ADD & ADHD Epidemic of a Phantom Disease

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ADD & ADHD

Epidemic of a Phantom Disease

There is no proof that " attention deficits " in children are anything but

normal human variants, yet medical practitioners are labelling more and more

children with this diagnosis and giving them dangerous stimulant drugs to

control their behaviour.

 

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Extracted from Nexus Magazine, Volume 12, Number 2 (February - March 2005)

PO Box 30, Mapleton Qld 4560 Australia. editor

Telephone: +61 (0)7 5442 9280; Fax: +61 (0)7 5442 9381

From our web page at: www.nexusmagazine.com

 

by Bob Jacobs, PsyD, JD © September 2004

Email: DrBobQA

 

 

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PSYCHOLOGICAL, SOCIAL, POLITICAL AND LEGAL IMPLICATIONS

Attention Deficit Disorder (ADD) is a completely unproven and highly

questionable diagnosis, yet it is the basis for putting tens of thousands of

Australian children on dangerous stimulant drugs. ADD and its popular

sub-type Attention Deficit Hyperactivity Disorder (ADHD) were invented and

not discovered, and efforts to popularise these diagnoses are based on

politics and economics and have little to do with medicine.

 

In 21st-century Australia, when a child habitually " misbehaves " he or she is

said to have a " disease " . There are absolutely no organic or physiological

findings to substantiate the existence of any " disease " . " Symptoms " of this

" disease " include such things as standing when told to sit, fidgeting, and

not being happy about doing chores or homework. Since when did these

childhood behaviours, ranging from normal to non-compliant, become a

disease?

Anyone with a modicum of common sense can read the diagnostic criteria for

ADD or ADHD and see the absurdity of this invented " disease " . When the

medical community and the pharmaceutical companies-the chief proponents of

this disease model-admit that they don't know what " causes " this strange

disease and cannot even prove it exists, the chuckles evoked from reading

the diagnostic criteria change to gasps of disbelief. When we learn that

tens of thousands of Australian children are being drugged with powerful and

dangerous drugs based on this invented " disease " , the gasps turn to cries of

outrage.

There are vast implications in labelling children as " diseased " for

behaviour considered undesirable and then drugging them into compliance. Do

we want children growing up believing that the answer to their problems lies

in taking drugs? Do we want children learning that they are not responsible

for their own behaviours and can instead blame a mysterious " disease " ? Do we

want to allow organised psychiatry, which as recently as 25 years ago told

us that homosexuality is a " disease " , to label childhood misbehaviour as a

" disease " in the absence of any proof? Do we want a society that

pathologises non-compliance and values conformity over individuality,

creativity and free expression?

The physical safety and emotional well-being of Australia's children are

being threatened by the ADHD/ADD diagnosis and the accompanying

proliferation of stimulant drug prescriptions. A comprehensive inquiry must

go beyond the self-protective jargon of the medical/pharmaceutical community

and ensure, at the very least, that parents and children are exposed to all

sides of this controversy and given an opportunity for meaningful informed

consent before accepting this diagnosis and filling their prescriptions.

 

Key Points

.. The number of children diagnosed throughout Australia as having " ADHD " (or

" ADD " ) continues to skyrocket.

.. A significant percentage of these children are placed on stimulant

medications, which are highly dangerous drugs with significant short-term

and long-term side effects.

.. The availability of these stimulant medications represents a significant

public health threat in Australia.

.. The " ADHD " diagnosis demonstrably lacks reliability.

.. The validity of the " ADHD " diagnosis is spurious.

.. Parents and children are not given enough information to be able to give

meaningful informed consent before commencing stimulant treatment for

" ADHD " .

.. " ADHD " remains a popular and seductive concept, and in the absence of

intervention the use of the diagnosis and stimulant drugs is likely to

continue to escalate.

 

The Popularity of " ADHD "

The numbers of children diagnosed as having ADHD or ADD are staggering and

continue to increase. The popularity of the diagnosis in Australia has

resulted in more and more children receiving stimulant medications.

For years, clinicians have noted that stimulants have a paradoxical effect

on children. There have been myriad theories advanced as to the

physiological reasons for this, but none has won universal acceptance. In

the past decades the pharmaceutical industry has told us that ADHD continues

into adulthood and it has advocated the use of stimulant and stimulant-like

drugs for adults as well. This suggests that while the stimulant effect

seems " calming " , it may relate more to a form of intense focusing on one

thing (or no thing) as opposed to being aware of and involved in the various

aspects of the environment.

According to the 30 June 2002 Sydney Sun-Herald: " It is estimated that at

least 50,000 Australian children are now on these prescription drugs. " 1 The

increase has been nothing short of meteoric.

" Between 1991 and 1998, prescriptions dispensed for dexamphetamine sulphate

increased by 2400 per cent, while prescriptions for Ritalin increased by 620

per cent over the same period. " 2

" Australian consumption of dexamphetamine rose 592% between 1991 and 1995,

while consumption of methylphenidate rose 490% in the same time period. " 3

The New South Wales Commission for Children and Young People asked for

community input and heard many worried voices: " A great many submissions to

the inquiry expressed concern about the increasing use of psychotropic drugs

in children with ADD/ADHD, especially the long-term effects. " 4

The 1 July 2002 Brisbane Courier-Mail noted that, per capita, " More children

in Australia take psychotropic medication than do in the US " .5 With

estimates of the prevalence of ADHD in the United States ranging as high as

15-18% of school-age children, this trend is frightening and constitutes a

public health emergency in Australia.

