ADHD Maligned and Misunderstood

[Marciosos7 Probertiosos8]

"Jan" <jdrew...@aol.com> wrote in message
news:20031218224830...@mb-m15.aol.com...
> http://www.drhull.com/EncyMaster/A/ADHD.html
>
> ADHD - maligned and misunderstood
> Note: The format of this article is different because of its length. It
was
> designed specifically to be printed out.
>
> The topics of attention deficit disorder, circumcision, family bed, and
breast
> feeding must be in constant competition for generating the most passionate
> debate and often the least thoughtful comments among parents.
Unfortunately,
> the passionate dogmatism of True Believers obscures the reality that:
> medical knowledge is uncertain and changeable
> children and families are almost infinitely variable
> even scientists working in a rigorously controlled manner face almost
> insurmountable difficulties trying to explain human behavior
>
> I do not hold myself out as an expert on ADHD, rather as a reformed
sceptic1

I hope Jan took the time to read and understand the note of the good doctor.
He used his PERSONAL EXPERIENCE to change his beleifs about ADHD and learned
that it does exist, and that medication is the best treatment. read note 1
for details.

> who came to realise the extent of suffering this problem causes children
and
> their parents, and who wants in some way to help and comfort them.

I sure hope that Jan Drew read this and understands that her attitude is
exactly the opposite.

The
> following essay is presented in the spirit of giving you my personal views
on
> the subject of school attention problems and some idea of my approach to
the
> whole question of ADHD, whatever that might be. I do this with
reservation,
> because of the guarantee of, shall I say, displeasing some significant
segment
> of the population, but I do it anyway because many very good parents are
> confused by the jargon and frightened at the apparent implications of this
> "diagnosis2."
>
>
> Definition of terms
> I am going to discuss
> attention problems in a general way and of whatever cause, which I will
> designate simply as "attention problems"
> and dwell mostly on attention problems caused by factors which are, as far
as
> we know, intrinsic to the child and of neurological basis - which I will
> abbreviate ADHD

Thus, the doctor accepts that ADHD is caused to some degree by a
physiological problem. I wonder iof Jan Drew undertstood this.

> Some observers refine the term into Attention Deficit Disorder without
> Hyperactivty (ICD9 code 314.0) and ADD with Hyperactivity (ICD9 code
314.1). I
> think for this discussion we could just agree that some kids with
attention
> difficulties in school are just more squirmy and disruptive than others.
There
> are the daydreamers, and then there are the boisterous seat jumpers. That
is
> enough to know, and enough to give practical help. Specialists in ADHD
> treatment try to classify more precisely to aid selecting treatments. We
must
> also remember that not every child with attention problems in school has
ADHD.
>
> Our friend, the popular press
> The first difficulty parents face is that this topic is much in the
popular
> press. If there ever was a topic about which a little knowledge is a
dangerous
> thing, this is it. I suspect most parents have seen or heard of Oprah
Winfrey
> Show-style horror stories about the evils of Ritalin®. They have heard the
> sober pronouncements of "experts" who remind us that
> other countries have a much lower incidence of diagnosed ADHD (there, the
kids
> are just given a good caning and sent off to bed without supper...)
> there is a 20:1 male:female ratio, proving a conspiracy against boys
> greedy doctors and drug companies are in collusion to manufacture a phony
> disease and provide a phony cure for profit
> America's youth is being drugged into a zombie-like state (as if TV should
cast
> stones...)
> the medications have terrible side effects; what conscientious physician
would
> prescribe them and what loving parent would allow their use?
> and as Yul Brynner said in The King and I: "et cetera, et cetera, et
cetera..."

Again, I hope that Jan sees herself in this paragraph. She is a purveyor of
the popular press, and regurgitates every negative story about ADHD and its
treatment.

