Attention deficit hyperactivity disorder controversies

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PET scans measure the activity of various parts of the brain. The image on the left illustrates areas of activity in the brain of a person without ADHD while doing an assigned task. The image on the right illustrates the areas of activity of the brain of someone with ADHD when given that same task. There is some controversy over the meaning of the research by Dr. Alan Zametkin that produced these images; the statistical findings visually demonstrated here were found to be the result of sampling error. The adults in these studies were in most cases severely dysfunctional.[1]

Attention-deficit hyperactivity disorder (ADHD) holds the distinction of being one of the most controversial pediatric disorders.[2] It is a controversial disorder despite being a well validated clinical diagnosis.[3] Claims that the diagnosis and treatment of the disorder deserve greater scrutiny are made by some news sources, social critics, religions, and medical professionals.[4] The "Every Child Matters" websites states that ADHD is a "controversial diagnosis". [5] . Ethical and legal issues with regard to treatment have been key areas of concern for these critics. [3]

While stimulant medications are widely considered safe when used as prescribed, critics point to the the UN's International Narcotics Control Board issued warnings in 1996 and the dramatically increased use of methylphenidate at that time in the United States although the use of medication has since leveled off.[6] There was also concern in 1996 that the use of Ritalin was being actively promoted by an influential parent association, which had received significant financial contributions from the preparation's leading United States manufacturer. [7]

These critics contend that ADHD can be better explained by other theories such as the Hunter vs. farmer theory. Other critics such as those critics who believe in the social construct theory of ADHD disagree over the cause of ADHD, question research methodologies[8] are skeptical toward its classification as a mental disorder,[9] and wonder about the effects of diagnosis on the mental state of patients.[10][11] Critics point to changing standards of diagnosis, such as the American Academy of Pediatrics (AAP) issuing a more careful set of standards in 2000 to aid clinicians than merely using DSM-IV.[12] Certain religions and groups, especially Scientology also hold viewpoints about the disorder. Scientologists are against almost all aspects of psychiatric practice, and are highly skeptical that the diagnosis denotes a genuine impairment. Conversely, those critical of Scientology believe that much of the controversy generated about ADHD is manufactured.

Concerns about medication

Ritalin 10mg Pill (Ciba/Novartis)
Main article: Attention-deficit hyperactivity disorder treatments

The National Institute of Mental Health states that, "stimulant drugs, when used with medical supervision, are usually considered quite safe".[13] Some parents and professionals have raised questions about the side effects of drugs and their long term use.[14] Safety of stimulants has not been determined beyond two years.[15] On February 9, 2006, the U.S. Food and Drug Administration voted to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat attention deficit–hyperactivity disorder (ADHD).[16]

There are concerns that medication is sometimes resold by patients as a recreational drug and that it is used as a study aid by some students without ADHD.[17]

Concerns over funding of ADHD doctors and lobby groups

In 2008 it was revealed that Dr. Joseph Biederman of Harvard, failed to report to Harvard that he had received 1.6 million dollars from drug companies between 2000 and 2007.[18] E. Fuller Torrey, executive director of the Stanley Medical Research Institute which finances psychiatric studies, said “In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.”[19]

Concerns about methods of diagnosis

Much of their criticism does not reject the concept of ADHD as a valid disorder, but alleges that children with problematic behaviour are often diagnosed with ADHD when the cause of the behaviour may be from another source. Majority scientific opinion believes in the validity of the diagnosis and does not believe that the rate of error in the diagnosis is a major concern[citation needed]. Social critics[who?] state that these children may often have different more complex problems or that their problems are caused by their diet or environment. They state that some children diagnosed with ADHD, or labelled ADHD by parents or teachers, are normal but don't behave in the way that responsible adults want them to behave. Social critics make the connection between the extra funding some schools receive for children with ADHD and the increase in the diagnosis[citation needed].

There is no brain scan. There is no blood test that definitively says who has ADD [or ADHD] and who doesn't...The decision where to draw the line between abnormal and normal variance of behavior is an arbitrary one.

— Dr. Lawrence Diller, http://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/diller.html

Media coverage of ADHD controversies

The media have reported on various ADHD controversies and on the views of individuals and organisations who have controversial opinions.