 

The Dangers of Stimulant Medications

The most popular stimulant drugs used for " ADHD " -Ritalin (methylphenidate)

and dexamphetamine-are pharmacologically similar to cocaine. Just like

cocaine, these drugs have significant effects. They cause children to become

more docile and more compliant. This is true of all children, as any remnant

of the myth that only " ADHD " children react this way has long since been

dispelled. " Indeed, stimulant medications have been shown to have similar

types of effects in children with diagnosed ADHD and individuals regarded as

normal controls (Peloquin and Klorman, 1986; Rapoport, Buchsbaum and Monte,

1980; Rapoport, Buchsbaum and Zahn, 1978). These results emphasise that the

diagnosis of ADHD cannot be determined by a positive response to

medication. " 6

 

Drugged children become more docile and compliant and get into " less

trouble " , thus pleasing parents and teachers. But at what cost? Occasionally

the child pays the ultimate cost:

" Stephanie Hall, of Canton, Ohio, believed ADHD was a disease. She took her

Ritalin, religiously. Her parents, Mike and Janet Hall, believed it too.

Stephanie Hall died in her sleep, 6 days before her 12th birthday, not from

ADHD-because there is no such thing-but from Ritalin, because Ritalin is an

amphetamine and because amphetamines have a long history of causing sudden

cardiac deaths, even in the young. " 7

" Death caused from long-term use of methylphenidate (Ritalin): Death

certificate of 14 y/o Matthew Smith, 21/03/01, Oakland County, Michigan. " 8

 

In one sense, it should not be surprising that the use of psychostimulants

can be dangerous and even fatal. These drugs are among the most controlled

and restricted because of their acknowledged danger. In Queensland, as in

some other states in Australia, physicians must get approval for every

prescription they write for stimulants, and if the treatment persists beyond

two months they must provide an explanation. " Both dexamphetamine and

methylphenidate are controlled drugs under Schedule 8 of the Health (Drugs

and Poisons) Regulation 1996, and they are classified as specified condition

drugs under section 78 of the same regulations, with additional supply and

use restriction. " 9

Stimulant drugs may lead to depression and thereby might be contributory to

suicide. " The [south Australia Parliamentary] Committee was disturbed to

hear or read the examples of a number of children who had expressed suicidal

thoughts. " 10 " Suicide is a major complication of withdrawal from this

stimulant and similar amphetamine-like drugs. " 11

 

Drugs in general, and stimulants in particular, pose a significant long-term

risk with children because of their potential developmental effects. It is

intuitively obvious that powerful drugs could affect the process of growth

and development in a child, and this has been widely acknowledged in the

mainstream press, even by the American Psychiatric Association (publisher of

the Diagnostic and Statistical Manual, or DSM) itself:

" The term developmental toxicology refers to unique or especially severe

side effects caused by interaction between a drug and the process of growth

and development. Children and adolescents are growing and developing not

only physically but also cognitively and emotionally. It is important that

medications not interfere with learning in school or with the development of

social relationships within the family or with peers. " 12

Inevitably we must face the fact that if stimulants affect growth and

development, they very likely affect the developing brain:

" There is now a mountain of evidence that stimulants disrupt growth hormone

production on a daily basis and that they also can reduce the child's

overall growth, including height and weight. It is hard to imagine a more

serious warning flag than growth inhibition, since it affects the overall

growth of the body and all its organs, including the brain. " 13

" The drug commonly used to help Australian children with attention deficit

hyperactivity disorder may cause long-term changes in the brain. University

of Buffalo scientists have found that Ritalin produced changes in the brains

of rats similar to those seen with stimulants such as amphetamines and

cocaine. Study author Professor John Balzer said the findings belied the

belief that Ritalin, known generically as methylphenidate, was short-

acting. " 14

" By issuing psychotropics to children, we do in fact create an interaction

between the chemical, the drug, and the developing organism, and in

particular the developing brain, which is the target organ of a

psychotropic. " 15

" Stimulants such as Ritalin and amphetamine have grossly harmful impacts on

the brain-reducing overall blood flow, disturbing glucose metabolism, and

possibly causing permanent shrinkage or atrophy of the brain. " 16

The spectre of these negative effects on growth and development is even more

ominous in light of the fact that children under the age of six are

routinely prescribed stimulants, despite specific warnings that they are not

safe for use in children that young. There have been reports of Australian

children as young as 15 to 18 months being given prescriptions for

psychostimulants, and at the 2003 Queensland State Youth Conference in

Mackay one parent reported that her doctor suggested her nine-month-old had

" ADHD " and needed to be medicated (fortunately she refused).

Almost more frightening than the potential long-term effects of

psychostimulants is the relatively common " zombie-like " effect induced in

children. Shockingly, two of the leading biopsychiatric advocates in the

United States, L. Eugene Arnold and Peter S. Jensen, acknowledged the

" zombie effect " in their chapter on ADHD in the Comprehensive Textbook of

Psychiatry: " The amphetamine look, a pinched, somber expression, is harmless

in itself but worrisome to parents. The behavioral equivalent, the 'zombie'

constriction of affect and spontaneity, may respond to a reduction of

dosage, but sometimes necessitates a change of drug. " 17

The zombie effect has been described by Dr Peter Breggin this way: " [This]

drug-induced docile behavior is caused by chemically blunting or subduing

the child's higher brain function. That part of the child's brain requiring

creativity, freedom, play, energetic activity, consistent discipline and

inspiring educational activities will be blunted. " 18

With the skyrocketing prevalence rates of this " disorder " , there is a very

real possibility that we are raising a generation of children whose

creativity, thinking and spirit are being blunted by drugs without a

verifiable medical justification.