> Horror stories
> Well, first off, is there anything to the horror stories? You betcha.
There are
> a half-million plus physicians in the United States. At any given moment,
a few
> of them are incompetent, drunkards, or insane. Surprise. It is always
possible
> to find cases of incompetence, stupidity, or abuse where patients are
badly
> mistreated; where children are given ridiculous overdoses of medication,
where
> clear side-effects are ignored with permanent consequences.
>
> It is also possible to find ignorance, avarice, stupidity and malice in
every
> other profession. Yes, insane judges sentence people to crazy sentences.
Cops
> violate citizens rights egregiously. Priests have sex with parishioners or
> worse, their parishioners' children. That is the real world. Thank
goodness
> these are rare exceptions and not the rule.
>
> However, parents of children with attention problems don't have the luxury
that
> Oprah or Sally Jesse have. They cannot be content with clucking and
tut-tutting
> about these bloody-shirt cases. They need help for their children.

And, regurgitating them to the degree that is doen, by the popular press and
Jan Drew makes it even more difficult for the parents who have to deal with
this difficult problem.

> The problem at first blush
> Parents in my practice are usually greatly distressed when the teacher
raises
> the issue of their child's apparent attention problem in her class. The
shoe
> may drop in kindergarten, when the child (almost always a boy) is rated as
> being immature for the grade level. Perhaps the issue is raised in a later
> primary grade. In any event, this verdict, delivered by an educational
> professional and usually reinforced by the parents' own observations and
> concerns, is typically a very troubling one. This is especially so for
today's
> parents, living as they do in a world of Parents Magazine articles and
Oprah
> show horror stories.
>
> Because the male predominance issue is often mentioned to buttress
> conspiracy-theory arguments, I want to discuss it at this point. It is
> important for parents to begin with some feeling that there are two sides
to
> the coin, that perhaps there is a less sinister explanation and perhaps
even
> some hope for their child.
>
> The male predominance problem
> Why does this problem seem to affect mainly boys? There are a number of
> possible explanations:
>
> it is a sex-linked trait on the X chromosome; there is certainly evidence
for a
> genetic basis for attention problems, or at least the observation that
they run
> in families
> boys are rambunctious and fidgety by nature
> school is boring - boys just want to have fun
> boys are less mature upon school entry than girls - of course the lack of
> maturity is defined because boys act as if they are less interested in
> book-learning. The definition is somewhat circular.
> boys are rowdy in class because they orient more toward male authority
figures
> than females. Schools are run by and large by women.
> All of these (or none of these) factors may play a part in the observed
20:1
> ratio in boys over girls of identified ADHD. This great male preponderance
is
> often cited as evidence that ADHD is a phony diagnosis, and a conspiracy
of
> doctors and teachers against little boys. This argument, while pleasing to
> some, has no real weight. No one questions the fact that breast cancer has
such
> a great predominance in women, even though males have breasts, too. That
males
> so vastly outnumber females with identified ADHD can either be read as a
> conspiracy against boys or an intrinsic, genetic trait which would
according to
> this observed distribution have to be associated with the sex chromosomes,
> specifically the X chromosome. Either explanation "works" after a fashion,
but
> there is no way to my knowledge to totally refute either hypothesis, and
the
> second explanation makes a lot more sense to calm observers. In any event,
boys
> apparently have much more trouble with this phenomenon than girls, but
girls
> certainly can have significant attention problems as well. Some
authorities now
> believe that girls have basically the same incidence of attention deficit
as
> boys, as opposed to the observable lower incidence of identified
hyperactivity
> in girls. The girls do not get noticed while they quietly daydream, or
their
> fidgety behavior is written off to tomboyishness. So the male
preponderance
> problem may be an illusion.
>
> The nail that sticks up gets hammered down
> Just to remind ourselves why we should bother with this whole exercise at
all,
> let us consider what happens to a child who has attention problems and
begins
> to have "trouble in school." What we mean by that is that the teacher is
> constantly having to "get Johnny back on task." She seats him
preferentially by
> her desk so that she can observe and correct him even more easily. The
child
> realises he is different from the other children, and the other children
> certainly know it as well. Johnny gets a number of bad messages about
himself
> each and every day at school:
>
> you are different
> you are stupid
> you are naughty
>
> Now, I am not a big proponent of the self-esteem is everything movement. I
> would rather children develop more self-respect (character) and a shade
less
> self-esteem (pride). But I think we can all agree that this is not an
optimal
> school environment for Johnny to learn.
>
> Johnny's options are few if he does not get some help. What seems to
happen is
> that he eventually more or less gives up on that school thing. If he
cannot
> compete with the other kids, why bother? Sooner or later, a permanent
distaste
> for the pursuits of the mind is engraved upon his psyche. Lacking the
> competitive edge of education, and having been convinced of his outsider
> status, he will likely carry a legacy of his school troubles into
adulthood.

