responsible adults want them to behave. There is concern about teachers being used to assist in diagnosing students with ADHD. Social critics make the connection between the extra funding some schools receive for children with ADHD and the increase in the diagnosis.

ADHD is a subjective diagnosis with no definitive test. This leads to situations where one doctor would say a child needs psychotropic medication while another doctor could say the child is perfectly normal.

Different views of ADHD outside North America

The view that ADHD is a problem requiring medical intervention is far less prevalent outside of the United States and Canada. In Great Britain and France roughly one percent of children are diagnosed with hyperkinetic syndrome, the equivalent of ADHD in the International Classification of Diseases (the diagnostic system used by most medical professionals outside North America.) The British Psychological Society said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: “The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians.”

Anti-psychiatry movement

Members of the Anti-Psychiatry movement such as Fred Baughman and Peter Breggin have extensively used the popular media to criticize ADHD and medications used for ADHD. Fred Baughman has also published articles about ADHD in peer reviewed journals. They have testified at Congressional hearings on the use of Ritalin and supported legal challenges such as the Ritalin class action lawsuits. There is an antipsychiatry movement that often refers to their writings, but in contrast to scientolgists, they are not "anti-psychiatry," but critics of some of its practices.

Scientology

According to an article in the Los Angeles Times, "the uproar over Ritalin was triggered almost single-handedly by the Scientology movement." The Citizens Commission on Human Rights, an anti-psychiatry group formed by Scientologists in 1969, conducted a major campaign against Ritalin in the 1980s and lobbied Congress for an investigation of Ritalin. Scientology publications identified the "real target of the campaign" as "the psychiatric profession itself" and said that the campaign "brought wide acceptance of the fact that (the commission) [sic] and the Scientologists are the ones effectively doing something about psychiatric drugging". Scientology states "the controversy over the many deaths and irreversible damage caused by psychiatric drugs prescribed for children labeled with... ADHD continues to grow". The church states that mental disorders are a fraud, "mental and behavioral problems are largely incorrect diagnoses that cover symptoms and don't handle the real problems, which may be physical or spiritual".

Alternative theories concerning origins

Hunter vs. farmer theory of ADHD

Main article: Hunter vs. farmer theory

The hunter vs. farmer theory is a hypothesis proposed by author Thom Hartmann about the origins of attention-deficit hyperactivity disorder (ADHD). He believes that these conditions may be a result of adaptive behavior of the species, his theory states that those with ADHD retained some of the older hunter characteristics.

Neurodiversity

Main article: Neurodiversity

Proponents of this theory assert that atypical (neurodivergent) neurological development is a normal human difference that is to be tolerated and respected as any other human difference. Social critics argue that while biological factors may obviously play a large role in difficulties sitting still and/or concentrating on schoolwork in some children, for a variety of reasons they have failed to integrate into the social expectations that others have of them.

Social construct theory of ADHD

Main article: Social construct theory of ADHD

Social critics question whether ADHD is wholly or even predominantly a biological illness. A minority of these critics maintain that ADHD was, "invented and not discovered". They believe that no disorder exists and that the behaviour observed is not abnormal and can be better explained by environmental causes or just the personality of the "patient."

Concerns about medication

Main article: Attention-deficit hyperactivity disorder treatments

The National Institute of Mental Health states that, "stimulant drugs, when used with medical supervision, are usually considered quite safe".

Concerns about side effects and long term effectiveness

Some parents and professionals have raised questions about the side effects of drugs and their long term use. Neither safety nor efficacy of stimulants has been determined beyond two years. On February 9, 2006, the U.S. Food and Drug Administration voted to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat ADHD.

Non specific nature

Stimulant medications lead to improved concentration and behavior in all children regardless of whether or not the child has ADHD. Due to there non specific actions stimulants have been used by witters to increase productivity as well as by the US airforce to increase concentration in combat.

Stimulant misuse

Stimulant are controlled psychotropic substances. They are classified as Schedule II substances, considered highly addictive but having defined medically accepted uses.

Stimulant edications are commonly resold by patients as recreational drugs, and methylphenidate (Ritalin) is used as a study aid by some students without ADHD.

Non-medical prescription stimulant use is high. A 2003 study found that non prescription use by college students in the US was 6.9% with 4.1% using them within the last year.


Concerns over funding of ADHD lobby groups and physicians

Dr. Russell Barkley, a well known ADHD researcher, admits to taking money from drug companies for speaking and consultancy fees. There are concerns that this may bias his publications.

