ADHD Nation Children, Doctors, Big Pharma, and the Making of an American Epidemic

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Alan Schwarz

ADHD Nation is as important for understanding the evolution of the diagnosis and treatment of attention disorders, the role of Big Pharma, and how attention disorders have been mismanaged as are the books NeuroTribes and In a Different Key for understanding the evolution of our understanding of autism.

Alan Schwarz is an award-winning investigative journalist whose work made public the seriousness of concussions in the NFL. Like concussions in sports, the potential side-effects of ADHD medications have been largely ignored. Big Pharma and the scientists they support have been complicit in this omission.

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ADHD medications have the potential to improve attention, motivation, and energy which is not dependent on having ADHD. When used properly, the drugs can help many people and the side-effects are minimized. But the statistics make it clear that the condition is being over-diagnosed in this country. The drugs are also being used (and misused) by many high school and college students and by others who feel that they need a boost and have never been diagnosed. The causes of their problems are not being investigated nor are other possible means of treatment. Consider the following…

In the 1930s, a drug was developed with the goal of treating asthma or nasal congestion which, serendipitously, was found to make people feel good. Smith, Kline, & French “licensed it before knowing exactly what medical condition the stuff might actually treat. Finding out was a lot easier then than it is today: Lax federal regulations did not require any proof of safety, let alone efficacy, before a drug was released for public experimentation. So SKF sent boxes of what it called ‘Benzedrine sulfate’ to any doctor willing to try the drug on patients with various ills, from asthma to postpartum depression.”

Due to known problems with amphetamines, a close cousin to amphetamines was developed to have the same effects with fewer side effects. “CIBA termed the chemical formulation of this drug ‘methylphenidate’. The company released it to the American market in 1956 as Ritalin, a treatment for narcolepsy, chronic fatigue, depression, and erratic behavior caused by senility. (Again, only in adults; the medication was untested in children.)”

Dr. Keith Connors, author of the Connors Rating Scale, is the best-known researcher in the field of ADHD. “Connors needed no questionnaire to assess the effects of Ritalin on himself. Late one afternoon, following an exhausting day in the lab, he had to attend an eight-p.m. lecture by Harry Harlow, a behavioral psychologist famous for locking young monkeys away from their mothers and studying their emotional demise. Knowing he’d never stay conscious for the whole thing, Connors found the tub of Ritalin capsules so generously donated by CIBA and took one. Within thirty minutes he snapped awake and thought to himself, ‘This is fantastic!’ He kept working until eight. He skipped dinner. He zoned in on the lecture, chatted with folks afterward, and stayed up until three in the morning. Just one dose felt so beguiling, that he never tried the stuff again for the rest of his life.”

In the early 1990s, Obetrol was an amphetamine which was prescribed for weight control but it was not a financial success. After a pediatrician discovered that it worked for some children who did not respond well to Ritalin, Obetrol was remarketed as Adderall.

“Psychiatry journals teemed with more than a thousand studies on ADHD conducted by Biederman, Barkley, and other pharma-sponsored scientists. The Food and Drug Administration relied on them when green-lighting medications as safe and effective. Their findings served as the backbone for the lectures that drug companies’ key opinion leaders delivered on world tours. The whirlwind created a self-affirming circle of science, one that quashed all dissent.”

“While almost all other developed nations immediately closed the loophole that Metadate had exploited – expressly banning direct-to-consumer advertising of controlled substances, usually through legislation – the United States sat back and let the market take over. To this day, the United States is only one of two developed nations that allow advertising of ADHD medications to the general public.”

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“Appallingly, some children have heightened anxiety interpreted not as a side effect of medication, meaning the drug should be reconsidered, but a new condition needing additional treatment…. Diagnosing young children with several overlapping psychiatric conditions became de rigueur in the 2000s, resulting in what some call a ‘medication cascade’. No doctor was more responsible for the trend than Joe Biederman up at Harvard, who evaluated dozens of drugs on behalf of his Big Pharma benefactors and almost invariably declared them safe and appropriate for children with multiple diagnoses like ADHD and bipolar disorder. Yet neither he nor anyone else tested the performance or risks of these drugs in combination – no pharmaceutical company would ever sponsor such a study, considering it too risky to their product’s reputation.”             “Adderall and methylphenidate have always been among the most addictive substances in medicine. Weird as it may sound, stimulants are dangerous by being not dangerous enough – the drugs have found a sweet spot in which their advantages are more common and immediately obvious than their more latent risks, lulling all involved into complacency.”