In 2001 PBS's Frontline ran a five-part TV series entitled "Medicating kids".[20] The program included a selection of interviews with representatives of various points of view. In one segment, entitled backlash, retired neurologist Fred Baughman and Peter Breggin, founder of the 'International Center for the Study of Psychiatry and Psychology', who PBS described as "outspoken critics who insist [ADHD is] a fraud perpetrated by the psychiatric and pharmaceutical industries on families anxious to understand their childrens' behavior,"[21] were interviewed on the legitimacy of the disorder. Russell Barkley and Xavier Castellanos, then head of ADHD research at the National Institute of Mental Health (NIMH), defended the viability of the disorder. In Castellanos's interview he stated how little is scientifically understood.[22] Lawrence Diller was interviewed on the business of ADHD along with a representative from Shire Plc.

A number of notable individuals have given controversial opinions on ADHD. Scientologist Tom Cruise's interview with Matt Lauer was widely watched by the public. In this interview he spoke about postpartum depression and also referred to Ritalin and Adderall as being "street drugs" rather than as ADHD medication. In England Baroness Susan Greenfield, a leading neuroscientist,[23] wanted a wide-ranging inquiry in the House of Lords into the dramatic increase in the diagnosis of ADHD in the UK and possible causes[24] following a 2007 BBC Panorama programme which highlighted US research (The Multimodal Treatment Study of Children with ADHD by the University of Buffalo showing treatment results of 600) suggesting drugs are no better than therapy for ADHD in the long-term. Other notable individuals such as Terence Kealey, a clinical biochemist, has given a controversial opinion outside of their field of expertise. He believes ADHD medication is used to control unruly boys' behaviour.[25] Newspaper columnists such as Benedict Carey have also written controversial articles on ADHD.[26][27]

Portrayal of ADHD in popular media

In popular non-news media ADHD, and similar diagnoses like ADD and Oppositional Defiant Disorder are often portrayed as 'psychobabble' euphemisms for children who simply misbehave. For example a Southpark episode featuring children becoming zombielike after easily getting themselves misdiagnosed with ADHD, and an advert for a 'brand new' ADHD cure which turns out to be discipline.

Religious and Social critics

According to an article in the Los Angeles Times, "the uproar over Ritalin was triggered almost single-handedly by the Scientology movement."[28] The Citizens Commission on Human Rights, an anti-psychiatry group formed by Scientologists in 1969, conducted a major campaign against Ritalin in the 1980s and lobbied Congress for an investigation of Ritalin.[28]. Scientology publications identified the "real target of the campaign" as "the psychiatric profession itself" and claimed the campaign "brought wide acceptance of the fact that (the commission) [sic] and the Scientologists are the ones effectively doing something about [...] psychiatric drugging".[28] Scientology states "the controversy over the many deaths and irreversible damage caused by psychiatric drugs prescribed for children labeled with... ADHD continues to grow".[29] The church contends that mental disorders are a "fraud"[30], "mental and behavioral problems are largely incorrect diagnoses that cover symptoms and don't handle the real problems, which may be physical or spiritual".[31]

Members of the Anti-Psychiatry movement such as Fred Baughman and Peter Breggin[32][33][34][35] have extensively used the popular media to criticize ADHD and medications used for ADHD. They have also testified at Congressional hearings on the use of Ritalin and supported legal challenges such as the Ritalin class action lawsuits. Both doctors had associations with Scientology in the past but neither belongs to the church.[36][37][38][39][40][41] There is an antipsychiatry movement that often refers to their writings, but in contrast to scientolgists, they are not "anti-psychiatry," but critics of some of its practices.

