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Does ADHD Actually Exist?

 
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tatee View Drop Down
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    Posted: Mar 17 2014 at 7:12am

Doctor: ADHD Does Not Exist

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Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children—and now adults—who can't live without stimulants is no solution.

This Wednesday, an article in the New York Times reported that between 2008 and 2012 the number of adults taking medications for ADHD has increased by 53%, and that in the case of young American adults, it has nearly doubled. While this is a staggering statistic, and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over the course of my 50-year-long career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school and at work, and diagnosing themselves with “ADHD.”

And why shouldn’t they?

If someone finds it difficult to pay attention or feels somewhat hyperactive, “Attention-deficit and Hyperactivity Disorder” has those symptoms right there in its name. It’s an easy, catch-all phrase, which saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. But what I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the DSM and as it exists in the public imagination — does not exist.

Allow me to explain what I mean.

Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention-deficit hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery the medical community began labeling children exhibiting these symptoms as having “minimal brain dysfunction,” or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the Diagnostic and Statistical Manual of Mental Disorders, or DSM, changed the label numerous times, from “hyperkinetic reaction of childhood” (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition), to the current label ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.

Today, the fifth edition of the DSM only requires one to fulfill five of eighteen possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list yet, look it up. It will probably bother you. How many of us can claim we have difficulty with organization, or a tendency to lose things; that we are frequently forgetful, distracted, or fail to pay close attention to details? Under this subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts, it’s a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive compulsive disorder, and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

“What’s so bad about stimulants?” you might be wondering. They seem to help a lot of people, don’t they? The aforementioned article in the Times mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.

Firstly, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; big pharma is understandably not as concerned.

Secondly, there are many side-effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are consequences that are even less well-known. For example, many patients who are on stimulants report having erectile dysfunction when they are on the medication.

Thirdly, stimulants work for many people in the short-term, but in cases where there is an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are the former, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cellphone use while they’re working, and most importantly, do something they’re passionate about. As with many children who act out because they are not being challenged enough in the classroom, adults who have work or class subjects that are not personally fulfilling, or who don’t engage in a meaningful hobby, will understandably become bored, depressed, and distracted. Similarly, today’s standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living long-term.

For my second group of patients, who have severe attention issues, I make them undergo a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.

It’s time to rethink our understanding of this condition, offer more thorough diagnostic work, and help people get the right treatment for attention deficit and hyperactivity.

Dr. Richard Saul is a Behavioral Neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is published by HarperCollins.

http://time.com/25370/doctor-adhd-does-not-exist/

read more

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/experts/exist.html

http://www.nytimes.com/2014/03/12/us/report-says-medication-use-is-rising-for-adults-with-attention-disorder.html?_r=1

http://ac360.blogs.cnn.com/2013/04/01/cdc-data-shows-increase-in-kids-with-adhd/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+rss%2Fcnn_ac360blog+%28Blog%3A+AC360%29

http://www.drugfree.org/wp-content/uploads/2013/04/PATS-2012-KEY-FINDINGS.pdf

http://www.samhsa.gov/data/2k13/dawn073/sr073-add-adhd-medications.htm







Edited by tatee - Mar 17 2014 at 7:19am
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JamCaygirl View Drop Down
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Post Options Post Options   Thanks (2) Thanks(2)   Quote JamCaygirl Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 7:36am
I personally don't believe it exists to the extent people claim.... stop feeding kids so much sugar and starch and watch the change in their behaviour.....

I do however believe that children born addicted to drugs as their mothers were drug addicts do exhibit certain behavioural problems which ticks ADHD boxes. My family has worked with a number of these children  from newborn to teenagers and it is heartbreaking the lingering effects of having been born a drug baby....


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Post Options Post Options   Thanks (1) Thanks(1)   Quote iliveforbhm Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 7:57am
Yeah in the same breath as Santa Claus and the Easter bunny. It's more deficiency in vitamins and other nutrients and too much sugar. That's the problem, not drugging the kids up.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Sang Froid Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 8:04am
Originally posted by JamCaygirl JamCaygirl wrote:

I personally don't believe it exists to the extent people claim.... stop feeding kids so much sugar and starch and watch the change in their behaviour.....