“Today, misuse of ADHD medications by high school students is far more widespread that most anyone realizes. About a million high school kids nationwide use Adderall, Concerta, Vyvanse, and others without a doctor’s prescription, getting them either from friends or from dealers for a few dollars a pill.”

“Dozens of studies since the 1990s have estimated that about 8 to 35 percent of undergraduates take stimulant pills illicitly to try to improve their grades; a reasonable estimate among high-pressure colleges is probably 15 to 20 percent. Most students, of course, don’t experience terrible outcomes – if they did, the dangers would already be better recognized. But many do. One 2006 study found that about one in ten adolescents and young adults who misused ADHD medications became addicted to them, with some of them becoming psychotic or suicidal.”

“A different study found that teachers suspected ADHD far more often in elementary school children whose birthdays made them one of the youngest in their grade – just a tick over six, say, when the rest of their classmates were nearing seven. Therefore, many kids were being diagnosed merely because they were born in the wrong month: ‘The youngest children in fifth and eighth grades,’ it concluded starkly, ‘are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.”

ADHD Spectracell

At the end of his working career, Dr. Keith Connors sent a letter to a colleague and closed with the following: “Beware the simple & sovereign explanation.” That is good advice to all of us.

Alan Schwarz includes in the book a mock doctor/patient interview from a certified continuing education program purported to teach physicians how to diagnose ADHD. From the start of the conversation to the writing of the Rx was six minutes. Also, it was not revealed that there was a possible conflict of interest but the following was discretely printed at the end: “Supported by an independent educational grant from Shire.”

http://www.psychologytoday.com/tests/health/adhdattention-deficit-disorder-test

There are many possible causes for ADHD behaviors other than primary “brain dysfunction”. Since there is no litmus test for ADHD like blood work or imaging, ADHD is primarily a diagnosis of exclusion. Other possible causes of ADHD should be investigated and ruled out prior to considering medication. Visual problems are one of the possible causes of these signs and symptoms but so are the accelerated curriculum, fewer recesses in school, less time playing outside, more stimulation from video games, more organized activities which reduce free time, instant communication and responses, less sleep, and more pressure. Children whose problems are not primarily due to attention, may also do better with medication, but their underlying problems are not being addressed and they may be being medicated unnecessarily. “The human brain has evolved over many thousands of years, yet only in the last hundred, a blip on that time line, have we demanded that each and every young one sit still and pay attention for seven hours a day.”

MONASTRA VIDEO

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https://www.cdc.gov/ncbddd/adhd/index.html

 

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The Power of Play

David Elkind

This book addresses the concerns that many of us have about ignoring child development and the ranges of development within a grade level and even within individuals when educational standards are set. David Elkind reminds us that most children are enthusiastic learners in the appropriate circumstances but may be anxiously unsuccessful in other conditions. Continue reading

Welcome to Your Child’s Brain

IMG_4199Sandra Aamodt & Sam Wang

While Welcome to Your Child’s Brain is part of the self-help genre, it is written by two neuroscientists who bring their own research and that of others to the key questions of child development. For those who are interested in which areas of the brain are involved in different behaviors, the current research on this is presented, but effectively raising children has similarities to effectively using a computer. You need to know how the programs work. You do not need to know the inner workings of the computer. In the case of children (and other humans) we don’t need to know the areas of the brain which are involved, most of which is still poorly understood. This book, like others which I have reviewed, is a response to some of the misleading information, toys, and educational programs which are being presented to parents and it is this information which has the potential to be most beneficial. To make this as concise as possible, I will present bullets in the form of excerpts and will include page numbers if you would like to read more on any of these statements or conclusions.

