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Patrick D Hahn

Patrick D Hahn
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I used to wash trucks for a living.

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SEPTEMBER 9, 2011 8:54AM

An invented disorder UPDATED AGAIN

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Teacher's little helper 

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

 

Author Robert Whitaker reviews the history of the condition once known as hyperactivity, then as Attention-Deficit Disorder or ADD, and now as Attention-Deficit Hyperactivity Disorder, or ADHD. It is my conviction that hundreds of years from now historians will regard our obsession with drugging children to control their behavior the way we now regard witch hunts: What the Hell were those people thinking?

 

Read the evidence and decide for yourself. In 1980, the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual, which for the first time included Attention-Deficit Disorder. (In 1987, a revised version of DSM-III broadened the diagnostic criteria for this disorder and re-named it Attention-Deficit Hyperactivity Disorder) At one stroke, literally millions of children who might otherwise have been labeled as “naughty” or “fidgety” or, for that matter, perfectly normal, were now judged to be mentally ill and in need of powerful brain-altering drugs.

 

The drug of choice for this “disorder” is Ritalin, a stimulant similar to amphetamine in its chemical structure and to cocaine in its mode of action. At the time the diagnostic category ADD was invented, about 150,000 children were taking Ritalin for the condition then known as “hyperactivity.” Today that number has risen to 3.5 million. This is almost exclusively an American phenomenon, by the way. The United States, with less than five percent of the world’s population, accounts for a staggering 75% of stimulants consumed by children. This certainly has been a windfall for the drug companies. How did it work out for the rest of us?

 

Ritalin has been touted for its ability to change children’s behavior. And it sure does. A 1978 double-blind study of the effect of Ritalin on schoolchildren by Herbert Rie noted that children taking the drug:

 

…appeared distinctly more bland or flat emotionally, lacking both the age-typical variety and frequency of emotional expression. They responded less, exhibited little or no initiative or spontaneity, offered little indication of either interest or aversion, showed virtually no curiosity, surprise, or pleasure, and seemed devoid of humor. Jocular comments and humorous situations passed unnoticed. In short, while on active drug treatment, the children were relatively but unmistakably affectless, humorless, and apathetic.

 

All of which makes for a more manageable child in the classroom. Indeed, the diagnosis of ADHD normally is a response to teacher complaints, not parental concerns. But does this short-term increased tractability translate into any long-term benefits for the child?

 

According to Whitaker, the answer is a big fat NO.

 

The aforementioned Herbert Rie noted “[T]he major effect of stimulants appears to be an improvement in classroom manageability rather than academic performance.” A 2002 review published in the Canadian Journal of Psychiatry found “little evidence indicates that stimulants improve academic attainment, even after as long as 1 year of treatment.” The 1994 edition of the American Psychiatric Association’s Textbook of Psychiatry averred that “Stimulants do not produce lasting improvements in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long-term adjustment.” A long-term study by the National Institute of Mental Health (NIMH) concluded “The long-term efficacy of stimulant medication has not been demonstrated for any domain of child functioning.”

 

At this point I can do no better than to quote Whitaker verbatim:

 

[T]he NIMH found that over the long term there was nothing to be entered on the benefit side of the ledger. This leads only the risks to be tallied up, and so now we need to look at all the ways that stimulants can harm children.

 

Ritalin and other ADHD medications cause a long list of physical, emotional, and psychiatric adverse effects. The physical problems include drowsiness, appetite loss, lethargy, insomnia, headaches, abdominal pain, motor abnormalities, facial and vocal tics, jaw clenching, skin problems, liver disorders, weight loss, growth suppression, hypertension, and sudden cardiac death. The emotional difficulties include depression, crying jags, irritability, anxiety, and a sense of hostility toward the world. The psychiatric problems include obsessive-compulsive symptoms, mania, paranoia, psychotic episodes, and hallucinations.

 

The kids who are given these drugs feel a “sense of hostility toward the world?” I wonder why?

 

There is also strong evidence that stimulants as Ritalin are one of the causes of the epidemic of juvenile bipolar disorder sweeping the nation. I shall have more to say about that in my next post.

 

But I submit there is even more at stake here. What is at stake is an entire world view. Am I the only one who is horrified by this vision of ourselves as creatures who have no need for self-discipline, self-control, or free will? Just pump us full of the right drugs and we’ll do whatever our masters want.