 

The Public Health Issue

By classifying psychostimulants as Schedule 8 drugs, the Australian

government obviously intended to restrict their availability. Yet the

proliferation of prescriptions for " ADHD " has made these psychostimulants

readily available for recreational use on school playgrounds across

Australia.

The illicit use of ADHD drugs is a major problem in Queensland, as noted by

the Crime and Misconduct Commission: " The abuse of ADHD prescription drugs

is a potential problem for society, the public health system and law

enforcement agencies. " 19

In New South Wales, " Concern was expressed, in several submissions to the

inquiry, about school children selling, swapping or sharing their

prescription drugs or medication with other children at school " .20

The International Narcotics Control Board (INCB) of the United Nations has

warned of the increasing recreational abuse of methylphenidate worldwide.21

Recreational use of psychostimulants has also been associated with other

forms of drug addiction and frequently serves as an easy " first step " into

the world of self-medicating.

" Elizabeth Wurtzel, writing in the New York Times of April 1, 2000, says

that Ritalin has been a gateway drug for many with whom she has interacted

at Narcotics Anonymous meetings, where mothers have admitted stealing

Ritalin prescribed for their kids, and discussed her own experience of

chopping up Ritalin pills and snorting them through her 'nostrils almost

continuously'. " 22

The United States Drug Enforcement Administration (DEA) has spoken about

this problem, saying that " a number of recent studies, drug abuse cases, and

trends among adolescents from various sources indicate that methylphenidate

use may be a risk factor for substance abuse " .23

Tellingly, as reported in the US press: " A recent study by researchers at

the University of California at Berkeley-a study of 500 children over 26

years-found that Ritalin is basically a 'gateway' drug to other drugs, in

particular cocaine. Lead researcher Nadine Lambert, as reported in the Wall

Street Journal, concluded that Ritalin 'makes the brain more susceptible to

the addictive power of cocaine and doubles the risk of abuse'. " 24

There is widespread acknowledgement, even among staunch advocates of the

medical model of " ADHD " , that there are other forms of " treatment "

available, such as family counselling, respite care and parenting education.

None of these modalities involves risking the physical well-being of

children. Particularly in light of a recent meta-analysis that demonstrated

there is no educational/learning benefit for children being treated with

psychostimulants,25 it is completely senseless to risk not only the

well-being of the medicated children but the health of the community of

children at large by continuing to permit the indiscriminate distribution of

these dangerous drugs.

 

Lack of Reliability of Diagnosis

The " reliability " of a diagnosis refers to the degree to which it is

dependable; that is, the degree to which we can rely on the fact that the

diagnosis will be the same regardless of who is doing the assessment or

where the assessment is being done. For example, a broken arm is diagnosed

through X-rays and there is a high likelihood that if you visited 100

orthopaedic physicians with the same X-ray, all 100 would make the same

diagnosis. " Broken arm " is a highly reliable diagnosis. In contrast, " ADHD "

is an almost completely unreliable diagnosis. " There are no objective

diagnostic criteria for ADHD-no physical symptoms, no neurological signs,

and no blood tests... No physical test can be done to verify that a child

has 'ADHD'. " 26

 

The suggestion that 100 clinicians would likely come to no consensus on a

child diagnosed by anyone as " ADHD " is borne out by the shocking differences

in international prevalence rates. " [T]he prevalence of ADHD in the UK is

generally estimated at 1% or less, whereas it is at least 10-12 times

greater than that in Australia and the US. " 27 Shockingly, this means that if

you flew 12 " ADHD " children from Perth to London and had them assessed, the

statistical likelihood is that only one would be a " confirmed " diagnosis.

Factually, then, the " disorder " is either grossly overdiagnosed in the US,

Australia and Canada, or grossly underdiagnosed in the UK (and most of the

rest of the world). In either case, it is not a diagnosis that can be

depended upon; it lacks reliability.

Even within countries, wide variations in prevalence rates preclude the

reliability of the diagnosis. For example, an analysis of the use of

stimulant drugs for ADHD in the US found that " Southern youngsters were

about 71% more likely than kids in the Northeast or West to get the drugs,

and Midwesterners were 51% more likely " .28

 

A closer look at the diagnostic criteria and an understanding of the DSM

process highlights some of the reasons for this unreliability. Laypeople

assume there is some scientific or objective process in the identification

of disorders. This is typically true in medicine, but it is often not true

in psychiatry. The American Psychiatric Association publishes the " bible " of

psychiatric diagnoses, the Diagnostic and Statistical Manual, which is

currently in its fourth edition (DSM-IV). An observer at the 1987 APA DSM

hearings made the following disturbing comment: " The low level of

intellectual effort was shocking. Diagnoses were developed by majority vote

on the level we would use to choose a restaurant. You feel like Italian, I

feel like Chinese, so let's go to the cafeteria. Then it's typed into the

computer. " A prominent American psychiatrist, a former chief of the National

Institute of Mental Health's Center for the Study of Schizophrenia, put it

this way: " DSM-IV is the fabrication upon which psychiatry seeks acceptance

by medicine in general. Insiders know it is more of a political than

scientific document. "

 

Dr Lawrence Diller, discussing the process by which the DSM-IV criteria were

decided, offers this illustration of how shockingly political the process

was. " The main study group had determined that only five of nine symptoms

would be required to qualify for a diagnosis of 'ADHD:

hyperactive/inattentive subtype' [that is, a 'combined' version of the

disorder]. But then the supervisory DSM-IV task force astonishingly

overruled this decision and increased the number of symptoms required to

six! Presumably they were concerned that five criteria were too few and

might result in too many children being diagnosed with this type of ADD, but

the arbitrariness of their action has little to do with science. " 31

In Western society, which often deifies physicians, it can be truly shocking

to people to realise that this popular psychiatric diagnosis was invented by

a group of folks sitting around the table, not by a group of scientists

discovering something in a laboratory.

