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18 September 2012, 6.38am EST

Moving the diagnostic goalposts: medicalising ADHD

OVER-DIAGNOSIS EPIDEMIC – Today, Rae Thomas looks at the growing prevalence of attention deficit hyperactivity disorder. Does your five-year-old have difficulty sustaining attention? What about organising tasks or waiting her turn? How was she as a four-year-old? These are three of the 18 criteria…

9f9z44sz-1347846658 — Not asking critical diagnostic questions is one of the causes ofthe high prevalence rates for ADHD. Jeff Meyer

OVER-DIAGNOSIS EPIDEMIC – Today, Rae Thomas looks at the growing prevalence of attention deficit hyperactivity disorder.

Does your five-year-old have difficulty sustaining attention? What about organising tasks or waiting her turn? How was she as a four-year-old? These are three of the 18 criteria (here’s the whole lot) used to differentiate children with attention deficit hyperactivity disorder (ADHD).

There are other questions, such as how often does your child do this? Does it impact him socially or academically? Who is reporting such behaviour? These are critical diagnostic questions that can differentiate problematic and normal behaviour. But they’re not always asked.

And not asking these questions results in two outcomes – the medicalisation of normal behaviour and high prevalence rates for attention deficit hyperactivity disorder.

A childhood epidemic

Childhood mental illness has been described as the leading cause of childhood disability in the United States. And attention deficit hyperactivity disorder is one of the most widely-cited and controversial of all disorders routinely diagnosed in childhood.

But why has there been such a large increase in children diagnosed with mental health problems? Are we now better able to identify problem behaviour, or are the definitions of mental health diagnoses simply getting wider?

The lack of objective tests for ADHD make it easy to change definitions of the disorder. www.shutterstock.com

Let me be clear from the outset. I’m a psychologist with over 20 years’ experience working with children with very challenging behaviours and their parents in tertiary facilities. I have seen children diagnosed with attention deficit hyperactivity disorder who have truly benefited from the diagnosis, subsequent medication and psychological intervention.

But I have also seen many children with ADHD symptoms, diagnosed with the illness and medicated to assist with behaviour management without fulfilling all the DSM IV-TR criteria. DSM stands for Diagnostic and Statistical Manual of Mental Disorders and is sometimes referred to as the psychiatrist’s (or psychologist’s) “bible”. There are different versions or editions (hence the Roman numbers). The latest version is DSM IV-TR (with the TR standing for Text Revised) and DSM V is expected early next year.

I believe that attention deficit hyperactivity disorder is a real disorder; I also believe it’s too frequently diagnosed and over-treated.

Diagnosing ADHD

There’s no blood test, no functional magnetic resonance imaging (fMRI), positron emission tomography (PET) or computed tomography (CT) scan to diagnose attention deficit hyperactivity disorder. In fact, there is no objective test at all.

Currently, our best diagnostic tests are standardised symptom checklists (usually for parents and teachers to report about a child’s behaviour) based on the diagnostic criteria in the DSM IV-TR. To make a diagnosis of childhood attention deficit hyperactivity disorder, a practitioner must be familiar with normal development; gather, collate and interpret information from several sources; and determine if the symptoms significantly impair the child’s functioning.

The minimal diagnostic criteria from the current DSM are:

a child’s behavior symptoms must fulfil either six or more (out of nine) criteria for inattention (for a diagnosis of predominantly inattentive type);
six or more (out of nine) for hyperactivity-impulsivity (for predominantly hyperactive-impulsive type); or
six or more in each to be diagnosed with attention deficit hyperactivity disorder combined type.

Once the category is settled, the severity and impact questions must be asked.

Despite numerous theories and over 30 years of research, we don’t know what causes attention deficit hyperactivity disorder. But Australian draft guidelines for the treatment of the disorder recommend stimulant medication as front line treatment for school-aged children. Although the guidelines are still published online, last week new clinical practice information encouragingly recommended a combination of treatment approaches and actively called for practitioners to consider alternative explanations for child behaviours.

On average, the worldwide prevalence of ADHD is about 5%, but there are large variations. A recent systematic review, for instance, reported that prevalence rates for attention deficit hyperactivity disorder varied from 1.3% in Yemen to over 12% in Iran.

The Australian rate is reported to be 8% for children between six and 17 years. Variation of prevalence rates in attention deficit hyperactivity disorder can be largely attributed to (a) differing DSM versions (the definition has widened in more recent versions) and (b) how the diagnostic criteria are implemented.

ADHD symptoms are required to have been observed before the age of seven (in more than one context); have persisted for at least six months; and have clear evidence of clinical and significant impairment.

Variation in diagnoses

Analyses of pharmaceutical trials in a 2006 systematic review revealed that only 45% of trials using the two latest DSM versions implemented the full diagnostic criteria for ADHD when admitting participants into their study. And a small but recent study investigated practitioner adherence to ADHD diagnostic criteria and reported that up to a fifth of practitioners diagnosed it even when all criteria were not met.

The school age cut-off may also impact a diagnosis of ADHD. Nick Chapman

The month of a child’s birth compared to the school age cut-off may also impact the diagnosis of attention deficit hyperactivity disorder. Another recent study, of over 900,000 children aged between six and 12, reported diagnosis and treatment for ADHD was more likely for the younger children in a classroom. This suggests that younger children’s behaviours are being compared to older peers in the same classroom and may be leading to inappropriate diagnoses of attention deficit hyperactivity disorder. One year makes a large difference in early childhood.

DSM V is due for release in 2013. There’s a proposal to expand the criteria for attention deficit hyperactivity disorder, increasing the number of symptoms from 18 to 22. But the proposed changes will retain the current minimum cut-off of 12 symptoms (six in each subtype).

The age of symptom onset is proposed to be increased from seven to 12 years, and the wording regarding impairment is proposed to change from “clinical significant impairment” to “interfere with”. The diagnostic threshold for attention deficit hyperactivity disorder will effectively be lowered.

Once a diagnosis of attention deficit hyperactivity disorder is made, children are more likely to be prescribed medication. But we don’t know the long-term harms or benefits of medicating or labelling children.

Prevalence rates for attention deficit hyperactivity disorder are quite high now. Some practitioners are not following the full diagnostic criteria and DSM V may lower the threshold for diagnosis.

Be prepared for the childhood mental illness epidemic (certainly with respect to ADHD) to continue.

Have you or someone you know been over-diagnosed? To share your story, email the series editor.

This is part seven of our series on over-diagnosis, click on the links below to read other articles:

Part one: Preventing over-diagnosis: how to stop harming the healthy

Part two: Over-diagnosis and breast cancer screening: a case study

Part three: The perils of pre-diseases: forgetfulness, mild cognitive impairment and pre-dementia

Part four: How genetic testing is swelling the ranks of the ‘worried well’

Part five: PSA screening and prostate cancer over-diagnosis

Part six: Over-diagnosis: the view from inside primary care

Part eight: The ethics of over-diagnosis: risk and responsibility in medicine

Part nine: Ending over-diagnosis: how to help without harming

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51 Comments sorted by

Jack Arnold

Director

A well written article. Thank you Rae.