 

If you do not accept that view, then all we are left with is the hard gritty work of building character, of learning from our mistakes and trying again. And it is my observation that most people do just that. The angry person learns to control his temper, the timid person learns to assert himself, the goof-off gets serious, and the introvert opens up to his fellow human beings. It is my observation that most people get better with advancing years. Watching this process unfold is one of the privileges of being human. To throw this away in exchange for a compliant, drugged child who may grow into a permanently damaged adult strikes me as the height of insanity.

 

I wonder if there is a pill we can take for that?

 

Photo via Wikimedia Commons

 

UPDATE 30 JANUARY 2012: The January 29 edition of the New York Times features an essay by L. Alan Sroufe, Professor Emeritus at the Institute for Child Development at the University of Minneota, which says in part:

 

To date, no study has found any long-term benefit of attention deficit medication on academic performance, peer relationships, or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.

 

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

 

UPDATE 31 JANUARY 2012: Dr. Sroufe has kindly directed my attention to the paper, “The MTA at 8 years: Prospective Follow-Up of Children Treated for Combined ADHD in a Multisite Study,” published in the May 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. 579 children at six sites diagnosed with ADHD were randomly assigned to one of four treatment groups: 1) Medication management, 2) Multicomponent Behavioral Therapy, 3) Medication + Therapy, or 4) Usual Community Care (whatever that means). After eight years, there were no statistically significant effects of treatment group assignment on any of 24 outcome variables tested.

 













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My mother’s brother was a public high school art teacher for twenty years. He was also a bodybuilder who was good enough to have turned pro if he had wanted to. Anyway, he did not enjoy his job as a teacher, but he had an interesting proposal. He said that at the age of ten we should just take all the boys out of the classroom and send them to a place where they would just wring them out, with strenuous work and strenuous play, all day long. Then, when they reached the age of fifteen, they would be returned to the classroom. Said he: “You know how long it would take them to make up the time they missed? Six months.”

I don’t know that we have to do anything as drastic as what Uncle Philip proposed, but perhaps we ought to give more thought to channeling youthful energy to constructive ends, rather than trying to suppress it.
As always, I would like to hear from people who have taken these drugs, or whose kids have taken them. How did that work out for you/them?
To see facts laid out here that answer all of the questions I have had about this alleged disorder is simultaneously fascinating and unnerving. Thank you for this most educational post, Sir. R
Thank you for reading and commenting. It is a pleasure to make your acquaintence. The subject of my next post will be juvenile bipolar disorder. I think you will find it of interest.
Ver informative. You might like this too:

http://www.szasz.com/manifesto.html
Congratulations on posting something of actual importance. I saw my nephew ravaged by Ritalin, and fought my ex tooth and nail over the issue of medicating my own son. (I won. I think. I was never sure if she wasn't slipping him a mickey now and then.)

I will take this argument further. The enormous growth of polydrug addictions began only AFTER the widespread administration of Ritalin, which suggests an anecdotal association between Ritalin and the drug epidemic in the US.

More certainly, the process of acclimating young children to drug taking behavior as a means of mood management.

On an even more sinister level, there is evidence that the federal government has actively promoted drug use as a means of population control, something that became evident in the early 1970s, when the CIA was actively involved in drug trafficking in the United States. Even today, we continue to continence the cultivating of poppies in Afghanistan, knowing full well that the heroin made from those poppies was going to end up in the United States.

Today, it is virtually impossible to find a psychiatrist who is willing to provide talk therapy. All they do is drug their patients. If you want talk therapy, you have to go to a psychologist, doubling your mental health costs.

I could go on, but I will refrain....
I have an education degree and tutor at local schools. I feel the same as you regarding drugging our children. If someone had asked me to drug my own children I would have fought it, for sure. Yet, I am shocked at the difference in behavior as to when these children take their pills and when they do not. It is certainly easier to get through the day and they behave much better when they take their pills. They are not constantly disrupting the entire class. They are not hitting other children or dumping every toy, book or pencil onto the floor.

There are so many issues in today's classrooms I do not know how teachers teach any longer. With the abuse some of these children suffer, with their parents being in jail, with the poverty they experience how can we not expect them to be anxious and mad?