I do however believe that children born addicted to drugs as their mothers were drug addicts do exhibit certain behavioural problems which ticks ADHD boxes. My family has worked with a number of these children  from newborn to teenagers and it is heartbreaking the lingering effects of having been born a drug baby....



They just need a lil' weed.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote niecy Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 8:54am
Originally posted by JamCaygirl JamCaygirl wrote:

I personally don't believe it exists to the extent people claim.... stop feeding kids so much sugar and starch and watch the change in their behaviour.....

I do however believe that children born addicted to drugs as their mothers were drug addicts do exhibit certain behavioural problems which ticks ADHD boxes. My family has worked with a number of these children  from newborn to teenagers and it is heartbreaking the lingering effects of having been born a drug baby....



Basically. 

I've always seen ADHD, along with a few other disorders/medical issues, as just an excuse to prescribe some unnecessary medicine to people when really the probably could be fixed by doing other things that dont require medication.


Edited by niecy - Mar 17 2014 at 8:54am
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Post Options Post Options   Thanks (5) Thanks(5)   Quote nekamarie83 Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 9:29am
It exists, just not to the ridiculous extent that people are diagnosing it. Sometimes it's diet, lack of discipline or… kids being kids. Personally, I think many parents (legit diagnosis or not) use it an excuse to not do their jobs as parents.They will be quick to phone it in and say "well you know ____ is ADHD" (not has ADHD-- but that's another discussion) and medicate (and/or get a disability check). Then their kids carry that excuse with them as to why they act xyz or do abc without even attempting to change/regulate/work with their behavior.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote iliveforbhm Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 9:59am
Originally posted by nekamarie83 nekamarie83 wrote:

It exists, just not to the ridiculous extent that people are diagnosing it. Sometimes it's diet, lack of discipline or… kids being kids. Personally, I think many parents (legit diagnosis or not) use it an excuse to not do their jobs as parents.They will be quick to phone it in and say "well you know ____ is ADHD" (not has ADHD-- but that's another discussion) and medicate (and/or get a disability check). Then their kids carry that excuse with them as to why they act xyz or do abc without even attempting to change/regulate/work with their behavior.
 
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Post Options Post Options   Thanks (9) Thanks(9)   Quote Samoneisthebest Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 10:29am
This is like saying depression doesn't exist because everybody gets sad and the medication can be addictive.

Bipolar disorder doesn't exist because everybody has conflicting personalities sometimes.

The symptoms in the DSM just need to be more lucid and specific. Either way, We don't go to doctors for them to just look up something in a book and tell us what they read. We expect them to be able to be incisive enough to determine what is really going on.

When I was diagnosed with ADHD my doctor explained to me that the description in the DSM was broad and could describe a number of disorders. She went on to get more detailed information about me and my history in order to determine what was really going on. I was 21, not a "bad" child who just needed discipline nor a drug addict looking for a fix.


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Post Options Post Options   Thanks (8) Thanks(8)   Quote Samoneisthebest Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 10:43am
I also want to add that medicating yourself is totally voluntary. I do not take medication on a regular basis.

There are indeed alternative ways to treating ADHD like diet changes and time management classes, but this does not "cure" anything.; it only helps to manage it. ADHD is genetic and is not something that you can "cure" nor grow out of or in to.
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Post Options Post Options   Thanks (2) Thanks(2)   Quote reesegurl11 Quote  Post ReplyReply Direct Link To This Post Posted: Mar 17 2014 at 10:56am
I was going to type up a whole bunch of stuff but I decided not to and instead I just thanked Samone instead. I will say that until you have a child who has been diagnosed with ADD or ADHD than you have no idea. My cousin was diagnosed with ADHD and I don't believe he had it his mother was just lazy and never let him out to play. But my son has been diagnosed with ADD after 3yrs of me being in denial and trying everything to help him not need meds. His dad has it as well and I believe that the medication I was on to keep him from being born early has a LOT to do with the problems I have with him. Either way I do any and everything I can to help him and unfortunately I do have to give him a small dose of meds right now and even though his teacher keeps trying to get me to give him higher dosage I will NOT do it.
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