 

The result of the DSM process is a diagnostic category, ADD/ADHD, which is

completely arbitrary and based solely on behaviours. The diagnostic criteria

raise obvious questions about validity (discussed in the next section), but

the description of the " symptoms " is also hopelessly subjective and

therefore inherently unreliable. In order to be diagnosed as having ADHD, a

child must have either six out of a list of nine symptoms of " inattention " ,

or six out of a list of nine symptoms of " hyperactivity-impulsivity " . The

symptoms " must have persisted for at least 6 months to a degree that is

maladaptive and inconsistent with developmental level " (italics added).

However, there is no objective guideline for assessing the requisite degree

of maladaptation; it is left to the discretion of the individual clinician.

Even more outrageous, every one of the 18 " symptoms " of ADHD is qualified by

the word " often " . What constitutes " often " fidgeting, or " often " having

difficulty organising tasks and activities? There are no objective

guidelines. To one evaluator, a child who is fidgety every day might seem

normal; but to another evaluator (perhaps a childless one), a child

fidgeting a great deal on two occasions might constitute " often " . The

reliability problems don't end there.

 

" Even aside from 'often', the rest of the definition is riddled with

ambiguous and vague terminology. Which mistakes are 'careless' ones? What

constitutes being spoken to 'directly'? What constitutes 'difficulty' in

organising things? Who decides what activities require 'sustained mental

effort'? What is 'easily' distracted? When does a small movement qualify as

a 'fidget' or a 'squirm'? Who determines when 'remaining seated is

expected'? When is running or climbing or talking 'excessive'? " 33

Some of the most mainstream US proponents of the medical model of ADHD,

believing that it is a valid medical disorder, have acknowledged the lack of

diagnostic reliability. In 1998, the National Institutes of Health held a

Consensus Development Conference on Diagnosis and Treatment of ADHD and

heard testimony from a number of " experts " , virtually all of whom supported

the medical model. At the end of the conference, panel chairman Dr David

Kupfer acknowledged that " [t]here is no current validated diagnostic

test " ,34 and another panel member noted succinctly that " the diagnosis is a

mess " .35

 

Lack of Validity of Diagnosis

The " validity " of a diagnosis refers to the extent to which it describes

something that is real and can be proved. " Despite millions of dollars spent

on research over the past twenty years, much of it subsidised by hopeful

drug companies, no one has yet been able to identify this 'disease' called

ADHD. " 36

Incredibly, there are many highly respected professionals in various fields

who publicly acknowledge that there is no proof of the existence of ADHD.

Consider the following...

.. Psychology professor Diane McGuinness, PhD: " Methodologically rigorous

research indicates that ADHD and hyperactivity as 'syndromes' simply do not

exist. " 37

.. Neurologist Fred A. Baughman, MD: " We are not mis-diagnosing or

over-diagnosing, mis-treating or over-treating ADHD. It has been a total,

100% fraud throughout its 35-year history. " 38

.. Associate Professor Robert Reid, PhD, University of Nebraska: " [T]he

causes of ADHD are simply not known. " 39

.. The Australian National Association of Practising Psychiatrists (NAPP):

" [ADHD] is not an inherited genetic disorder or organic disease " and

" scientific evidence to support ADHD as a disorder is unproven " .40

.. Psychiatrist Denis Donovan, MD: " ADD is a bogus diagnosis. Parents and

teachers are rushing like lemmings to identify a pathology... Our current

pathologizing of behavior leads to massive swelling of the ranks of the

diseased, the dysfunctional, the disordered and the disabled. " 41

.. Physician William B. Carey, MD, of the Children's Hospital of

Philadelphia: " What is now most often described as ADHD in the United States

appears to be a set of normal behavioral variations. This discrepancy leaves

the validity of the construct in doubt. " 42

.. Psychologist John Breeding, PhD: " The diagnosis of ADHD is, itself,

fraudulent. " 43

.. Tunku Varadarajan, Wall Street Journal deputy editorial features editor:

" t's just as much nonsense-on-stilts as ADHD as it was pure poppycock as

ADD. " 44

.. Author Beverly Eakman: " These drugs make children more manageable, not

necessarily better. ADHD is a phenomenon, not a 'brain disease'. Because the

diagnosis of ADHD is fraudulent, it doesn't matter whether a drug 'works'.