The “best gift” you can give your children is self-control. Self-control and other executive functions of the brain (like working memory, flexible thinking, and resisting the temptation to go on automatic) contribute to the development of [children’s] most important basic brain function: the ability to control their own behavior in order to reach a goal.” P. xii

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It probably doesn’t matter exactly what excites your children; as long as they are intensely engaged by an activity and concentrate on it, they will be improving their ability to self-regulate and thus their prospects for the future.” P. xii

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Babies start to follow an adult’s gaze as early as four months of age. P. 7

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Being effective in the world is enormously rewarding for children and adults alike. P. 25

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One reason that people get so worked up over the nature vs. nurture debate is the widespread assumption that genetic contributions to development are deterministic, while environmental contributions are flexible… Nearly all genes that influence behavior act by changing the odds of a particular developmental outcome, not by specifying it exactly – so your child’s heredity is not destiny… Indeed, from an individual neuron’s perspective, it would be hard to distinguish between “genetic” and “environmental” influences. Signals that enter your brain through your eyes or ears (that is, via experience) influence development by causing chemical signals to modify genes or proteins – just as genetic influences do. Some of these changes are reversible, and some are not, but whether they originated inside or outside the body is not the determining factor. Pp. 32 – 33

Epigenetics is a new field which is not easy to understand. Environmental influences can determine if and when genes are expressed and some of these can even be passed on to future generations. The following excerpts relate to epigenetics.

When epigenetic modifications occur in sperm or eggs, they can affect future generations. This process is best understood in laboratory animals. For example, female mice that spent a particular two weeks of their youth in an “enriched environment” (with many toys) learned more easily as adults. And so did their pups – even when those pups were raised by a foster mother and did not receive any enrichment themselves. The pups instead benefited from their mother’s experiences passed down through epigenetic modifications to her DNA. P. 34

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To start with a basic principle, your child’s genes can influence his environment – and vice versa. His personal characteristics lead him to seek out certain experiences in life and his tendencies to react to other people in certain ways affect how they behave toward him…. Because the influences run in both directions, many developmental processes are feedback loops, in which our genes influence our environment, which then influence our genes (or at least the way they are expressed), and so on…. With all of this interaction, it is nearly impossible to figure out how much of a particular behavior is caused by genes and how much by environment. P. 35

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Sleep debt has serious consequences, including reduced mental performance, depressed mood, impaired health, and weight gain. P. 78

 

Perception of large-scale motion patterns, like raindrops seen through the windshield of a moving car, improves rapidly between three and five months and then continues to develop slowly through middle childhood. This aspect of motion processing, the most vulnerable to disruption, is impaired in some developmental disorders, including dyslexia and autism. P. 83

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Young children’s play contributes to the development of their most important basic brain function: the ability to control their own behavior in order to reach a goal. P. 112

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Preschool children’s ability to resist temptation is a much better predictor of eventual academic success than their IQ scores. P. 112

Succeeding at challenging self-control tasks builds more success, but repeated failure may instead teach the child that there’s no point in trying. P. 120

 

Active children have higher self-esteem than inactive children. P. 131

 

All of us have experienced emotions that seemed overwhelming and out of control. Imagine feeling that way much of the time, and you have a picture of your child’s daily experience. One reason that life with toddlers is such a wild ride is that the parts of the nervous system that produce raw emotions mature earlier than the brain regions that interpret and manage them. P. 155

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Until their own regulatory capacity is fully developed, your children rely on you to moderate their emotions, by soothing and distracting them, and to help them learn how it’s done. Parents who are more sensitive to their infant’s needs and respond quickly to emotional cues tend to raise children who are better at regulating their own emotions. Pp. 161 – 162

 

If your child believes that intelligence is a fixed characteristic, that belief will make her act less smart. Children who think a test measures their innate competence do not try as hard or perform as well as those who think that the effort is the major determinant of success or failure. P. 188

 

Word-form recognition is learned through experience. This capacity seems to be an example of a more general ability of the inferior temporal cortex to visually recognize objects. P. 212

 

Stress profoundly affects the developing brain. P. 224

You may not think of nagging as a way of rewarding your child for misbehaving, but even yelling can actually encourage the behavior you’re trying to stop, especially if that’s the best way for your child to get your attention. Completely ignoring the problem behavior is usually the most effective way to get it to stop – if you can stick with it long enough.

It’s common for parents to turn to yelling or spanking as their first response to problem behaviors, but a large body of research shows that this negative approach to behavior modification is not very effective in the long run. The effects of punishment are fleeting and tend not to generalize to other situations. P. 248

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So many of the things we do instinctively and many of the things promoted in our culture are correct, but many are not. Concepts of child-rearing tend to change, but children remain mostly the same as the environment changes. Due to many pressures, some of what is being done in education at this time is not in the child’s best interest nor will it produce the desired changes in a significant percent of the population. We have many new distractions with which to cope and we can’t pretend that they don’t exist. I hope that this information is helpful.