Jan, this is truly insightful of the doctor. He is describing, here, the
roots of the problems that cause addiction, delinquency, etc. By your
denying the condition exists, and by your steadfast refusal to recognize
that medication is helpful in treatment, you are dooming these children.

> So the stakes are high. What could be the cause of this troubling
phenomenon?
> Why your child?
>
> What is not the cause
> Before discussing the cause of ADHD, let me briefly reassure you what it
is
> not:
>
> it is not "minimal brain dysfunction" or "minimal brain damage." In other
> words, ADHD is not a sort of low grade cerebral palsy. These old terms
have
> been discarded because there is no scientific basis for them. They were
> guesses, and now are old and quite out of fashion guesses at that. Your
child's
> Apgar score really has nothing to do with it.
> it is not the product of too much TV. While watching a lot of TV may
indeed
> shorten attention spans - this does not explain why the majority of
children
> watch just as many episodes of Power Rangers and still pay attention in
school.
> it is not caused by anything the parents, especially the mother, did or
did not
> do during pregnancy with the documented exceptions of heavy alcohol and
drug
> abuse, and the possible exception of heavy smoking.
> it is not the product of any particular parenting style. "Why, if you
would
> just..." Children with ADHD are products of all types of parenting styles,
and
> parents of children with attention problems usually try all the different
sorts
> of parenting styles in a futile attempt to manage the problem behavioraly.
If
> that worked, we would certainly know it; it doesn't.

Jan, to good doctor heartily disagrees with your claims regarding the cause
of ADHD being bad parents.

> ADHD is situational
> Remember that attention problems are basically situational. For example,
no kid
> has trouble paying attention while he is watching Jurassic Park and the
ripples
> form in the water-filled dinosaur track. But plenty of adults doze and
fidget
> during a boring sermon on Sunday morning. Not every teacher is the kind of
> spark plug who can ignite a class to constant interest, and multiplication
is
> rather dull.
>
> The cause of ADHD - the common sense explanation
> This is the easy and reassuring part to explain. If your child has been
> diagnosed with the dread ADHD, I hope you feel better by the time you read
the
> end of this section.
>
> Imagine that we staged a footrace for one hundred children from your
child's
> grade at school. We line them up at a line we have marked on the field,
give
> the starting signal, and let them race to the finish line we have provided
on
> the playground. We time each student's performance, having motivated them
for
> maximal performance with promises of a party at the end of the school day
if
> they all try their best.
>
> You know already what we will observe when we plot each child's time on a
> graph. The students will be distributed in a more or less "normal"
distribution
> (the technical term) - the fabled "bell curve" to all us ex-students.
>
> Or perhaps we choose to measure the children"s musical ability and devise
some
> test of memory of musical pitches. We again generate some numerical score
which
> we plot on a chart, and again, the bell curve distribution of scores.
>
> For each ability of these children that we measure we will produce a new
and
> different sorting out of abilities. We will always find that some are very
good
> at the task, some are very poor, and the majority are about average.
> Conceptually, this is nothing new for teachers or for most parents, for
that
> matter.
>
> Now I have a surprise for you. The same thing holds, believe it or not,
for the
> ability to pay attention. Children differ in their ability to pay
attention to
> things that are basically boring. The typical classroom can certainly fill
the
> bill in that regard from time to time.
>
> If we do some sort of objective and repeatable measure of the ability to
pay
> attention with our group of school children, again plotting the results on
a
> graph as we did for running ability and musical pitch, we will again
generate
> our old friend the bell curve. But now we are shocked to find that there
are
> children who are - believe it or not - below average in the ability to
attend
> to boring tasks. Some are even quite a bit below average; in fact, we know
a
> few of them already - they are having problems in school.
>
> Let us examine our graph of the childrens' ability to pay attention. Mass
> standardized education programs such as those in which your children are
> enrolled are designed to educate - more or less effectively - those
children in
> the middle part of the curve.
>
> Of course, children who can pay much better attention that average are
never a
> problem. They do well in school and get nothing but praise. It is those
> children whose ability to pay attention for whatever reason lies in the
shaded
> area to the left that have trouble in school.
>
>
> The role of medication
> For the average child with ADHD - a significant, innate inability to pay
> attention as well as other children in the class - the most effective
treatment
> is medication. A recent large multicenter study of ADHD3 found that, like
it or
> not, the alternatives to medication just do not work.