Children are being forced to take a drug that is stronger than cocaine for a

disease that is yet to be proven. " 45

.. Psychologist Richard DeGrandpre, PhD, citing a study in Pediatrics, a US

medical journal, showing that 80% of children reported as hyperactive at

home or school showed exemplary behaviour and no signs of hyperactivity in

the physician's office: " This finding is consistent with numerous studies

showing, and dozens of newspaper articles reporting, considerable

disagreement among parents, teachers, and clinicians about who qualifies for

a diagnosis. This can only raise questions about the existence of ADD as a

real medical phenomenon since it is these symptoms alone that are the basis

of the diagnosis. " 46

.. Psychiatrist Peter R. Breggin, MD: " It is important for the Education

Committee to understand that the ADD/ADHD diagnosis was developed

specifically for the purpose of justifying the use of drugs to subdue the

behaviors of children in the classroom. " 47

.. United States Senator Hillary Rodham Clinton: " Some of these young people

have problems that are symptoms of nothing more than childhood or

adolescence. " 48

.. Psychiatrist Sidney Walker III, MD: " The medical community has elevated

Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity

Disorder (ADHD) to the status of diagnoses, and most people believe these

are real diseases. They aren't, and doctors who label children ADD or ADHD

don't have a clue what's really ailing them. " 49

.. Educator and researcher Brenton Prosser, PhD: " The dominant definition of

the condition argues that it is physiologically based and is best treated

with amphetamines, while there remains no biological basis for these

claims. " 50

.. The 1998 Consensus Development Conference, held by the US National

Institutes of Health, came to this conclusion: " [W]e do not have an

independent, valid test for ADHD, and there are no data to indicate that

ADHD is due to a brain malfunction. " 51

The question remains as to why practitioners and the public alike refer to

" ADHD " as a demonstrable disorder, when there is ample evidence that it is

not. This phenomenon was explained by Dr John Jureidini, head of the

Department of Psychological Medicine at the Women's and Children's Hospital,

Adelaide, South Australia, in response to a question by a parliamentary

commission:

" There is monumental literature that takes as a given that ADHD is a

neurobiological condition and starts from there to talk about different

forms of treatment. Once you have many thousands of articles published about

something, how can it possibly make sense for someone to stand up and say

'This is not an entity'? I want to emphasise that I quite clearly

acknowledge that there are children who are very compromised because of

difficulties with impulsiveness, attention and activity. I am not saying

that these children are not suffering or are not worthy of attention. I am

saying that, as a disorder, ADHD is a spurious entity. " 52

In distinguishing between literal and metaphorical diseases, American

psychiatrist Thomas Szasz notes: " [T]he suggestion that, say, AIDS and

ADHD...are radically different kinds of diseases-or, more precisely, that

the latter is not a disease at all-is politically so incorrect that it is

dismissed out of hand. " 53

Proponents of the biomedical model of ADHD are fond of saying that they

believe we are on the brink of discovering an aetiology; discovering that

" ADHD " actually exists. But they have been saying the same thing for over 20

years. The fact remains that, in scientific terms, there is no validity to

the construct of a " disease " called ADHD.

The Lack of Informed Consent

There is no more fundamental human right than the right to bodily integrity.

A hallmark of most legal systems is that innocent people are protected from

anything happening to their own body without their consent. According to an

article in the DePaul Journal of Health Care Law: " [T]rue consent to what ha

ppens to one's self is the informed exercise of choice, and that entails an

opportunity to evaluate knowledgeably the options available and the risks

attendant upon each. " 54

The issue of consent to health care of young people was the subject of a

major 1996 report issued by the Queensland Law Reform Commission.55 It has

also been identified by representatives of various organisations as a major

issue throughout Australia:

" The Commissioner for Children and Young People advised the committee that

issues of confidentiality and consent to health care of young people were

major concerns raised by representatives of more than thirty youth and

health-related organisations at a National Youth Health Summit organised by

the Australian Medical Association held in Canberra in July 2001. " 56

Consent without information is no consent at all, and parents who are told

their child has " ADHD " are virtually never told of the lack of scientific

reliability or validity to the diagnosis. Typically they are not told that

there is no organic or physiological finding associated with the diagnosis,

nor are they told that no one has been able even to demonstrate that " ADHD "

exists. Parents are also often not told about the dangers of

psychostimulants. Australian common law, international law (particularly the

United Nations Convention on the Rights of the Child, to which Australia is

a signatory) and a basic sense of human decency demand that any individual

has a right to consent to an invasion of their personal/physical integrity.

Children are almost never given an opportunity to give consent to treatment

with psychostimulants, nor are they privy to the debate that rages in the

professional community about this diagnosis. This egregious violation of a

basic human right would not be tolerated were it done directly, but in the

guise of " helpful medical care " it becomes more elusive and difficult to

combat.

Why Is ADHD Diagnosis So Popular?

The rise in the number of children diagnosed in Australia with ADHD over the

past 25 years has been nothing short of astronomical. Given the acknowledged

lack of a known aetiology or organic/biological marker for ADHD, the

question remains as to why this diagnosis is so popular. There are four

primary " constituencies " for whom the ADHD diagnosis has been an economic,

practical and emotional godsend.

1) The Drug Companies. The market for stimulant medication specifically to

treat ADHD exceeds US$600 million annually in the United States alone! With

this sort of profit motive, it is not surprising that major pharmaceutical

companies have been outspoken proponents of psychiatric diagnoses in general

and ADHD in particular.

Novartis Pharmaceuticals-which held the original patent on methylphenidate

(Ritalin), the most popular US drug for ADHD-has advertised extensively in

both professional journals and popular media, with ads in the latter aimed

specifically at convincing parents that their child might benefit from using

stimulants. Novartis has also been a generous financial supporter of

Children and Adults with Attention Deficit Disorder (CHADD), the national

parent support group for ADHD.

