Growing Concerns about ADHD

Does this child have ADHD?

In the U.S. today an estimated 25 million people may have Attention-Deficit Hyperactivity Disorder or ADHD.  The now household term brings up images of loud uncontrollable children who struggle to learn and who lack the ability to sit still.  In this article I’d like to talk a little bit about what ADHD is, what it is not, and what every parent, teacher, and physician should know about it.

ADHD is a highly controversial disorder.  There is wide disagreement on whether it exists at all and if it does what we should do about it.  What is known and generally agreed upon is that some children do have trouble keeping still and paying attention in class and that these children often seem to also have trouble organizing their own work.  Proponents of ADHD believe that many students with these issues can be diagnosed with a disorder which is considered at least partially genetic.  The prevailing treatment recommendations for ADHD are prescription stimulants such as amphetamines like Adderall or methylphenidates like Ritalin.  Because these types of drugs are controlled, both in the United States and internationally, for their potentially harmful effects and addictive nature, their use on children contribute to the controversy surrounding the disorder.

Critics of ADHD, on the other hand, generally suggest that these symptoms could be the result of any number of other things.  Some suggest that many of the symptoms can be caused by simple normal genetic variance in the human population.  Some children have high energy personalities, or just a low IQ, and there is no reason to medicate them for it.  One theory in this category has been promoted by talk radio host Thom Hartmann.  The theory goes that, in the nomadic history of the human race, some high energy genes became preferable and thus more common.  Since humans became farmers, and eventually industrial-computer using-farmers, these genes and the traits associated with them have become more and more of a nuisance.

Another group of critics believe that ADHD has no genetic basis at all and is primarily caused social and environmental factors.  This view puts the blame on the modern lifestyle and its effects on the family and social lives of children.  In the last 30-40 years children have spent less and less time interacting with parents and more time in structured environments such as daycare, school, after school programs, and organized sports, or even just sitting in front of the tube or computer.  Growing up in such families has lead many young people to question the authority of adults or simply act out in an effort to get more attention.  Other critiques from the environmental side blame diet.  ADHD symptoms have been directly linked to food coloring, and an exciting new study shows that supplementing a child’s diet with Omega 6 & 3 fatty acids can bring about a 25% reduction in symptoms.  Although sugar, a long time suspect, does not seem to directly cause symptoms, the idea that a high sugar diet lacking other foods rich in vitamins and nutrients, especially proteins, is causing a lot ADHD is becoming more popular.

Critics of all stripes agree that, whatever is happening in the lives of these children, medication is not the answer.  The stimulant medications used to treat ADHD could be very dangerous, but we don’t know.  Some studies show that ADHD meds do not improve children’s academic scores and stunt growth.  Drugs in this category, like Adderall or Ritalin, may be addictive, or even cause cancer.  Since there has never been a long term study on the health effects of these medications it is impossible to tell what could result from eight or even twelve years of use.  These concerns have lead the UK’s National Institute for Health and Clinical Excellence to recommend that medications be used only as a last resort.

The American Academy of Pediatrics recommends the use of therapy and stimulant medications, with periodic follow up visits to ensure the patient is progressing well, however Congressman Dan Burton suggests the reality is a bit different:

“When you take your child to a doctor, instead of blood tests and a thorough medical evaluation, you have a conversation with a doctor about the school’s checklist. And you leave a few minutes later with a prescription for your young child for a psychotropic drug.”

The congressman is certainly right about one thing.  If you bring your child to the doctor for ADHD, she won’t run any tests, because there is no scientific way to see if a child has the disorder or not.

It seems clear that something doesn’t add up here.  An unheard of, and undiagnosable, psychological condition comes to light and thirty years later millions of children have been diagnosed.  If ADHD is such an immense issue why wasn’t it discovered earlier? How could so many children be found to be sick with a psychological condition that is undefinable scientifically?

Dr. John Breeding, author of The Wildest Colts Make the Best Horses, believes that the answer lies in the pharmaceutical industry which has great economic interest riding on ADHD.  Breeding has been ringing alarms since the mid 1990s, but the news went national this past summer when Harvard professor Dr. Joseph Biederman was exposed for failing to report at least $1.6 million dollars from the pharmaceutical industry and associated lobby groups.  Biederman has authored hundreds of papers on ADHD and was considered among the world’s foremost experts on the matter.  His work helped ADHD’s expansion through America’s homes and classrooms but it was all bought and paid for.  So, for now, it seems, the jury is still out on ADHD’s existence and its implications.