IOW, there are no alternative treatments, no supplements, no diets, no
nothing...other than medication.

Psychobehavioral
> interventions alone do not have any real benefit, and psychobehavioral
> interventions in combination with medication are no better than medication
> alone. This comes as no surprise to me, but I was gratified to see a
reputable
> research team confirm what I have observed in the practical arena for
years. So
> parents have to make a choice: go with medication, try behavior
modification
> techniques that are known to be largely a waste of time, or do nothing.

Jan's position regarding treatment is tantamount to doing nothing.

> The most commonly used medications for attention problems are generally in
the
> chemical class of stimulants. They are in the same family as lowly
caffeine -
> coffee. For the same reason that adults consume mass quantities of coffee
to
> stay sharp enough to work - kids may need help staying focused at school.
It
> really is that simple.

I suspect that Jan will not understand this.

> It was thought for years (back in the "minimal brain dysfunction" days)
that
> children with ADHD had strange brains that reacted "paradoxically" to
stimulant
> medications (the reverse of the expected effect). Actually, everybody
reacts
> about the same to the medication. The medications stimulate any brain to
focus
> better, as demonstrated by standardized tests meant to measure that
ability.
> This better concentration reduces the fidgeting that "hyper" kids
demonstrate
> and the distractibility of attention impaired children - the daydreamers.
>
> So what the medication really does is to move everybody to the right on
the
> attention curve so that those kids who were functioning poorly now lie
more in
> the normal range of attention ability.

This is a wonderful explanation of the situation.

> The medications simply improve the ability to concentrate and focus,
shifting
> the poor attention kids up into the range of normal school function. To
repeat,
> they have the same effect on everyone who takes them; people with good
> attending ability don't need help and so don't take these medications. I
think
> it is important for every parent to understand this basic fact. There is
> nothing "weird" about your child, nor anything to be ashamed of, any more
than
> you would be ashamed if he were a lousy singer.

Lousy singing is not associated with ADHD. At my cousin's daughter wedding
my son sang 'Music of the Night" from _Phantom of the Opera_ withthe band
accompanying him. My cousin said, "Gee, I did not know he could sing so
beautifully." My comment was: "Neither did I." (It was one of their two
wedding songs, and was the intro to the wedding video. What a wonderful
gift.)

> What about the side effects?
> The side affects of the major medications used for ADHD are those of
stimulants
> in general:
>
> sleep disturbance
> evening wakefulness - staying up too late
> nightmares
> appetite disturbance - poor lunchtime appetite (usually compensated for at
> supper)
> growth disturbance - temporary reduction in the rate of height gain while
on
> high doses of medication - probably reversible and perhaps related to
appetite
> suppression
> neurological disturbance
> tics - involuntary facial movements or vocalizations
> Tourette syndrome, discussed under tics
> mood disturbance - either depressive feelings when the medication wears
off, or
> a general feeling of strangeness - "dysphoria"
> And of course there are others, that are more rare. Obviously, any time a
child
> taking any medication exhibits symptoms or behavior that strike the
parents as
> significantly different, the child's physician should be notified
immediately.
> That is common sense for every medication, and especially for any type of
> neurological medication.

Good advice.

> Be aware that there are some other medications used for either extreme
> hyperactivity, or concomitant mood and personality disorders that I won't
> include in this very general discussion. These situations lie beyond the
scope
> of this discussion of the much more common manifestations of ADHD.
> Are the medications addicting?
> Not for your child. Taken properly for school problems, they do not create
any
> sort of long-term dependency and addiction. It is possible to abuse these
> medications, and they can cause addiction - in addicts. There is more to
> addiction than to take a potentially addictive substance. This is not a
> reasonable worry for parents.

Wow. Now who has been saying just this? Moi! Jan will disagree.