Perhaps most troubling is the concern expressed by a University of Michigan

neuroscientist and Professor Emeritus of Psychology: " I am convinced that

the pharmaceutical industry spends enormous amounts of money to increase its

sales and profits by influencing physicians and the public in ways that

sometimes bend the truth and that are often not in the best interests of

science or the public. " 57

2) The Physicians. The primary reason that physicians are seduced by the

idea of ADHD as a biomedical entity is that they desire to be helpful to

their patients. Their entire training and perspective is steeped in the

" medical model " : a patient comes to see them with a symptom and they

diagnose and treat it. If ADHD does not exist, and the behaviours are either

part of the range of normal childhood experience or reflective of some

dysfunctional environment, the medical practitioner is helpless. Plus, as

we'll see in a moment, the stimulant drugs they can prescribe do produce the

desired effect for parents and teachers, so physicians are positively

reinforced by their patients (or at least their patients' parents) for being

helpful.

At the same time, it would be naïve to overlook the profit motive in this

part of the equation. American psychiatrist Peter Breggin noted: " Biological

interest groups have been pressing for decades to capture the child market

for drugs and for their professional services. " 58

Tunku Varadarajan of the Wall Street Journal wrote: " For psychiatrists to

receive payments from health insurance companies, they must find a way to

label a patient with a recognised condition-which is why they recognise

more, and more, and more conditions. Wait for the next DSM, and there will

be at least another 50 conditions added to the existing list. " 59

3) The Parents. The strongest force in popularising the ADHD diagnosis (and

the use of stimulant drugs) has been parents. Without a " market " , the ADHD

phenomenon would have died in its tracks. Parent support groups, such as

CHADD, vehemently deny any implication that ADHD is anything but a " real "

disorder, and many parents cite the diagnosis and the prescription for

stimulants as having been a miracle for their child and for their family.

The seductiveness of the diagnosis for parents is readily seen by anyone who

has worked clinically with families experiencing behaviour problems with a

child.

In Western society there is an implication that if your child is

misbehaving, then you are an inadequate parent. If your child is constantly

misbehaving around other people or " getting into trouble " at school, there

is an unspoken assumption that you are unable or unwilling to discipline

properly. The idea of a disease afflicting these children and causing their

misbehaviour is emotionally perfect for some parents, as they can go

instantly from being under suspicion of inadequate parenting to being

martyrs, struggling to cope with a sick child. Instead of going to family

therapy and learning how they might understand why their child is really

misbehaving or what they could do about it, they can go to support groups

and receive positive strokes and sympathy for having been dealt such a cruel

biological hand.

The seduction is complete with the introduction of stimulant medication.

Studies are conclusive that stimulants cause all children-whether they have

" behaviour problems " or otherwise-to become more compliant and docile.

Obviously, parents who are troubled by their children's " misbehaviour " will

be pleased as their kids become more obedient. No more social embarrassment,

no more calls from the school. No wonder so many parents seek the ADHD

diagnosis-and swear by it.

4) The Schools. It is a fact of modern society that many public schools are

overcrowded and underfunded. Teachers often have to deal with 30, 35 and

more students in their class as they try bravely to provide a decent

education. When a particular student is a distraction or disruption, the

teacher understandably wants the distraction to cease. When other parents

are complaining to the school administration about the misbehaving child,

the administration wants the misbehaviour controlled. If the misbehaving

child can be " diagnosed " and drugged, the classroom and the school will run

more smoothly. This dynamic has been so powerful that several US states have

had to pass legislation prohibiting non-medical school personnel from

diagnosing children and suggesting medication.

With all these powerful forces combined as not-so-strange bedfellows, it

becomes very clear why ADHD has become an " epidemic " in Australia. It is a

complete circle, too, because when the diagnosis is made and the child is

drugged, everyone is happy. The drug company has another sale, the physician

has another customer, the parent is vindicated and the school loses a

behaviour problem. Everyone is happy except the child, and the child has no

voice.

Recommendations

(Note: These are adapted from Queensland Children At Risk: The Overdiagnosis

of " ADHD " and the Overuse of Stimulant Medication.60)

Clinicians, educators and researchers sometimes tend to equivocate and

" sugar coat " in an effort to sound really " professional " . When our

children's physical health and emotional well-being are in danger, it is

time to be very direct. It is time to " cut to the chase " , look at the facts

and tell the truth.

.. We are giving powerful and dangerous drugs to children for a " disorder "

that has never been shown to exist.

.. We are allowing pre-schoolers to be drugged with stimulants, despite the

fact that these are not recommended for use in children under six and

despite the fact that no one knows the potential long-term damage.

.. We are allowing such a proliferation of stimulants that these drugs are

also being sold and shared by children like candy.

.. We are exposing our children to these dangerous drugs despite evidence

that they have no positive effect and only " work " by creating more obedient

and docile children.

.. We are failing to provide parents with the information they need to be

able to give meaningful informed consent, and we are failing to give

competent children any information so they may do the same-in violation of

ethical medical practice, the common law and international law.

There is very little that everyone can agree upon in the controversial area

of ADHD, but most would agree that further research needs to be done. At

this point there are too many unknowns, and anyone who claims there is

" proof " is not telling the truth.

It is bad science to attempt to treat something before we know what it is.