The beauty of the childhood mental illness epidemic is that few children under school age are sufficiently articulate to discuss their alleged symptoms for ADD or ADHD that is often described as "the disease you have when the doctor cannot find anything else".

So well meaning parents naturally empty their wallets for the medical services presumed to be for the health benefit of their offspring.

Somehow our lower primary school had the solution; first…
Read more

A well written article. Thank you Rae.

The beauty of the childhood mental illness epidemic is that few children under school age are sufficiently articulate to discuss their alleged symptoms for ADD or ADHD that is often described as "the disease you have when the doctor cannot find anything else".

So well meaning parents naturally empty their wallets for the medical services presumed to be for the health benefit of their offspring.

Somehow our lower primary school had the solution; first period was always exhausting exercise; running around until all the hormones etc that had built up overnight in growing bodies had been burnt off by exercise.

In 30 years of teaching & being involved in sport I have observed that regular exhausting physical exercise is a great 'cure' for students allegedly having ADD/ADHD. Certainly I have observed that the other positive attributes of alleged ADD 'suffers' include total concentration making the final putt for the PGA Championship, multi-channel listening capability, independent thinking ability to provide unique & 'obvious' solutions to problems.

A sedentary Western life style including a high sugar diet creates many opportunities for the medical profession to make a fortune.

9 months ago report
Brenton Prosser

Senior Research Fellow in Policy, Sociology and Public Health at University of Canberra

An excellent introduction to the topic of ADHD over diagnosis. Thanks Rae.

The trap with this debate is we can stop with the important question of are doctors prescribing properly, when there are other questions researchers should be asking. Questions that look at ADHD as more than the some of its individual parts. Questions like...

How do diagnosis patterns relate to the inattentive and hyperactive subtypes of ADHD? Or, to be colloquial, do hyper kids get more drugs?

Is there evidence to…
Read more

An excellent introduction to the topic of ADHD over diagnosis. Thanks Rae.

The trap with this debate is we can stop with the important question of are doctors prescribing properly, when there are other questions researchers should be asking. Questions that look at ADHD as more than the some of its individual parts. Questions like...

How do diagnosis patterns relate to the inattentive and hyperactive subtypes of ADHD? Or, to be colloquial, do hyper kids get more drugs?

Is there evidence to support the common view that Australian children with indigenous or Asian born parents do not get diagnosed with ADHD?

Does research in some Australian states that white, lower class, males are diagnosed and medicated more apply in all jurisdictions? How does US research that Afro-American children are seen to be more hyperactive but are less medicated relate to the Australian experience?

I agree with Rae, many are benefitting from diagnosis, many may be missing out on a helpful intervention, and many would benefit from interventions other than ADHD medication.

But the problem with the how many is too many debate is that it overlooks important questions of diagnosis for whom, where, and most importantly why?

9 months ago report
1. william mcinnes
  
  investigator into medical negligence
  
  In reply to Brenton Prosser
  
  Most of what I have read in this article can be challenged as it is the cause of ADHD that is important not the subsequent treatment by psychologists .
  
  Contrary to the view of the authors that:
  
  (A) there is no blood test, no functional magnetic resonance imaging (fMRI), positron emission tomography (PET) or computed tomography (CT) scan to diagnose attention deficit hyperactivity disorder. In fact, there is no objective test at all.
  
  (B) Despite numerous theories and over 30 years of…
  Read more
  
  Most of what I have read in this article can be challenged as it is the cause of ADHD that is important not the subsequent treatment by psychologists .
  
  Contrary to the view of the authors that:
  
  (A) there is no blood test, no functional magnetic resonance imaging (fMRI), positron emission tomography (PET) or computed tomography (CT) scan to diagnose attention deficit hyperactivity disorder. In fact, there is no objective test at all.
  
  (B) Despite numerous theories and over 30 years of research, we don’t know what causes attention deficit hyperactivity disorder.
  
  NOTE: If your child has ADHD please read the following "The etiology of attention-deficit hyperactivity disorder: imaging evidenc for neonatal hypoxic-ischemia" which describes the following:
  
  1. The two most likely causes of ADHD are inheritance of the disorder AND early lesions to the brain.
  2. Hypoxic-ischemia (HI) is a common cause of brain lesions in neonates and it has been reported to be responsible for up to 25% of all brain damage in neonates.
  3. HI induced lesions have also been correlated with the development of ADHD later on in life;
  4. Magnetic Resonance Imaging (MRI) is a structural imaging technique that has been used to identify brain abnormalities and lesions in ADHD children.
  5. In addition to structural findings, changes in levels of various neurotransmitters and proteins in the brain have been observed using Magnetic Resonance Spectrometry (MRS).
  6. These changes can result from HI damage and have been correlated to symptoms of ADHD in addition to lesions;
  7. There are 3 types of ADHD which have been identified;
  
  In my opinion if hypoxic ischemic damage (a lack of oxygenated blood flow to the fetal brain) was the cause of a childs ADHD then the first thing to do is seek out the hospital records of the childs birth (through a freedom of information form) to see if it suffered asphyxia at birth which caused an insult to the brain due to a lack of oxygen. If that happened, and it was as a result of negligent or inappropriate treatment then its a lawyer that needs to be seen, not a psychologist.
  
  Its time psychologists recognized that in many cases the child has brain damage and that has to be treated but not with disdain.....
  
  9 months ago report
2. Jack Arnold
  
  Director
  
  In reply to william mcinnes
  
  Thank you William for this contribution. It reminds me that in too many years of teaching I observed that many left handed persons displayed behaviours that could reasonably be described as ADD or ADHD. Indeed, many world class sportspersons exhibit many of the positive traits of ADD or ADHD like hyper-concentration & original problem solving while the world would be very dull without the creativity that often accompanies ADD/ADHD.
  
  An article in 'Nature' from about 1975 identified that the most…
  Read more
  
  Thank you William for this contribution. It reminds me that in too many years of teaching I observed that many left handed persons displayed behaviours that could reasonably be described as ADD or ADHD. Indeed, many world class sportspersons exhibit many of the positive traits of ADD or ADHD like hyper-concentration & original problem solving while the world would be very dull without the creativity that often accompanies ADD/ADHD.
  
  An article in 'Nature' from about 1975 identified that the most likely cause of left-handedness was one or more oxygen deficiency events of undetermined duration late in pregnancy or during the birthing process due to innumerable causes. The brain then repaired itself creating unique nerve connections to compensate for bypassing any damage. This earlier article appears to be supporting your hypothesis.
  
  I should disclose that I was one of the first generation of left handed persons who was not caned into right handed submission. Sadly, I note that psychologists rarely have sufficient scientific training to form such science based hypotheses as you suggest. I would strongly counsel against the "identification" disease of the psychology & education professions.
  
  8 months ago report
Peter Ormonde

Peter Ormonde is a Friend of The Conversation.

Farmer

Brave woman Rae!

There will be more red flags on this discussion than a May Day march in Beijing.

Some parents seem to regard a diagnosis of ADHD as a badge of honour. Perhaps as a vindication. So that's why little Shaunticleer is such a bloody nuisance and won't do what he's told.

No physical indicators - no MRI evidence - just a nest of reported behaviours.
Not much allowance for individual differences in development or the fact that some stroppy -often smart - kids resent being…
Read more

Brave woman Rae!