> Well, does taking the medications lead to addiction to other substances?
We
> just cannot answer that definitively (or at least I cannot). However,
research
> has suggested strongly that untreated ADHD kids left to struggle through
the
> educational system without effective help have a higher incidence of
addiction
> problems in adulthood. This really only makes sense. They have a higher
than
> average incidence of other problems, as well - probably related to years
of
> negative messages and academic underachieving. To restate what is a basic
> premise of mine: I think it is more reasonable to worry about what the
likely
> outcome is for your child if you do not do something effective to help him
(or
> her) adapt better to his or her school situation.

Most insightful.

> Will my child be on medication forever?
> Not likely. Most children with attention problems seem to improve with age
and
> stop using medication by high school. Some need it right through college.
> Humans are adaptable creatures, and children can learn over time how to
> compensate for their lower ability to concentrate in the school arena.
Those
> who lie just a little out of the normal range can learn to cope, and will
not
> need help once relieved of the task of school. It is a fact that some
adults
> are treated for ADD symptoms; this question is out of my range of
expertise and
> not germaine to the discussion. I think it is reasonable to expect the
> condition could continue to trouble at least some adults enough to warrant
> treatment. After all, what is so magic about turnign 21 years old? It is
still
> the same body, just bigger and older. Often a parent realizes and reports
once
> his child is diagnosed and helped that he himself suffered with exactly
the
> same symptoms all through childhood, and may still experience difficulties
as
> an adult.
>
>
> --------------------------------------------------------------------------
> ------
> 1 Yes, when I started in pediatrics (back during the Coolidge
Administration) I
> was sceptical about ADHD in general. I knew all the arguments listed above
and
> then some. I would not write Ritalin® prescriptions. I had all the
answers - so
> I thought. Ah, but Experience is such a stern and relentless teacher. The
day
> came when I could no longer ignore the real and dramatic benefits - the
> happiness and relief - that treatment gave many of my patients and their
> families. So I changed my mind.
> --------------------------------------------------------------------------
> ------
> 2 The task of understanding exactly what is meant by the concept of
> "diagnosis"is difficult at best. Apparently, the human mind automatically
> labels and categorizes everything it encounters, in an attempt to make
sense
> out of the confusing jumble of sensory inputs that existence affords
> when we encounter something new, we see if it seems to fit some category
with
> which we are already familiar (and perhaps think we understand)
> we tend to attempt to apply a label as part of this process
> the label or the category we choose then tends to greatly influence if not
> totally determine how we regard this item in the future
> So if we see a child having an apparent attention problem at school - not
> fitting in - we are prone to comprehend this problem as a variation of
> something we are familiar with - that is, for which we have a pre-existing
> category. This includes ADHD or attention problems in general -see ADHD
mimics.
>
> Since almost every Western industrial parent accepts to "greater or even
> greater" degree the nurture assumption, it is easy for us to slip this
problem
> right into the category of "disorders of faulty upbringing," enjoy a quick
> resolution of our uncertainty, and best of all have at our disposal a
number of
> pre-conceived solutions to "share."
>
> If as a lay person you find these distinctions confusing, take heart that
they
> are a pitfall for physicians as well. What I am driving at here is that
putting
> a name on something and thinking we understand that thing can mislead us
> dreadfully. Of all the "diseases" of mankind, perhaps the most devastating
is
> "hardening of the categories."
>
> Those interested in further consideration of the problems that arise when
we
> fall into the trap of thinking that naming an idea or concept makes the
idea or
> concept into a real thing - so-called reification (RAY-if-uh-CAY-shun) -
should
> read some of the works of Thomas Szasz, M.D., a psychiatrist who has
written
> extensively on this topic.
>
>
> --------------------------------------------------------------------------
> ------
> 3 The National Institute of Mental Health and Department of Education
> multicenter collaborative study of ADHD, presented to the American Academy
of
> Child and Adolescent Psychiatry in late 1998.
>
>
> As usual, I am ready to discuss the article with anyone who is civil and
> constructive. But it is of course yet another no flames topic.

Agreed. however, Jan killfiles anyone who does not want to put up with her
antics who wants to seriously discuss a topic like this with her.

I know, I will email this to Jan.

I hope others repost it, and also email it to her.