Given the acknowledged dangers of stimulant drugs to children, families and

society, it is common sense to stop using these drugs until we have

identified what, if anything, ADHD really is. We need to:

1) Declare a moratorium on stimulant use until such time as researchers are

able to identify a specific organic aetiology for ADHD, show that stimulants

are effective in remediating the discovered pathology and show that

stimulants are safe for growing children to use in the long term. At the

very least, call for an immediate moratorium on the use of stimulant drugs

in children under six.

2) Ensure that parents and children are fully informed of both sides of the

ADHD debate, and require that they both sign meaningful informed consents

before receiving any stimulant drugs.

3) Require a review by a child guidance professional prior to beginning any

child on medication, and require reasonable trials with other suggested

interventions prior to initiating the use of stimulant drugs.

Putting the clamps on the runaway ADHD train will not be popular with

parents who in large numbers rely on stimulants to control their children

and absolve themselves of guilt or responsibility at the same time. It will

not be popular with teachers who rely on stimulants to subdue difficult

children in the classroom. It will not be popular with children's physicians

who may not know any other way of being helpful in these situations besides

offering stimulant drugs for behaviour control. It will certainly not be

popular with the drug companies, which will see any open and honest

discussion as a potential threat to their billion-dollar golden goose.

This submission is a plea to all concerned individuals to take a hard and an

honest look at a controversial issue. It is a plea to protect our children,

who cannot protect themselves from these harmful and needless labels and

drugs. Finally, it is a plea to celebrate the creativity, spontaneity and

energy of childhood and to embrace the unique beauty of every child. ?

About the Author:

Dr Bob Jacobs has been a children's advocate for over 30 years as teacher,

counsellor, psychologist and attorney. He has a PsyD degree from United

States International University and a JD degree from the University of

Florida. Among many other activities and roles, Dr Jacobs is presently an

Equal Justice Works Fellow and is on the national steering committee for the

Children's Rights Network of Amnesty International, USA. His article is

based on research he conducted in 2002 in association with the Youth Affairs

Network of Queensland (see website http://www.yanq.org.au), as well as on

his extensive experience. Dr Jacobs can be contacted by email at

DrBobQA.

Endnotes

1. Psychologist Rosemary Boon, quoted in " 50,000 hyperactive children on

pills " , The Sun-Herald, Sydney, June 30, 2002, p. 10.

2. Mackey, P. and Kopras, A., " Medication for Attention

Deficit/Hyperactivity Disorder (ADHD): An Analysis by Federal Electorate " ,

Parliament of Australia, Current Issues Briefs 11, 2000-2001, April 3, 2001,

p. 2.

3. Shaw, Mitchell and Hilton, " Are stimulants addictive in children? " ,

Australian Family Physician, vol. 29, no. 12, December 2000.

4. New South Wales Commission for Children and Young People, Issue Paper No.

5, 2002, p. 6.

5. Ryan, Siobhain, " Australian kids first in mind medicine " , The

Courier-Mail, Brisbane, July 1, 2002, p. 5.

6. National Health and Medical Research Council (NHMRC), " Attention Deficit

Hyperactivity Disorder " , 4.1, 1997.

7. Baughman Jr, Fred A., MD, The ADHD Consensus Conference: End of the

Epidemic.

8. Smith, Lawrence and Parent, " Ritalin prescription takes life of

14-year-old " , available at http://www. rense.com/general25/14.htm (last

visited 05/07/02).

9. " Is Drugging Children the Answer? " , Media Release, Youth Affairs Network

of Queensland, July 1, 2002, at http://www.yanq.org.au/.

10. Parliament of South Australia, Inquiry Into Attention Deficit

Hyperactivity Disorder, Sixteenth Report of the Social Development

Committee, January 10, 2002.

11. " ADHD " Facts, available at http://www.fightforkids.com/adhd_facts.htm

(last visited July 5, 2002).

12. Dulcan, M. (1994) Treatment of Children and Adolescents " , in R.E. Hales,

S.C. Yudofsky and J.A. Talbot (eds), The American Psychiatric Press Textbook

of Psychiatry, American Psychiatric Association Press, Washington, DC, 1994,

2nd edition, pp. 1209-1250.

13. Breggin, Peter R., Talking Back to Ritalin, 1998, p. 25.

14. The Courier-Mail, Brisbane, November 13, 2001, p. 3.

15. Benedetto Vitiello, at National Institutes of Mental Health (NIMH) and

Food and Drug Administration (FDA) joint conference on future testing and

use of psychotropic drugs in children, 1995.

16. Breggin, supra note 13, p. 54.

17. Arnold, L. Eugene and Jensen, Peter S., MD, in Comprehensive Textbook of

Psychiatry, 1995.

18. Breggin, Peter R., MD, " Upcoming Government Conference on ADHD and

Psychostimulants Asks the Wrong Questions " , available at

http://www.breggin.com/consensuswrong.html (last visited July 5, 2002).

19. Crime and Misconduct Commission (CMC), " The Illicit Market for ADHD

Prescription Drugs in Queensland " , Crime Bulletin Series, no. 4, April 2002,

p. 2.

20. New South Wales Commission for Children and Young People, Issue Paper

No. 3, 2002, p. 6.

21. CMC, " The Illicit Market for ADHD Prescription Drugs in Queensland " ,

ibid., p. 3.

22. USA Today Magazine, March 2001.

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Paper) " , Drug and Chemical Evaluation Section, Office of Diversion Control,

DEA, US Department of Justice, Washington, DC, October 1995.