There will be more red flags on this discussion than a May Day march in Beijing.

Some parents seem to regard a diagnosis of ADHD as a badge of honour. Perhaps as a vindication. So that's why little Shaunticleer is such a bloody nuisance and won't do what he's told.

No physical indicators - no MRI evidence - just a nest of reported behaviours.
Not much allowance for individual differences in development or the fact that some stroppy -often smart - kids resent being shoehorned into what we regard as acceptable compliance.

And Ritalin? Speed? Why? Because it "works"? How? On what?

What's wrong with the tried and tested chemical straightjacket - good old largactyl, - the psychnurses' best friend - talk about compliance! A management tool.

I can't remember the details now but several years back I recall reading a report from the APA which stated that the most commonly applied "tests" for ADHD could only be reasonably applied to children over 7 or 8 years old. Yet we are having diagnoses of pre-schoolers.

Google up "ADHD tests age"... the interweb is filled with concerned parents wanting their three year olds tested. And MD's in the US at least willing to do it and prescribe accordingly.

Here's one picked at random:

"My son is 3 and is EXTREMELY wild. He has become very defiant, and it is almost impossible to take him out in public because of his behavior, and it's bad at home, too. He refuses to listen to any kind of discipline, whether its a "naughty chair", a spanking, time out, taking a toy away, quiet time, no TV, fixing/apologizing for what he's done, etc. and he will not do anything I ask or demand of him. Everyone always says "oh it's because he's a boy," or "it's only cuz' he's 3", but I had ADHD when I was younger, my husband has ADD, and my younger brother has ADHD (with the destructive behavior) and my 1st cousin also has it. When can I ask a pediatrician to at least observe him (I know I know....labeling.) & see if my hunches are right? I love my son very much but it is so hard with him being defiant, destructive, & I can't get him to LISTEN to anything. Sometimes I think he's deaf! (And yes, I've had his hearing checked....) I don't know what to do, and I'm worried a Dr. won't listen!"

So first stop is the GP then the chemist and we're off on a pill-popping childhood. Not parenting advice. Not suggestions about how to encourage rather than spank, punish and discipline. It's a "condition" - his. Not ours.

This is dodgy science - very dodgy psychology - extremely dodgy medication.

Experimenting on our kids. What a strange species we are.

Ritalin and SSRI's in the water supply - now!!!

9 months ago report
1. Emma Anderson
  
  Artist and Science Junkie
  
  In reply to Peter Ormonde
  
  Just a thought of the top of my head re: that random comment
  
  1. Yes, it's because he is 3.
  2. Parents sound over anxious about their kids. Anxiety involves distractability and in this case the anxiety seems to be that their kids are like them (have ADD whether or not the parents actually do).
  3. Parents almost obsessive concern fulls the distraction of anxiety. Distraction reinforces self-belief that "I have ADD and maybe my kid does too". Reinforces paying attention to kid mucking-up…
  Read more
  
  Just a thought of the top of my head re: that random comment
  
  1. Yes, it's because he is 3.
  2. Parents sound over anxious about their kids. Anxiety involves distractability and in this case the anxiety seems to be that their kids are like them (have ADD whether or not the parents actually do).
  3. Parents almost obsessive concern fulls the distraction of anxiety. Distraction reinforces self-belief that "I have ADD and maybe my kid does too". Reinforces paying attention to kid mucking-up.
  4. Kid realises on some level he's getting attention when he's mucking up. So what if he gets in trouble, he's getting attention. So his mucking up is actually being reinforced by what looks like punishment.
  
  Prescription:
  1. Parent stops worrying about what may or may not be his or her problem and his or her kids problem and,
  2. Removes the reinforcement. That is, pay attention to the kid when he's being a little darling, and unless he's actually in danger, ignore when he's mucking up. If he's not going to have all eyes on him when he chucks a tanty, he'll stop. Boundary set, basic good behavior program learned. Kid will be fine.
  
  7 months ago report
Sean Lamb

Science Denier

I would like to say something intelligent about this subject, unfortunately I didn't get past the first paragraph.

The photos of the mountains is nice (where is it?) But I am struggling to understand the connection "The lack of objective tests for ADHD make it easy to change definitions of the disorder. " Maybe it would have helped if I could have finished the article.

9 months ago report
1. Reema Rattan
  
  Editor at The Conversation
  
  In reply to Sean Lamb
  
  Goalposts, Sean!
  
  9 months ago report
Peter Gerard

Retired medical practitioner

I would like to pose a question:
Does ADHD, in most cases, simply represent one end of a spectrum of behaviour in boys that has always been the case but has now become a 'problem' because of the inability of teachers to discipline children in class. The fact that the majority of primary school teachers are women and that some boys come from single parent homes must be contibuting to this problem. Women, admittedly on anecdotal evidence only, do seem to have trouble controlling restless boys. Would affirmative action, to get more male teachers, back into the classrooms, likely reduce the incidence of so-called ADHA?

9 months ago report
1. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Peter Gerard
  
  Peter,
  the question is best answered by the number of adults coming forward for treatment of ADHD missed in their childhood. They come forwards because their inattention, disorganisation and verbal/emotional impulsivity cause problems in their home life and parenting abilities, and risk their ability to earn an income for their families.
  
  Whether their behaviour is "the end of a normal spectrum" or a discrete disorder, it is a problem to them and remains intractable to all their own attempts at "self discipline".
  
  9 months ago report
2. Jack Arnold
  
  Director
  
  In reply to Peter Gerard
  
  Good question Peter. Hard experience shows that ADD/ADHD is more frequently expressed in high school English & Mathematics than practical subjects like Technics or Home Science.
  
  The reasons are likely many, including poor student skills in the academic subjects & more student interest in the practical subjects. Also the practical subjects have a safety component requiring active participation or class exclusion.
  
  8 months ago report
Anna Bowden

logged in via email @iinet.net.au

The issue, I believe, is not so much as over diagnosis of ADHD, but a lack of clarity around the nature and impact of neurodevelopmental issues and therefore the inability to help bright children who present with “symptoms” (the symptoms often don’t include hyperactivity, in this case the child would be diagnosed with inattentive ADHD)

What we don’t have, however, is the framework to describe executive functioning, reasoning , visual processing or any other “brain” based weaknesses in an easily…
Read more

The issue, I believe, is not so much as over diagnosis of ADHD, but a lack of clarity around the nature and impact of neurodevelopmental issues and therefore the inability to help bright children who present with “symptoms” (the symptoms often don’t include hyperactivity, in this case the child would be diagnosed with inattentive ADHD)

What we don’t have, however, is the framework to describe executive functioning, reasoning , visual processing or any other “brain” based weaknesses in an easily understood way. Schools simply have no framework for understanding unless something is presented as ADHD or dyslexia. It is impossible to get additional resource help or even a hearing unless you have a diagnosis. Certainly schools are not the starting point for parents to get help with these issues, except in the most severe cases.

