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

Thinking Goes to School:Piaget’s Theory in Practice

Hans G. Furth and Harry Wachs

There has always been a temptation to ignore the influence of child development. Development takes time; not everyone develops at the same rate; and all areas may not develop on the same schedule within one individual. There is an increased temptation to ignore development when there is pressure to push students to meet short-term academic goals. Continue reading

Visual Intelligence

 

Sharpen Your Perception, Change Your Life

Amy E. Herman

The title of this book is an obvious draw for me. The draw is even greater since the author is a lawyer and an art historian, not an optometrist or vision scientist. Amy Herman successfully trains the visual perception of professionals around the country to improve their ability to make critical decisions. Continue reading

Reclaiming Conversation

Sherry Turkle

Conversation is becoming a lost art, particularly in the younger generations who primarily use electronic connections instead of face-to-face conversation. In Reclaiming Conversation Sherry Turkle explores what we lose when we substitute texting for talking. The constant distraction of electronic interruptions, or even just having a smart phone nearby, compromises sustained attention and the quiet which is necessary to think, plan, solve problems and to be creative. mediakids Continue reading

The Importance of Being Little

 

What Preschoolers Really Need from Grownups

Erika Christakis

Ericka Christakis is well-qualified to write on this topic. She currently is an early childhood educator at the Yale Child Study Center, her undergraduate degree is in anthropology from Harvard College, she has been a pre-school teacher, and she has experienced the challenges of trying to be the best parent she can be. Like many parts of contemporary American life, much of education has become caught in the faster is better/more is better trap while ignoring that effective learning is interactive. It is based on relationships, communication, guiding children’s natural curiosity, stimulating playful learning experiences, and time. In the author’s own words… Continue reading