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25. Purdie, N., Hattie, J. and Carroll, A., " A Review of the Research on

Interventions for Attention Deficit Hyperactivity Disorder: What Works

Best? " , Review of Educational Research, Spring 2002.

26. Breggin, Talking Back to Ritalin, ibid., pp. 141-142.

27. Jacobs, Bob, " Queensland Children At Risk: The Over Diagnosis of 'ADHD'

and the Overuse of Stimulant Medication " , Youth Affairs Network of

Queensland, August 2002, available at

http://www.yanq.org.au/pdfs/Queensland%20Children%20at%20Risk%20Web%20version.pd\

f.

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February 4, 2003.

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Ritalin: The Truth Behind ADHD " , available at

http://www.ritalindeath.com/Page/Contro4/html (accessed June 7, 2002).

30. Loren Mosher quoted in " Death from Ritalin: The Truth Behind ADHD " ,

available at http://www.ritalindeath.com/Page/ Contro4/html (accessed June

7, 2002).

31. Diller, Lawrence, Running on Ritalin, Bantam, 1998, p. 60.

32. Diagnostic and Statistical Manual, 4th edition, 1994.

33. Jacobs, supra note 27, p. 16.

34. Kupfer, David J., NIH Consensus Conference on Diagnosis and Treatment of

ADHD, November 16-19, 1998.

35. Vonnegut, Mark, NIH Consensus Conference on Diagnosis and Treatment of

ADHD, November 16-19, 1998.

36. Jacobs, Bob, " Australian Children at Risk " , Law and Policy Journal of

the National Children's and Youth Law Centre 6, September 2002, Article 13,

p. 7.

37. McGuinness, Diane, " Attention deficit disorder: The emperor's new

clothes, animal 'pharm', and other fiction " , in S. Fisher and R.P. Greenberg

(eds.), The Limits of Biological Treatments for Psychological Distress,

Lawrence Erlbaum Associates, Hillsdale, NJ, 1989, pp. 151-188.

38. Baughman, Fred A., " The Totality of the ADD/ADHD Fraud " , available at

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39. Robert Reid, Oral Testimony to the South Australia Parliamentary

Committee Inquiry into Attention Deficit Hyperactivity Disorder, Hansard,

June 21, 2001, p. 9.

40. Gil Anaf, Oral Testimony to the South Australia Parliamentary Committee

Inquiry into Attention Deficit Hyperactivity Disorder, Hansard, August 24,

2001, p. 61.

41. Denis Donovan, quoted in " ADHD " Facts, available at

http://www.fightforkids.com/adhd_facts.htm (accessed May 7, 2002).

42. Carey, William B., National Institutes of Health Consensus Conference on

ADHD, November 16-18, 1998.

43. Breeding, John, " Does ADHD Even Exist? The Ritalin Sham " , Mothering,

July 2000, available at http://www.wildcolts.com (accessed May 7, 2002).

44. Varadarajan, Tunku, " Shrinking to Excess: I'll be damned if I let a

psychiatrist near my son' " , The Wall Street Journal, August 21, 2001.

45. Eakman, Beverly, quoted in " ADHD " Facts at

http://www.fightforkids.com/adhd_facts.htm (accessed 07/05/02).

46. DeGrandpre, Richard, from Ritalin Nation (Norton, 2000), quoted in

" ADHD " Facts, available at http://www.fightforkids.com/adhd_facts.htm

(accessed 07/05/02).

47. Breggin, Peter R., Testimony before Subcommittee on Oversight and

Investigations, Committee on Education and the Workforce, US House of

Representatives, September 29, 2000.

48. Rodham Clinton, Hillary, in USA Today Magazine, March, 2001.

49. Walker III, Stanley, quoted in " Death from Ritalin: The Truth Behind

ADHD " , available at http://www.ritalindeath.com/Page/Control.html (accessed

07/05/02).

50. Prosser, Brenton, " Hearing Silenced Voices: using narrative research

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August 1998, available at

http://www.users.senet.com.au/~tolls/rants/hearingsilenced.htm (accessed

07/03/02).

51. National Institutes of Health Consensus Development Conference on ADHD,

Final Statement, November, 18, 1998.

52. John Jureidini, Oral Testimony to the South Australia Parliamentary

Committee's Inquiry into Attention Deficit Hyperactivity Disorder, Hansard,

September 21, 2001, p. 119.

53. Szasz, Thomas, Pharmacracy: Medicine and Politics in America, Praeger,

2001, p. xxiv.

54. Baker, J., " Tardive Dyskinesia: Reducing Medical Malpractice Exposure

Through a Risk-Benefit Analysis " , DePaul Journal of Health Care Law, 1997.

55. Queensland Law Reform Commission, Consent to Health Care of Young

People, Volume Three: Summary of the Commission's Report, Report No. 51,

December 1996.

56. New South Wales Commission for Children and Young People, " Inquiry Into

The Use of Prescription Drugs and Over-the-Counter Medications in Children

and Young People " , Issue Paper No. 1: Background Issues, 2002, p. 15.

57. Elliot Vanetin quoted in " Death from Ritalin: The Truth Behind ADHD " ,

available at http://www.ritalindeath.com/Page/Contro6.html (accessed July 5,

2002).

58. Breggin, supra note 13, p. 176.

59. Varadarjin, supra note 44.

60. Jacobs, " Queensland Children At Risk " , supra note 27.

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