I see many, many children who present with these kind of issues who get no help or understanding because there is no framework for discussion beyond simplistic terms. Put a child with a visual processing issue and motor issues in a classroom you get inattentive behaviours and difficulty learning in both an academic and social environment. Barbara Arrowsmith Young and Mel Levine http://www.allkindsofminds.org/ present an idea of a neurodevelopmental framework which can explain why some bright children struggle. I believe we need to start having a conversation in Australia that parents and teachers can easily understand that will provide real assistance to these children. “Overdiagnosis of ADHD” is a simplification of the issue, and no assistance at all to the children who need help

9 months ago report
Simon Easteal

Researcher

It should be pointed out that ADHD is no different from many other conditions in lacking objective biological criteria for diagnosis. Difficulty with diagnosis does not make a condition any less real and it can lead to under- as well as over-diagnosis. Analysis of over-diagnosis in the absence of comparable analysis of under-disagnosis provides a biased picture. We can get a better perspective of what is going on by comparing prescription rates with prevalence estimates. This comparison shows there…
Read more

It should be pointed out that ADHD is no different from many other conditions in lacking objective biological criteria for diagnosis. Difficulty with diagnosis does not make a condition any less real and it can lead to under- as well as over-diagnosis. Analysis of over-diagnosis in the absence of comparable analysis of under-disagnosis provides a biased picture. We can get a better perspective of what is going on by comparing prescription rates with prevalence estimates. This comparison shows there are far more people with ADHD than there are people being treated for ADHD. In other words, ADHD is seriously under-diagnosed and under-treated both in children and particularly in adults. Exclusive emphasis on inappropriate positive diagnoses for an under-diagnosed and treatable condition that can have serious, sometimes devastating, life-long consequences encourages the trivialisation of the very real problems faced by those with ADHD and their families. It contributes to a general attitude that makes dealing with those problems that much more difficult than it is already is, and it contributes to a failure to take seriously the very real societal costs of this very costly condition.

9 months ago report
1. John Zigar
  
  Researcher
  
  In reply to Simon Easteal
  
  Yes, but most 'conditions' have causes which have been identified. ADHD has not actually been substantiated as a single condition but could be the result of many undefined conditions lumped together. There is no test, no epidemiology, no evidence base.
  
  9 months ago report
2. Simon Easteal
  
  Researcher
  
  In reply to John Zigar
  
  Also not different from a great many other medical conditions. You might want to take a look at the extensive scientific (including epidemiological) literature on ADHD, starting with the 20,000+ articles that are returned from searching PubMed with "ADHD"
  
  9 months ago report
3. Richard Windsor
  
  Mycologist
  
  In reply to John Zigar
  
  Neither has cancer! THis name relates to an enormous number of diseases, affecting many different organs and tissues and has many different causes. The only commonality is cell proliferation. There are , of course, cell proliferative diseases that are not cancer but we don't have stand-up fights about those, do we.
  There is also high blood pressure , high blood sugar and a large number of other ill-defined malfunctions of the human organism where the aetiology is different and the end point also…
  Read more
  
  Neither has cancer! THis name relates to an enormous number of diseases, affecting many different organs and tissues and has many different causes. The only commonality is cell proliferation. There are , of course, cell proliferative diseases that are not cancer but we don't have stand-up fights about those, do we.
  There is also high blood pressure , high blood sugar and a large number of other ill-defined malfunctions of the human organism where the aetiology is different and the end point also. So why is it so important to refute this one example of a neurobiological malfunction that may have multiple contributing factors and differing progressions and end points but which shows a core of common characteristics, which despite the red herrings of DSM, may be seen to have a core of common attributes..
  It's not so long back that Multiple Sclerosis was seen as a manifestation of hysteia (whatever that is) Now it is clearly and unreservedly accepted as a legitimate illness despite the fact that aetiology is still disputed, that treatment is disputed and that the prognosis is anyones guess.
  
  9 months ago report
4. Andrew Kinsella
  
  General Practitioner.
  
  In reply to John Zigar
  
  Just like depression, congestive cardiac failure or chronic renal disease, ADHD almost certainly represents a cluster of similar conditions. It is highly likely that causality differs significantly from case to case.
  
  The label has use though, in that it suggests that a certain range of treatments are likely to be helpful, and some are unlikely to help.
  
  Regardless of these suggestions, management always has to be individualised.
  
  9 months ago report
5. John Harland
  
  bicycle technician
  
  In reply to Andrew Kinsella
  
  Just like depression, congestive cardiac failure and chronic renal disease, we might fairly ask if there is a strong environmental element.
  
  Is the child being given appropriate education? Is "ADHD" more common in children who do not feel challenged by the pace of classroom learning?
  
  Are they the children who learn more kinesthetically?
  
  Are they children who need a clearer context to what they are expected to learn?
  
  Do such children simply need more physical activity integrated with their learning?
  
  Is the child responding to unacknowledged parental expectations of their behaviour?
  
  Difference is not defect. Being non-average is not an illness.
  
  9 months ago report
John Zigar

Researcher

Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. Cartwright believed that with "proper medical advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented." Cartwright prescribed "whipping the devil out of them" as a "preventative measure". As a remedy for this "disease," doctors also suggested amputation of both big toes. (see http…
Read more

Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. Cartwright believed that with "proper medical advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented." Cartwright prescribed "whipping the devil out of them" as a "preventative measure". As a remedy for this "disease," doctors also suggested amputation of both big toes. (see http://en.wikipedia.org/wiki/Drapetomania).

I recall that homosexuality was, and still is in some states, termed a mental illness. In Tasmania, for example, sex with someone of the same sex, was punishable.

Electroconvulsive Therapy (ECT) is still popular today to treat a variety of mental disorders. No one knows why it works – it just does (http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Electroconvulsive_therapy). Also, remember how we were told that stress and eating fatty food leads to stomach ulcers? For the past 17 years we’ve known that the majority of ulcers are caused by a bacteria living in your gut. And let’s not forget when shrinks advocated gender re-alignment to turn a boy into a girl when the boy’s genitals were accidentally fried off during circumcision in the 60’s and 70’s? Well, despite hormone treatments and psychotherapy, telling boys that they were girls, didn’t work.

Oh, remember aderlass in the middle ages? If you were sick, the medical professionals would bleed you. Many died. If you had a headache, they’d drill a hole in your head to release the pressure. Many died. I bet a lot of people must have trusted physicians back in those days to go through such horrible treatments.

The DSM used to also label homosexuality as a mental disorder in the 1970’s. The DSM IV will undoubtedly change over time. New mental disorders will be ‘discovered’ while obsolete ones are removed. Let’s face it, ADHD is, as far as I am concerned, a behavioural issue in most cases that probably does not require medication. ADHD is a fad that will disappear once we better understand the mind and how environmental and societal influences impact our behaviour. This is not to say that there aren’t any children that don’t require medication to control violent outbursts and antisocial behaviour – but the majority of alleged ADHD sufferers are probably just maladjusted kids going through a phase.

History is littered with mistakes made by the medical fraternity. I believe in evidence based medicine and not quick-fixes, such as creating a disorder that has a few behavioural traits as a basis for diagnosis.

9 months ago report
1. Peter Ormonde
  
  Peter Ormonde is a Friend of The Conversation.
  