I do not know what the answer is other than counseling for all. That would be an impossible job. There are too many video games and much too much television being watched. Yet, the kids I teach are afraid to leave their home to play. They might be shot.
I agree with your post but should we blame it all on teachers? Ps - I'm not a parent or a teacher.
My oldest son was diagnosed ADHD and we chose not to medicate while surrounded by other parents who said I 'wasn't giving my son a chance" which is how I felt about their choice to medicate.
We found after much research, and most studies also show this, or they did when this was our issue, that exercise for these kids works to the same if not higher potential than any medicating. The added benefit for us was not training our son to feel he had to take a pill to be normal.
That said, without the hyperactive quotient, the scattered mind of ADD-- absent-minded, dreamers, we used to call them-- is a struggle for us circular thinkers in this linear world.
I still don't think medicating is the answer, just reading the side effects possible on these drugs ought to have any responsible parent running in the opposite direction.
And yes, that might be an inflammatory statement to some but I stand by it as far as my family, my experience, goes.
I will go further and say thank you to Tom Cruise for being the one public person willing to stand out during the height of this 'craze' and stating this drugging of our children wrong, all wrong.
I apologize for not editing my comment and the subsequent errors within : )

I also fully believe there is a connection to the proliferation of non-foods we call food, with the dyes and other strange ingredients, as well as the huge amounts of sugar and caffeine that our kids guzzle daily and then we wonder why they are hyperactive.

ps-- Raising a hyper kid without medication is a commitment, it's certainly not easy, but making those kids run every single day as well as giving them detailed projects to kick in their 'hyper-focus' as they call it -- for my son it was and still is jewelry making -- offer manageable hope to willing parents.
To Cognitive Dissonance: I have the book The Myth of Mental illness, although I haven’t gotten around to reading yet. But I promise I will!

To SageMerlin: Good for you for sticking up for your son. As for your nephew, I’d say that story rates a post of its own.

To MiddleAgedWomanBlogging: Our public school teachers have an impossible job. I could never do what they do. Thanks for reading & commenting & rating.

To Noah Tawls: I am sorry if I came across as if I were blaming it all on teachers. I assure you I am not. I’d say they bear a small amount of responsibility for this mess.

To Just Thinking: Good for you for sticking up for your son. I am glad to hear he is doing well.

Thanks to everyone for reading and commenting.
Patrick,

I don’t have a lot of time to write today. Blanket assertions do little to promote reasonable dialogue. I have a 20 yr old son doing well with his ADHD and he’s been using Adderal wisely since third grade. I have a PhD in Special Education and have spent 35 years working with students with behavior problems and learning disabilities. There is in fact a constellation of symptoms that includes hyperactivity that is very real and undoubtedly biochemical in causation. No practitioner worth his/her salt would simply argue for meds for kids. The deal is to get the child into a genuinely supportive instructional environment and then ADHD is in fact responsive to certain stimulant meds for some children.

I find it hard to even respond to people who are “for or against” medication. And to those who it make it into a giant big pharma or government conspiracy as at least one commenter did is – well – they might benefit from some meds.

Your main study cited (1978) is hopelessly outdated and there is a vast amount of good scientific literature on this subject available today. And Thomas Szasz is a fun read and was great in the “60’s – but really – so were the Beatles.

I applaud your effort to tackle a difficult subject. I’m not certain an “either or” approach is of much use though.

Best,
I'm usually skeptical of polemical approaches to subjects of which I have little or no expertise, especially when political implications are woven into the argument. This may stem in part from an aversion to the hard sell as opposed to a more modulated presentation of information with at least the appearance of a fair balance of available points of view with supporting facts.

As someone who was diagnosed with ADD about a decade ago - as an adult - I have done some reading on the topic, but in no way consider myself qualified to debate the merits of various treatments. Since my diagnosis I've been taking a generic equivalent of Ritalin under a psychiatrist's supervision and it has benefited me noticeably. Of course there is also the psychological relief of understanding that difficulties in focusing and concentrating, which I've experienced all of my life, with the resultant emotional fragility and its consequences on my sense of well-being, can be explained neurologically rather than morally - a placebo effect, perhaps, but a sustained positive effect nonetheless. I have no clue as to how I might have turned out as an adult had I begun the medication as a child.