In 2008, it was revealed that Dr. Joseph Biederman of Harvard, who has played a significant role as a frequently cited ADHD expert, failed to report to Harvard that he had received 1.6 million dollars from drug companies between 2000 and 2007. E. Fuller Torrey, executive director of the Stanley Medical Research Institute which finances psychiatric studies, said “In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.”

Concerns about the impact of labeling

Parents could be concerned that telling children they have a brain disorder could possibly harm their self-esteem. Dr. Russell Barkley believes labeling is a double-edged sword; there are many pitfalls to labeling but that by using a precise label, services can be accessed. He also believes that labeling can help the individual understand and make an informed decision how best to deal with the disorder using evidence based knowledge. Furthermore studies also show that the education of the siblings and parents has at least a short term impact on the outcome of treatment. Dr. Russell Barkley states this about ADHD rights: "..because of various legislation that has been passed to protect them. There are special education laws with the Americans with Disabilities Act, for example, mentioning ADHD as an eligible condition. If you change the label, and again refer to it as just some variation in normal temperament, these people will lose access to these services, and will lose these hard-won protections that keep them from being discriminated against. . . ." Psychiatrist Harvey Parker, who founded CHAAD, states, "we should be celebrating the fact that school districts across the country are beginning to understand and recognize kids with ADHD, and are finding ways of treating them. We should celebrate the fact that the general public doesn't look at ADHD kids as "b-a-d" kids, as brats, but as kids who have a problem that they can overcome".

Social critics believe that this knowledge can effectively become a self-fulfilling prophecy mainly through self-doubt. Dr. Thomas Armstrong states that the ADHD label is a "tragic decoy" which severely erodes the potential to see the best in a child . Armstrong is a proponent of the idea that there are many types of "smarts" and has adopted the term neurodiversity (first used by autistic rights activists) as an alternative, less damaging, label . Thom Hartmann has said that the brain disorder label is "a pretty wretched label for any child to have to bear."

Media coverage of ADHD

The media has reported on many issues related to ADHD and has also reported on controversial opinions of individuals.

In 2001 PBS's Frontline ran a five-part TV series entitled "Medicating kids". The program included a selection of interviews with representatives of various points of view. In one segment, entitled backlash, retired neurologist Fred Baughman and Peter Breggin, founder of the 'International Center for the Study of Psychiatry and Psychology', who PBS described as "outspoken critics who insist a fraud perpetrated by the psychiatric and pharmaceutical industries on families anxious to understand their children's behavior," were interviewed on the legitimacy of the disorder. Russell Barkley and Xavier Castellanos, then head of ADHD research at the National Institute of Mental Health (NIMH), defended the viability of the disorder. In Castellanos's interview he stated how little is scientifically understood. Lawrence Diller was interviewed on the business of ADHD along with a representative from Shire Plc.

A number of notable individuals have given controversial opinions on ADHD. Scientologist Tom Cruise's interview with Matt Lauer was widely watched by the public. In this interview he spoke about postpartum depression and also referred to Ritalin and Adderall as being "street drugs" rather than as ADHD medication. In England Baroness Susan Greenfield, a leading neuroscientist, wanted a wide-ranging inquiry in the House of Lords into the dramatic increase in the diagnosis of ADHD in the UK and possible causes following a 2007 BBC Panorama programme which highlighted US research (The Multimodal Treatment Study of Children with ADHD by the University of Buffalo showing treatment results of 600) suggesting drugs are no better than therapy for ADHD in the long-term. Other notable individuals have made controversial statements about ADHD. Terence Kealey, a clinical biochemist, has stated his belief that ADHD medication is used to control unruly boys behaviour. Newspaper columnists such as Benedict Carey have also written controversial articles on ADHD.