See also

Notes

  1. ^ http://goldbamboo.com/topic-t1093-a1-6Attention_Deficit_Disorder_with_Hyperactivity.html
  2. ^ Mayes R, Bagwell C, Erkulwater J (2008). "ADHD and the rise in stimulant use among children". Harv Rev Psychiatry. 16 (3): 151–66. doi:10.1080/10673220802167782. PMID 18569037.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ a b Attention deficit hyperactivity disorder: legal and ethical aspects - Foreman 91 (2): 192 - Archives of Disease in Childhood
  4. ^ http://news.bbc.co.uk/1/low/health/7093944.stm
  5. ^ everychildmatters.gov.uk
  6. ^ PBS - frontline: medicating kids: backlash: united nations' warnings on ritalin
  7. ^ PBS - frontline: medicating kids: backlash: united nations' warnings on ritalin
  8. ^ http://www.psychminded.co.uk/news/news2006/feb06/Disordered%20thinking.htm Comment by James, Adam, “Disordered thinking?” Psychminded 14 Feb. 2006.
  9. ^ name="Tim&Rad">Timimi, Sami & Radcliffe, Nick. “The Rise and Rise of ADHD.” Making and Breaking Children's Lives. Ed. Craig Newnes. Ross-on-Wye: PCCS Books, 2005. 63-70.
  10. ^ name="Tim&Rad"
  11. ^ Article for Ethical Human Sciences and Services
  12. ^ PBS - frontline: medicating kids: adhd: american academy of pediatrics' guidelines
  13. ^ NIMH · ADHD · The Treatment of ADHD
  14. ^ Lakhan SE; Hagger-Johnson G. http://www.cpementalhealth.com/content/3/1/21 The impact of prescribed psychotropics on youth. Clinical Practice and Epidemiology in Mental Health 2007;3(21).
  15. ^ "What is the evidence for using CNS stimulants to treat ADHD in children?". March - May 2008. Retrieved 2008-09-10. {{cite web}}: Check date values in: |date= (help)
  16. ^ Nissen SE (2006). "ADHD drugs and cardiovascular risk". N. Engl. J. Med. 354 (14): 1445–8. doi:10.1056/NEJMp068049. PMID 16549404. {{cite journal}}: Unknown parameter |month= ignored (help)
  17. ^ CNN.com - Health - Ritalin abuse scoring high on college illegal drug circuit - January 8, 2001
  18. ^ Researchers Fail to Reveal Full Drug Pay - NYTimes.com
  19. ^ Researchers Fail to Reveal Full Drug Pay - NYTimes.com
  20. ^ http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/ Medicating Kids
  21. ^ PBS - frontline: medicating kids: opponents and backlash
  22. ^ PBS - frontline: medicating kids: interviews: xavier castellanos, m.d
  23. ^ Baroness Susan Greenfield
  24. ^ BBC NEWS | Health | Peer calls for ADHD care review
  25. ^ Boisterous boys are too much like hard work, so we drug them into conformity | Terence Kealey - Times Online
  26. ^ Parenting as Therapy for Child's Mental Disorders - New York Times
  27. ^ What’s Wrong With a Child? Psychiatrists Often Disagree - New York Times
  28. ^ a b c Sappell, Joel (1990-06-29). "Suits, Protests Fuel a Campaign Against Psychiatry". Los Angeles Times. p. A48:1. Retrieved 2006-11-29. {{cite news}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Backup copy link here
  29. ^ Real-Life Horrors Fuel Growing Outrage Over Deadly ADHD Drugs
  30. ^ Scientology's war on psychiatry - Salon.com
  31. ^ http://deseretnews.com/article/1,5143,595091823,00.html?pg=3
  32. ^ Talking Back to Ritalin-New Breggin Book Excerpts
  33. ^ An Anti-Psychiatry Reading List
  34. ^ Online Dictionary of Mental Health
  35. ^ TOC - Antipsychiatry Reading Room
  36. ^ Kurt Cobain - Citizens Commission on Human Rights
  37. ^ Psychiatric Drugs
  38. ^ Error
  39. ^ Why are Scientologists opposed to the use of Ritalin? The President of the Church of Scientology Answers Your Questions
  40. ^ Ritalin Information: Side Effects, Cautions, Alternatives, ADD, ADHD
  41. ^ The Child Protection Racket; Freedom Magazine

Further reading

  • Armstrong, Thomas "The Myth of the A.D.D. Child. 50 Ways to Improve your Child's Behavior and Attention Span Without Drugs, Labels or Coercion. (1995) New York: Penguin Group.

External links

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