  Farmer
  
  In reply to John Zigar
  
  Excellent. I'd forgotten about Drapetomania. But it raises an excellent remedy for rioting two year olds... I'd reckon chasing them about the house with boltcutters nipping at their tootsies would be just the trick. And it'll provide a much needed boost for appointment books of the caring professions as the kiddies enter later life.
  
  There was actually an outstanding radio documentary (on ABC RN from memory) a couple of years back tracing the amazing process by which homosexuality was voted down as a disorder requiring treatment in DSMIII - a deeply politicised process that involved psychologists delivering papers wearing masks to obscure their identity. Was finally resolved by a trip to a local bar actually. An amazing story.
  
  What a precarious business this diagnosing of behaviour.
  
  I wonder If I can claim a new set of boltcutters on Medibank or the PBS. Just what the doctor ordered.
  
  9 months ago report
Linus Bowden

management consultant

ADHD is NOT a "medical condition". If human evolution really has selected for some mutation that only appeared in rich, western populations, and overwhelmingly transmitted through the XY chromosomes, then can somebody direct me to the research that has identified this mutation and the necessary frenzy for rich, western populations to select those who carry the gene/s? Now, I'm no Dawkins, Frick, or Watson, but I cannot believe that in just three generations up to 10% of XY chromosomes suddenly express…
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ADHD is NOT a "medical condition". If human evolution really has selected for some mutation that only appeared in rich, western populations, and overwhelmingly transmitted through the XY chromosomes, then can somebody direct me to the research that has identified this mutation and the necessary frenzy for rich, western populations to select those who carry the gene/s? Now, I'm no Dawkins, Frick, or Watson, but I cannot believe that in just three generations up to 10% of XY chromosomes suddenly express invidious genes whose behavioural expressions require protecting 7 year olds by doping them up with amphetamines. The mantra of the Psychiatry-Big Pharma industrial complex seems to be 'Neuroplasticty be damned, we medical doctors will decide who gets legal access to speed'!

There is no doubt that the behavioural patterns attributed to "ADHD" exist, but rather than looking inside the 7 year old boy's chromosomal arrangements, perhaps we should be looking into the human-created institutional arrangements those boys are forced into, and particularly how they changed over the past two generations. I suspect a lot of people will not not allow their ideological blinkers to acknowledge some of the unpleasant realities of those social changes.

9 months ago report
1. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Linus Bowden
  
  There are a couple of issues here.
  
  The most critical one is that the syndrome is not exclusive to Western Industrial society- in fact I seem to recall that the country with highest prevalence is Brazil.
  
  Secondly there are marked differences in distribution within the USA- with much higher rates in heavily crowded or very poor states in the East of the US.
  
  One of the aspects of the debate about ADHD that has troubled me the most is that ADHD causation is predominantly genetic.
  That particular…
  Read more
  
  There are a couple of issues here.
  
  The most critical one is that the syndrome is not exclusive to Western Industrial society- in fact I seem to recall that the country with highest prevalence is Brazil.
  
  Secondly there are marked differences in distribution within the USA- with much higher rates in heavily crowded or very poor states in the East of the US.
  
  One of the aspects of the debate about ADHD that has troubled me the most is that ADHD causation is predominantly genetic.
  That particular model is convenient for Big Pharma, it is convenient for governments who do not want to spend more on schools, it is convenient for corporations that would like to force parents into the workforce (creating a larger workforce and deflating the price of labour), and it is convenient for people who do not wish to change parenting styles.
  
  Attention is a complex skill. Most of attention and executive function revolve around planning the next movement we make.
  
  So- eye hand coordination, and outdoors play are important to good attention.
  
  Secondly - emotional stability, the ability to self soothe, is vital to maintaining stability of attention (otherwise the mind is continually seeking threat in the environment).
  Where will that skill be learned in today's high pressure world?
  
  There probably is a genetic contribution to ADHD, and it is likely that individuals without one of the likely genotypes, may be most unlikely to develop ADHD.
  
  However, I suspect that people with the candidate genes for ADHD will not develop ADHD unless their upbringing occurs in a setting of significant psychosocial stress.
  
  In today's western society stress is so prevalent that it is the norm- it has become invisible, and those who cannot cope with it are seen as failures.
  
  9 months ago report
2. Yoron Hamber
  
  Thinking
  
  In reply to Andrew Kinsella
  
  Liked what you wrote Andrew. My thoughts on it is that it, if genetic, may have some survival importance to the human genome, maybe, that is. What I do know is that the treatment with weak amphetamines actually hits differently if you have this disorder. I've seen it on a friend and also heard his own impressions of receiving medication. It did not 'speed him up', but instead allowed him to interact where he formerly just would hide away, isolating himself. But giving it to kids I would call malpractice. After puberty and if having severe problems with ones relations there can be reasons for it, although only if agreed on by both parties. Any other way stink of force.
  
  9 months ago report
3. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Yoron Hamber
  
  Yoron,
  I have three things to say here.
  Firstly- I do not believe in coercive treatment of children. Most kids who respond well to the medication are very clear that it helps them and are pleased to stay on it. ( I have ADHD myself, and when medication has been useful its response has been much faster and much more clear cut than any antibiotic).
  
  Secondly, most psychiatric treatment is infested with the "if at first it does not work, double the dose" mentality. This is not clever, and not helpful…
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  Yoron,
  I have three things to say here.
  Firstly- I do not believe in coercive treatment of children. Most kids who respond well to the medication are very clear that it helps them and are pleased to stay on it. ( I have ADHD myself, and when medication has been useful its response has been much faster and much more clear cut than any antibiotic).
  
  Secondly, most psychiatric treatment is infested with the "if at first it does not work, double the dose" mentality. This is not clever, and not helpful.
  
  Finally, it is clear that some complemantary treatments are likely to outstrip all medical treatments.
  I have just spent 3 days working with a psychologist who is interested in neurobiofeedback. His comment is that he is well aware that kids who are good Ritalin responders are likely to be good responders to his treatment.
  The difference is that neurobiofeedback produces lasting changes.
  
  That is good for the patient, but bad for the drug company.
  
  I am awaiting some papers from him to support his observations.
  
  9 months ago report
4. Jack Arnold
  
  Director
  
  In reply to Linus Bowden
  
  HI Linus ... this topic creeps along excellently. I seem to remember that there is some cultural link in ADD/ADHD expression among children at least, there being few studies of ADD/ADHD among adults because adults are rarely grouped together in convenient school like groups for researchers to sample at their leisure.
  
  As I remember the data, ADD/ADHD has a greater frequency among so-called primitive hunter/gatherer communities where safety from being eaten while hunting is a real evolutionary factor. So, Kalahari Bushmen & remote Australian Aboriginal communities were noted. The effect is watching the horizon for dangerous threats encourages survival. Indeed, a theatre group discovered this effect when the audience of a travelling play group failed to recognise that the play action was confined to the stage only & did not extend to the wider horizon beyond the set that was still visible to the audience.
  
  8 months ago report
5. Yoron Hamber
  
  Thinking
  
  In reply to Andrew Kinsella
  
  Very interesting Andrew. and sorry I didn't answer faster here. Been undergoing some surgery if I that now makes an excuse :) Hope you will write here on that, maybe making it a joint 'paper' with your friend?
  