See also

References

  1. Mayes R, Bagwell C, Erkulwater J (2008). "ADHD and the rise in stimulant use among children". Harv Rev Psychiatry. 16 (3): 151–66. doi:10.1080/10673220802167782. PMID 18569037.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ "Attention deficit hyperactivity disorder: legal and ethical aspects -- Foreman 91 (2): 192 -- Archives of Disease in Childhood".
  3. Parrillo, Vincent (2008). Encyclopedia of Social Problems. SAGE. p. 63. ISBN 9781412941655.
  4. ^ "Treatment of Attention-Deficit/Hyperactivity Disorder". US department of health and human services. 1999. Retrieved 2008-10-02. {{cite web}}: Unknown parameter |month= ignored (help)
  5. Cohen, Donald J.; Cicchetti, Dante (2006). Developmental psychopathology. Chichester: John Wiley & Sons. ISBN 0-471-23737-X.{{cite book}}: CS1 maint: multiple names: authors list (link)
  6. Jadad AR, Booker L, Gauld M; et al. (1999). "The treatment of attention-deficit hyperactivity disorder: an annotated bibliography and critical appraisal of published systematic reviews and metaanalyses". Canadian journal of psychiatry. Revue canadienne de psychiatrie. 44 (10): 1025–35. PMID 10637682. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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  8. "BBC NEWS". {{cite web}}: Text "Health" ignored (help); Text "Peer calls for ADHD care review" ignored (help)
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  10. "Suffer the Restless Children: ADHD, Psychostimulants, and the Politics of Pediatric Mental Health".
  11. Hallahn, Dan P.; Kauffman, James M.. Exceptional Learners : Introduction to Special Education Allyn & Bacon; 10 edition (April 8, 2005) ISBN 0205444210
  12. http://www.usyd.edu.au/news/84.html?newsstoryid=2512
  13. http://www.mykidsdeservebetter.com/adhd/public_schools_benefit.asp
  14. http://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/diller.html
  15. http://www.britannica.com/EBchecked/topic/279477/attention-deficithyperactivity-disorder/216017/Controversy-mental-disorder-or-state-of-mind
  16. Talking Back to Ritalin-New Breggin Book Excerpts
  17. An Anti-Psychiatry Reading List
  18. Online Dictionary of Mental Health
  19. TOC - Antipsychiatry Reading Room
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  21. ^ Sappell, Joel (1990-06-29). "Suits, Protests Fuel a Campaign Against Psychiatry". Los Angeles Times. p. A48:1. Retrieved 2006-11-29. {{cite news}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Backup copy link here
  22. Real-Life Horrors Fuel Growing Outrage Over Deadly ADHD Drugs
  23. Scientology's war on psychiatry - Salon.com
  24. http://deseretnews.com/article/1,5143,595091823,00.html?pg=3
  25. Hartmann, Thom (2003). The Edison gene: ADHD and the gift of the hunter child. Rochester, Vt: Park Street Press. doi:http://books.google.ca/books?id=L0l5EaHppyoC&dq=hunter+vs+farmer+The+Edison+Gene:+ADHD+and+the+Gift+of+the+Hunter+Child&lr=&source=gbs_summary_s&cad=0. ISBN 0-89281-128-5. {{cite book}}: Check |doi= value (help); External link in |doi= (help)
  26. Rethinking ADHD >> Palgrave.com : Title Page
  27. "CG72 Attention deficit hyperactivity disorder (ADHD): NICE guideline" (PDF). NHS. 24 September 2008. Retrieved 2008-10-08.
  28. "NIMH · ADHD · The Treatment of ADHD".
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  34. "Air force rushes to defend amphetamine use - theage.com.au".
  35. "Controversy Erupts Over Ads for ADHD Drugs -- Rosack 36 (21): 20 -- Psychiatr News".
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  37. McCabe SE, Knight JR, Teter CJ, Wechsler H (2005). "Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey". Addiction (Abingdon, England). 100 (1): 96–106. doi:10.1111/j.1360-0443.2005.00944.x. PMID 15598197. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  38. Southall, Angela (2007). The Other Side of ADHD:Attention Deficit Hyperactivity Disorder Exposed and Explained. Radcliffe Publishing Ltd. ISBN 1846190681.
  39. ^ "Researchers Fail to Reveal Full Drug Pay - NYTimes.com".
  40. ^ PBS - frontline: medicating kids: interviews: russell barkley
  41. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007.pdf
  42. PBS - frontline: medicating kids: interviews: harvey parker
  43. Myth of ADD
  44. Special Education and the Concept of Neurodiversity
  45. Hartmann Interview
  46. http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/ Medicating Kids
  47. PBS - frontline: medicating kids: opponents and backlash
  48. PBS - frontline: medicating kids: interviews: xavier castellanos, m.d
  49. Baroness Susan Greenfield
  50. BBC NEWS | Health | Peer calls for ADHD care review
  51. Boisterous boys are too much like hard work, so we drug them into conformity | Terence Kealey - Times Online
  52. Parenting as Therapy for Child's Mental Disorders - New York Times
  53. What’s Wrong With a Child? Psychiatrists Often Disagree - New York Times

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