I do have one question, however, in light of the apparently consistent results of the cited studies that children receiving a stimulant respond in a manner counter to what one might expect from a central nervous system stimulant. My limited readings on ADD have led me to understand that stimulants in fact do have a counter effect on people suffering from the disorder. That instead of exhibiting the symptoms of the so-called "speed freak," with its nervousness and hyperactivity, the medication has a calming effect on the disordered individual, enabling him or her to better focus on tasks at hand. This occurs, to my understanding, because the stimulant in an ADD victim compensates for the deficiency of a certain enzyme present in a prefrontal lobal area in normal people that enables them to prioritize stimulii and control responses to them. If so - and admittedly my understanding is based on available information at the time of my diagnosis and the science may well have progressed much further since then - then it is irresponsible, in my opinion, to dismiss willy nilly a disorder that in fact has been demonstrated by neurological research.

Perhaps children are misdiagnosed is improperly medicated. If so, that is tragic. Yet, I should think that if their behavior responds to stimulating medication in a way that enables them to concentrate and focus in a positive way, then we would do them a tragic disservice to ignore such diagnosis and treatment.

As a side note, I arrived at this post at the urging Alan Milner (Sagemerlin), whose knowledge and opinions I respect enormously. I am disappointed to see that he and I disagree on this particular issue. Then again, perhaps it is time for me to update my reading on ADD.

Also, I am a tad pressed for time and am posting this without scrolling back up to proof my writing. Please forgive any obvious typos.
Sure - if ya sugar them up and dont run them hard a few of them will git wild and actually turn a teacher into a basket case. But we got to sell the sugar! And we got to sell the drugs! So what if we have to mess with kids to meet the bottom line? Heck you shouda be seeing what we do the old folks!
Is it possible the pharmaceutical companies have been the major force behind what is mostly a made-up condition? A teacher once suggested my then 10-yr.-old son had ADD and so I dutifully took him to the pediatrician who had me fill out a questionnaire; based on my answers to the vague questions which also applied to me, I should have also been given Ritalin. I got the Rx filled but he never got a chance to take it because his addict sister promptly stole his pills. I guess it worked out for everyone in the end.
Thanks to all for your comments. I'm always interested in hearing from people who have first-hand experience with these drugs.
As a general comment, I'll note that the societal consensus that existed when I was born has broken down. Public schoolteachers are on the front lines of that breakdown. I don't claim to know what to do about that. I am willing to entertain any suggestions that do not involve lying to people, and do not involve drugging children to keep them quiet.
This was incredible. A good and informed perspective... something I love to see!! Have you seen Thumbsucker??
A teacher once strongly suggested my youngest was ADD and that I seek medical "treatment" for her. While she was a bit of a handful I had no trouble with her at home nor had her previous teachers. While I understood the teacher had too many children to deal with a child who didn't pay attention I wasn't going to drug my child.

That was around the 3rd grade and she continued to struggle and her grades declined. I'd had her vision tested and it was fine, I no longer remember how but it was discovered that she did have a problem with her eyes. Again, I don't remember the diagnosis but she didn't need glasses, it involved her doing excercises with a chart to strenghthen the muscles. She simply couldn't see any of the board work well.

I was diagnosed with ADD about 9 years ago, best diagnosis I ever got! I informed everyone that I had it and now if I'm bored with a conversation or social situation I can wander off and no one is offended. I tried the Adderall (speed) but it didn't make endless business meetings or conversations about the antics of celebrities more interesting so I don't take it.

As far as my different diagnoses for bi-polar, depression, anxiety and other things for 30 years, none of the drugs ever worked, some made me feel much worse. I found that keeping mean people out of my life cheered me much more. I also ignore all TV advertising, it always makes me feel like I'm missing so much and that depresses me.

Getting enough sleep, eating well and a multivitamin work wonders. The biggest relief I've had is in taking a small melatonin supplement at night, it decreases estrogen production so I don't have severe PMS type symptoms and also reduces anxiety and depression. I did a lot of research to find out exactly what the pineal gland and melatonin does. Big pharma knows but suppresses the reports. I wish I'd known 30 years ago.

I'm enjoying your series, sorry I've only rating and not commenting.
Doris: Good for you for sticking up for your daughter.
In regard to children who disrupt the learning process, it seems to me that we must do one of three things: punish them, remove them, or drug them into submission. I'm not aware of any other alternative. If we choose the third alternative, let's at least be honest about what we are doing.

I'd like to hear from the public school teachers who deal with these matters every day. They are the ones who know most about it.

Again, thanks to everyone for reading and comenting.
This post is very true. I used to take Adderall for ADHD and, after getting tired of medicating myself, stoppped. By doing simple things like meditating and organizing, I got even BETTER grades than on Adderall.