  8 months ago report
6. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Yoron Hamber
  
  Surgery is a fair excuse for a late reply.
  I really have no background in research myself, but have had to deal with this ADHD problem very close to home.
  As a result I am finding myself exposed to a range of complementary treatments all focussing on neuroplasticity.
  They all are showing very good preliminary results, and excellent safety.
  
  I may well find myself in a position to integrate this material and produce some overview articles in the near future.
  
  8 months ago report
7. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Jack Arnold
  
  it is worth reflecting here that we have quite different attention systems involved in focussed attention versus open attention, and use different parts of the brain.
  
  Open attention is very good for subconscious scanning of the environment for threat, and in fact anyone who has ever been very anxious will have the same sort of wandering attention that troubles people with ADHD.
  
  8 months ago report
8. Yoron Hamber
  
  Thinking
  
  In reply to Andrew Kinsella
  
  Take a look at fish oil and make the study into two, three?
  make it a computer teaching some neutral subject with answers that you check or write.
  
  one part of the group getting no help in studying.
  one part of the group using neurobiofeedback
  one part of the group using neurobiofeedback, and fish oil
  one part of the group using fish oil.
  
  and then validate differences possibly?
  I think such a study would be interesting, and also present some hope for those not wanting to rely solely on drugs.
  
  8 months ago report
9. Emma Anderson
  
  Artist and Science Junkie
  
  In reply to Yoron Hamber
  
  What kind of neurobiofeedback? Be specific. That's a very broad term and could mean anything from TMS to making music using waveforms based on brain-wave and other biological patterns (I've done the second and so have other artists)?
  
  What populations being studied? Is it people with structural damage and/or suspected chemical imbalances, with controls? What kind for both? What other illnesses may or may not be present that may confound it?
  
  What is the safety profile of fish-oil?
  
  Does…
  Read more
  
  What kind of neurobiofeedback? Be specific. That's a very broad term and could mean anything from TMS to making music using waveforms based on brain-wave and other biological patterns (I've done the second and so have other artists)?
  
  What populations being studied? Is it people with structural damage and/or suspected chemical imbalances, with controls? What kind for both? What other illnesses may or may not be present that may confound it?
  
  What is the safety profile of fish-oil?
  
  Does adding fish oil work better than removing allergens? (some people with allergies present with neuro-psychological symptoms, such as in Celiac's disease)
  
  How does the efficacy of feeding kids fish oil compare to treating the parent's anxiety?
  
  What is the psychological implications on parenting in a sociological environment where competitiveness between parents is actively encouraged? For example, the idea that if you want your kids to get into uni they need to go to a selective school, but to get into that they need to learn to read and write when they can barely hold a tippy cup. How much parental stress leaks to the kids in a world were parents are judging themselves, being judged by each other, and have these other variables putting pressure?
  
  Maybe it's as simple as, we make parents work too hard and worry too much that the simple things anybody needs to learn to function effectively in relationships are not being learned and therefore, not being taught to the kids, and the are just doing normal kid stuff but it's being exacerbated by that.
  
  Or, maybe it's not!
  
  7 months ago report
Linus Bowden

management consultant

We also need to vigilant towards those in the Psychiatry-Big Pharma complex who deny ADHD is a medical disease. A lot of these increasingly insist that the kids don't have ADHD; they have "bipolar disorder"! A very convenient diagnosis, which gives BigPharma a "customer" for liife doped up on much stronger and much, much more expensive drugs.

9 months ago report
william mcinnes

investigator into medical negligence

Most of what I have read in this article can be challenged as it is the CAUSE of ADHD that is important not the subsequent treatment by psychologists .

Contrary to the view of the authors that:

(A) there is no blood test, no functional magnetic resonance imaging (fMRI), positron emission tomography (PET) or computed tomography (CT) scan to diagnose attention deficit hyperactivity disorder. In fact, there is no objective test at all.

(B) Despite numerous theories and over 30 years of research…
Read more

Most of what I have read in this article can be challenged as it is the CAUSE of ADHD that is important not the subsequent treatment by psychologists .

Contrary to the view of the authors that:

(A) there is no blood test, no functional magnetic resonance imaging (fMRI), positron emission tomography (PET) or computed tomography (CT) scan to diagnose attention deficit hyperactivity disorder. In fact, there is no objective test at all.

(B) Despite numerous theories and over 30 years of research, we don’t know what causes attention deficit hyperactivity disorder.

NOTE: If your child has ADHD please read the following "The etiology of attention-deficit hyperactivity disorder: imaging evidenc for neonatal hypoxic-ischemia" which describes the following:

1. The two most likely causes of ADHD are inheritance of the disorder AND early lesions to the brain.
2. Hypoxic-ischemia (HI) is a common cause of brain lesions in neonates and it has been reported to be responsible for up to 25% of all brain damage in neonates.
3. HI induced lesions have also been correlated with the development of ADHD later on in life;
4. Magnetic Resonance Imaging (MRI) is a structural imaging technique that has been used to identify brain abnormalities and lesions in ADHD children.
5. In addition to structural findings, changes in levels of various neurotransmitters and proteins in the brain have been observed using Magnetic Resonance Spectrometry (MRS).
6. These changes can result from HI damage and have been correlated to symptoms of ADHD in addition to lesions;
7. There are 3 types of ADHD which have been identified;

In my opinion if hypoxic ischemic damage (a lack of oxygenated blood flow to the fetal brain) was the cause of a childs ADHD then the first thing to do is seek out the hospital records of the childs birth (through a freedom of information form) to see if it suffered asphyxia at birth which caused an insult to the brain due to a lack of oxygen. If that happened, and it was as a result of negligent or inappropriate treatment then its a lawyer that needs to be seen, not a psychologist.

Its time psychologists recognized that in many cases the child has brain damage and that has to be treated but not with disdain.....

9 months ago report
Shauna Murray

Research Fellow

Thanks for a very interesting article.

I was quite surprised by that list of symptoms; I would say, depending on how you broadly or narrowly you interpret the symptoms, most 5 year old children I know would fit them, including my daughter.

No doubt its beneficial to many children to have some extra adult attention from time to time, particularly in our busy society. So from that perspective, I guess its not necessarily bad to diagnose kids and give them some individual attention and care.

But surely there are other treatment options or behaviour interventions that are just as affective as drugs, and therefore safer. What about indirect side effects, ie teaching them that being drug dependent is ok and normal?

For example, teaching them skills in mindfulness... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267931/

9 months ago report
1. Richard Windsor
  
  Mycologist
  
  In reply to Shauna Murray
  
  What you have missed reading is the "fine print"
  
  9 months ago report
2. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Shauna Murray
  
  All "mental disorders are just lists of behaviours- from anxiety up
  ADHD is no different in that respect.
  Richard is correct in directing your attention to "the fine print".
  Under current diagnostic criteria, there need to be at least 9 out of 18 symptoms (yse I know this is likely to be revised downwards, and have read some of the research supporting this revision).
  Each behaviour needs to be occurring significantly more frequently than the average ( the fine print definition is "beyond the 2 standard deviation" range, I think).
  Also the observations of a single witness are not sufficient to make the diagnosis in a child.
  