What if Everybody Understood Child Development? Part 1

Let Them Eat Dirt

Growing Up with Sensory Issues:Insider Tips from a Woman with Autism

Reclaiming Childhood:Letting Children Be Children in Our Achievement Oriented Society

Book Review: Nuture Shock: New Thinking about Children

How We Read

How We Read

Despite the continuing controversy over the best way to teach reading and over the best time to teach a child to read, a great deal is known and agreed upon about the hidden intricacies of accomplished reading. Reading may seem simple once it has been mastered, but it is amazingly complex. It is dependent on the interaction of many mechanisms which must be coordinated with precise timing. This coordination involves multiple areas of the brain. The evolutionary forces which selected for these mechanisms had their effects long before reading was invented. Areas of the brain which evolved for other purposes must be retrained and coordinated to make reading possible. While one of the functions of vision therapy is to help people develop visual skills whose visual problems make it difficult for them to read, most people learn to read without this intervention. I am more amazed that most people learn to read well than I am that some people have difficulty mastering reading. Complex systems such as reading and sending a rocket into space have multiple vulnerabilities. Prior suggestions that all reading problems have the same cause are as misguided as the assumption that all rocket failures are due to defective O-rings and that only one system can fail at a time.

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The visual process of reading is not as it seems. Our eyes do not move smoothly across the page. As with most of what we do, the process of efficient reading is controlled subconsciously and is not available for our conscious inspection. Our eyes make stops (fixations) and jumps (saccades) 4 times a second as we read. We do not take in visual information during saccades although our brain continues to process information. This phenomenon also happens every time we blink and whenever we look from one object to another. Although our visual input is discontinuous, our perception is continuous.

Frequent eye movements are necessary to gather information because we only see a very small area clearly at a time. (see Active Vision) Our eyes move from one area of interest to another area of interest as our brains construct the illusion that we are seeing everything clearly simultaneously. The clarity of our vision decreases sharply as objects are farther from the point of fixation. Only the central 5 degrees has clarity equivalent to 20/20. This correlates with 5 letter spaces. During each fixation which lasts 1/5 of a second, input takes place, new information is processed and combined with what has been read before, our attention shifts to where our eyes will move next, and we predict what the next word will be.

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When we think of vision, we think of our focal visual system; the primarily conscious component of our vision which enables us to see clearly, identify what we are seeing, localize it, and to see it in color. The ambient visual system, which works in parallel with the focal system, is primarily subconscious and outside of our voluntary control. It contributes to our balance, helps guide our eye movements, keeps our vision from smearing when our eyes move, and stabilizes our world even when we are moving or objects are moving around us. When this system is poorly developed or poorly integrated, people tend to be unaware that their perception of the world or of the printed page is different from that of others. Dysfunctions of this system become recognizable when the changes are sudden as is caused by head injuries, by excessive movement like spinning in circles, or by the ingestion too much alcohol.

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To process what we see efficiently, our eyes must be focused clearly and aligned precisely at each fixation, 4 times a second, and sustained over extended periods of time. If this alignment is off even hundredths of a degree, the information being sent to the brain will have increased ambiguity.

The connection between our eyes and our brain is different than the connections between the rest of our body and our brain. Each eye sends half of its information to each side of the brain. Everything seen to our left is sent to the right cerebral hemisphere by each eye and everything seen to our right is sent to the left cerebral hemisphere by each eye. Efficient readers land 1/3 of the way into a word so more attention is focused on the beginning of the word to facilitate word recognition. It is now recognized that this causes information from the beginning of a word to go to the right hemisphere first while information from the end of the word goes directly to the left hemisphere. The left hemisphere has the primary responsibility for interpreting language. It is not yet understood how this information is recombined in less than 1/5 of a second with information from the end of the word reaching the left hemisphere prior to information from the beginning of the word.

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When children start to read, they look at every letter and put the letters together to recognize the word. Not looking at the letters in the proper spatial sequence will make identifying the word more difficult. As the system becomes more efficient, words begin to be processed as single units. Accomplished readers process longer words at almost the same speed that they process shorter words which is known as the word length effect. But if the letters or words are too close together, neighboring letters and words start to interfere as would happen when fine black and white lines are too close together. School books and worksheets are often too crowded which creates more problems for some students than for others. Adults are not immune to this effect. (see Visual Crowding)

The average reading speed for high school students is 250 words per minute which is about 4 words per second or one word per fixation. A reasonable adult reading speed is 350 words per minute which means that we are reading 6 words a second or 6 words for each 4 fixations. We do not read faster by moving our eyes faster. We read faster by taking in more information with each fixation and by reducing the number of errors which are recorded by eye tracking instruments as retrograde saccades. Children start by reading orally and then progress to subvocalizing words as they read. Proficient readers stop subvocalizing most words and recognize the word and the word’s meaning without activating the speech areas of the brain. Persistent subvocalization constrains reading speed.

Over time we develop a sight vocabulary of thousands of words. Words are stored in what is known as the word-form area which develops in the same area of the brain that we use to store information about faces and names. The ability to visualize words enables the development of our sight vocabulary and is essential for successful spelling. When we recognize the shape of the face of someone that we know, a name should be associated with it. Likewise, when we recognize a shape in the form of a word that we know, a name should be associated with it.

What we read is primarily retained in visual images and accessed by recalling those images. As important as language is to our thinking, visual processing and recall develops before language. Visual thinking continues to be important although we may be less aware of when we are using visual processing that we are aware of using language.

When we think of reading and reading problems, we don’t tend to think of these low-level skills, but like many things that we do, it is difficult for our high-level skills to shine if we haven’t developed mastery and automaticity of the prerequisite low-level skills. This is as true of musicians, surgeons, athletes and artists as it is of readers. It should be mentioned that there are also low-level auditory processing skills that have a role in learning to read. As the visual system is sensitive to crowding in space, the auditory system is sensitive to crowding in time. Some people do not process streams of sounds as quickly as do others and coordinating what is seen and what is heard is important in the process of learning to read.

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All of this is not to disregard the importance of high-level processing.  Working memory is necessary to assimilate current input with what has just been read.  Comprehension is dependent on an adequate vocabulary and an information and experience base which enables the reader to relate what we are currently reading to our stored knowledge.  Strong language abilities form a rich foundation for reading.

A lot has been said about 10,000 hours being necessary to develop expertise in a complex skill. If a child has been reading daily from the time that they are able to read until they graduate from high school, they will have read over 10,000 hours. Barring complications, a child is expected to be a competent reader long before that time as long as they have been engaged in what they are reading and have not been reading only because they have been forced to read. (see The Talent Code)03282012Casa_hogar_niñas_tlahuac30

For more information see:

Reading in the Brain

Reading in the Brain, Part Two

What if Everybody Understood Child Development? Part 1

Visual word form area in visual cortex remembers words as pictures

Anatomy of an Epidemic:Robert Whitaker

 

 

Robert Whitaker looks at the history of the development of psychiatric drugs which is sobering. The outcomes of psychiatric care for conditions which received traditional therapy were overlooked because the treatments took such a long time. Unfortunately, this restricted view was also used when the effects of drugs for these conditions were evaluated. To put this in perspective, we need to look at the thinking at the time as would be necessary to study any event in history. At the time, lobotomies were being performed and the Nobel Prize in medicine was presented to the inventor of the procedure in 1949. Continue reading

Gut: The Inside Story of Our Body’s Most Underrated Organ

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Giulia Enders

If you are interested in the human body and interested in health, I recommend that you use the following link to watch an interview of Giulia Enders. https://www.youtube.com/watch?v=weskzCKki-s

Giulia Enders is a medical student/researcher whose writing is as careful and clear as are her responses in the interview. The book is easy to read but does not oversimplify. For those of you who have a known gut problem such as celiac disease, you may know much of this information already. I particularly recommend the book for individuals who have an undiagnosed, persistent health issue or just don’t feel as well as you think you should. (This could also be a problem for one of your children.) Gut issues are frequently overlooked, underrated, or misunderstood by the medical profession.

 

 

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The Slow Learner in the Classroom

 

Newell C. Kephart was an important figure in the perceptuo-motor school of education and remediation. While education now places less emphasis on perceptuo-motor development, other than in special populations, it is still part of how processing is viewed by psychology and optometry. Occupational therapy and physical therapy have also become involved. Continue reading