  Finally, children being diagnosed need to be investigated for other causes of attention problems including hearing and visual problems.
  
  So, yes, the fine print is very important. In fact the public debate on ADHD is dominated by individuals who do not understand that fine print.
  
  9 months ago report
3. Peter Ormonde
  
  Peter Ormonde is a Friend of The Conversation.
  
  Farmer
  
  In reply to Andrew Kinsella
  
  Behaviour triggers the examination and the diagnosis Andrew but to my way of thinking a nice chart from an MRI or CAT scan showing lesions or another recognised abnormality goes well beyond looking at behaviour at gets us towards a proper factual diagnosis. Otherwise we're just looking at what they do and having a stab at it. Physical forensic evidence is missing here.
  
  9 months ago report
4. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Peter Ormonde
  
  Peter,
  once again the answer is in the fine print.
  In the introduction to the DSM, it is formally stated that the whole DSM enterprise is a method of classifying symptoms of mental suffering according to clusters- so by definition the DSM is based on symptomatic phenomenology.
  
  If you look closer you will find that the diagnostic criteria are listed as provisional and as the basis for further research, not as definitive.
  
  The editors even admit that the "mental illness" model is unsatisfactory…
  Read more
  
  Peter,
  once again the answer is in the fine print.
  In the introduction to the DSM, it is formally stated that the whole DSM enterprise is a method of classifying symptoms of mental suffering according to clusters- so by definition the DSM is based on symptomatic phenomenology.
  
  If you look closer you will find that the diagnostic criteria are listed as provisional and as the basis for further research, not as definitive.
  
  The editors even admit that the "mental illness" model is unsatisfactory, but they could not think of another way to describe the problem!
  
  As far as definitive signs go-
  fMRI, SPECT and Quantitative EEG often show distinct patterns that do improve with treatment- but they are not diagnostic in all cases.
  
  The real problem is that the neuroanatomy is sufficiently minutely detailed to make assessment difficult.
  What is worse is from a diagnostic point of view, many "defective pathways"
  can be routed around to produce an adequate functional output- and in this case you might well see normal functional imaging, but still have an output problem ( this re-routing is costly in terms of time and energy consumption and may lead to effective working memory deficits and easy mental fatiguability).
  
  Once again this reflects that "ADHD" is a syndrome and there are a number of discrete pathways leading to it.
  
  So insisting on a distinct test that will demonstrate ADHD all the time might just be insisting on the impossible, and may well be doing a great disservice to the many individuals who have benefited from the diagnosis and effective treatment of their ADHD.
  
  My real opinion is that the discipline of functional neurology (a field of interest that started within chiropractic) is likely to provide more robust explanations and treatments for ADHD than conventional medicine.
  
  9 months ago report
5. Peter Ormonde
  
  Peter Ormonde is a Friend of The Conversation.
  
  Farmer
  
  In reply to Andrew Kinsella
  
  Then is it ADHD - or just a set of behaviours we don't know much about?
  
  Other than some of these behaviours are suggestive of a condition that has been voted into a syndrome. That's a possibility - not an absolute diagnosis. Not enough for a diet of amphetamines on the kid's crispies in my view.
  
  A mental illness - a disorder of the brain - should show up on something, even if it is just curious wiring..
  
  And the most disturbing part of this sort of hunchy diagnosis is that it is generally justified by the circular logic that Ritalin worked - so it must have been ADHD. But then so would largactyl.
  
  I suspect this happens a lot. A sort of suck it and see approach. Try him on these and see if it gets better - like anti-biotics - No?
  
  9 months ago report
6. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Peter Ormonde
  
  Hi Peter,
  I am sorry about the late reply- but the truth is all psychiatric illnesses really are just "sets of behaviour"- but they are sets of behaviour that have commonalities and predictive value both in terms of behavioural outcomes (like suicide in depression, or school failure, poor work performance and long term financial difficulties in ADHD).
  
  You are right that psychiatry does lag behind other areas in terms of "diagnostic accuracy".
  
  The DSM project is an attempt to examine human…
  Read more
  
  Hi Peter,
  I am sorry about the late reply- but the truth is all psychiatric illnesses really are just "sets of behaviour"- but they are sets of behaviour that have commonalities and predictive value both in terms of behavioural outcomes (like suicide in depression, or school failure, poor work performance and long term financial difficulties in ADHD).
  
  You are right that psychiatry does lag behind other areas in terms of "diagnostic accuracy".
  
  The DSM project is an attempt to examine human mental suffering according to a medical model- and all the categories including depression, PTSD, and obsessive compulsive disorder are "just sets of behaviours".
  If you have ever dealt with people struggling with those problems- you will understand that they are real enough- even if potentially ill defined.
  
  However DSM is an ongoing process and is subject to further revision as we deepen our knowledge.
  I would suggest that you look at this page:
  http://www.psych.org/practice/dsm/dsm-frequently-asked-questions
  to get a better understanding that most of your objections are covered.
  
  Yes there are problems with research being skewed by financial interest, but there are also real efforts being made to break out of that problem.
  
  I would also emphasise that I have a real concern that most health professionals seem over- inclined to call things like ADHD diseases, when they really are syndromes.
  
  8 months ago report
7. Andrew Kinsella
  
  General Practitioner.
  
  In reply to Andrew Kinsella
  
  Also- re suck it and see:
  Every single time we use any medication we are making an experiment of sorts.
  Every person is different- with different metabolism.
  One of the main reasons that medical professionals require so much training is that medication cannot be done by rote or by formula- and we need to acquire the knowledge and observation skills to be able to take the risk of a controlled experiment every time we prescribe, and to understand what constitutes a success or a failure.
  
  8 months ago report
john mills

john mills is a Friend of The Conversation.

artist

Some parents are hopeless,your standard politically correct yuppy for instance,they cant help it in someways, because they grew up in this non parent era,latch key style, the yuppy,of an era, late 80s to nowish, wouldnt have a clue parent, ever seen their kids,about as insecure as you get, ever seen the nanny,its on the telly, anyway, thats why they send the nanny in, to deal with the troubled child that the parents just cant deal with, or cope with, its not that their bad parents,they love like…
Read more

Some parents are hopeless,your standard politically correct yuppy for instance,they cant help it in someways, because they grew up in this non parent era,latch key style, the yuppy,of an era, late 80s to nowish, wouldnt have a clue parent, ever seen their kids,about as insecure as you get, ever seen the nanny,its on the telly, anyway, thats why they send the nanny in, to deal with the troubled child that the parents just cant deal with, or cope with, its not that their bad parents,they love like any parent, just not clued up ,not evolved enough,never, firmly and properly, guided themselves, thats why they cant guide and cope with their own children, they could get the nanny in, or go and see a psyche-o-logic and learn/be educated about some of the (causes) reasons why, and maybe get some direction there, maybe accept the reality of them not being aware, clued up parents,adults themselves, heaven forbid,read up on parenting skills, etc etc, but sadly they go to a psyche-try- a-twist, who does it all with a pill,much easier, (cant be them(oh no) gotta be the kid,)the psyche, who sees sick wherever he or she looks,and poisons it,naturally doing what he or she does, then, what weve got, is, all these drugged kids, all speeding, drug effected, dulled, vegied out, etc, why? (and whod blame them the way psyches incarecrate and force drug people) because we havent been able to cope with our kids, not because theyre defectivbe or mentally ill, but because the parent doesnt even know how they feel themselves,let alone deal with others feelings appropriately, but will rarely admit it to themselves, let alone a doctor, The doctor must knows this, but can see the parents skills, and will know things arent going to change for the child, untill, or, if the parents learn, from classes, counselling, to cope,but hard to teach an old dog new tricks though isnt it,The doctor cant or doesnt want to tell the parent thier hopeless, so he or she tags the child, and poisons the child, one because they know the parent isnt going to change in a hurry, and therefore the child isnt going to change in a huirry,two, perents so caught up in their own heads and them, that the attention they give is rare and not 100% truly honest, and truly, maturely, caring,and so its almost drug the child to cope with the parent, so disable the chiuld.
There are people who THINK and feel, then there are people who THINK and FEEL, then theres FEEL and think,the balanced aprent is THINK and FEEL, the other two are the parents of ADHD kids, now thinking theyre parents of a chemically imbalanced child, a child who 9/10 just needs a dose of the nanny, and to learn where they have gone wrong, where theyre going wrong, and what to do, and what not to do,The rest of it is for profit, and self esteenm,large scale legitemacy, ego, and to further create an industry(for themselves) that claims to be the see all, an be all of the mind, and heart, sorry mind, theyve got no heart when they drug little kids because the parents are faulty, or at fault, these are parents who will ask their child how they feel with a pethetic voice, when theyr obviously throwing a "tantrum" because they havent got their own way with something, or someone, it almost makes me feel sick, youd thing the parent was the child,no consistant boundaries, no real authority, and the security of that a child needs, no wonder there in trouble, anyone with half a brain knows if your feeling ok, your thinking ok, and more than likely behaving/acting ok, the nanny knows, i know, and my family knows that,generation to generation, intrinsically, naturally, so do the psyches, but their no good at making people feel good, thats their first mistake,too much sick , not enough well,they cant help it, its how theyre being taught, and the seven or ten years of sheltered academia, hasnt helped them be with people in the real world, has it, as in poeples people, no sociasl life, or skills, ive sat in many a session for others, and never seen one talk or act what id call, nice or friendly without alterior motives,(to find a sick to treat), they, sit looking for shit,so they have to be thinking shit to do it,and that type of head is ugly, let alone very dangerous to the temporary sufferer, and they leave their victim feeling shit after it, I dont know what experience others have had, but thats been ours, every time, theyre too far into judgement, and no where near non judgemental,theyre both important, but the overall good should be seen and believed in, before we go and see/find/imagine bad and drug it, its like this, id rather see them as ok first, before i start seeing them as sick,only because i know that every problem has a solution, and that mental concern is/are unresolved issues/concerns, lack of awareness, immaturity,behaviours, environment, etc before its a tag, your mental, ill, and a poison, and in doing that,i start with well, hoping to get better, as opposed to start sick,be sick, stay sick, but manage it,(your sick,my paypacket). My view isnt already offending them, and making them feel even less about themsleves, ie; your ok , start practising that first, or no your sick, take this poison to remind yourself,and start practising, to me thats about as wrong and as bent as you get. I remember a kid getting hit riding his bike, and i was there to comfort him, and i was going great, untill all these stupid adults, came up and started telling him he wasnt, and over reacting in words and expression, before you knew it he had taken on their advice/suggestion, and was in tears, and in pain, that he hadnt, or wasnt feeling,yes he was hurt,but feeding into that,building "it"(the crash the pain) up, and not trying to simply comfort him, end assure him as casually but caring, considerate under the circumstances, as could be that all is, and will be ok, outside of the crash and the pain, in other words, change the subject take the energy off the crash, the immediate, comfort him, assure him, ease his concern,not build on them, and thats what psychiatry is doing to the planet, not telling them, all will be well, but that all will be unwell, unless, you take my poison that will dull you, un-natural you, alienate you, dumb you down., etc, never mind just little kids, trouble is the planet is full of people who dont know themselves,and wont put in, to get to know themselves, which is a necessity for dealing with and knowing others, how they/and you feel and think, how to best treat others, etc, and settle for the easy, but wrong way out with a pill,no thinking needed. But the worst part about this is that theyre taking their kids with them for the ride,people who "will" believe, anything someone in a white coat tells them. why ? - because remember its hard work to work through your crap, and they don't know who they are, or how they really feel or think about things themselves, and their so lost in them, and what they're imagining, they wouldn't know reality if they fell on it. One way or another the focus on mental health needs to be, your ok, before your not, not ignorantly, or arrogantly,but medicinally,positively, or, is it the mental "HEALTH" dept, or really the mental "ILLNESS" dept. Stop selling/pushing/promoting ill and sick. Try effected, but WELL. Start from there.

9 months ago report
mark mc dougall

educator

sad that olympians are cheats for accessing (short term) "performance" via medications,
but here in troubled classrooms ......its easier...
health risks anyone?

8 months ago report
1. Richard Windsor
  
  Mycologist
  
  In reply to mark mc dougall
  
  When you are in a hole, the best advice is "stop digging".
  Before you raise the phantom of "health risks", inform yourself of the nature of comorbid disorders associated with ADHD, many of which , typically anxiety, depression, risk-taking behaviour etc, can be largely alleviated by adequately addressing the underlying (and causal) ADHD.
  Unfortunately, one can only infer the risks of failure to treat but a good idea can be gained from the papers looking at ADHD and poor school performance, ADHD…
  Read more
  
  When you are in a hole, the best advice is "stop digging".
  Before you raise the phantom of "health risks", inform yourself of the nature of comorbid disorders associated with ADHD, many of which , typically anxiety, depression, risk-taking behaviour etc, can be largely alleviated by adequately addressing the underlying (and causal) ADHD.
  Unfortunately, one can only infer the risks of failure to treat but a good idea can be gained from the papers looking at ADHD and poor school performance, ADHD and socioeconomic status, ADHD and substance abuse, ADHD and gambling, ADHD and poor driving performance etc. The list is too long to present in an exhaustive manner here. The clincher is to look at the correlation between ADHD and incarceration in correctional facilities. Causality is important in this issue.
  As an "educator" you owe it to your students to inform yourself of the inter-relastedness of ADHD and Specific Learning Difficulties, particularly, dyslexias, Central Auditory Processing issues and failure of stereoscopic vision. You might also appreciate that ADHD is, in itself, a learning difficulty associated with information processing and memory.
  
  8 months ago report
2. mark mc dougall
  
  educator
  
  In reply to Richard Windsor
  
  yep! laudanum cured asthma too, relieved the anxiety, the coughing,..no dieing of asthma, no wheezes,... just of suffocation/drowning in their own comfortably overwhelming phlegm,..
  I'ld rather have a purgative coughing fit..especially while young, building body and organs
  
  8 months ago report
3. Richard Windsor
  
  Mycologist
  
  In reply to mark mc dougall
  
  As I said previously, when you are in a hole, stop digging. Even a klutz can use Google to tell the difference between Asthma and Cystic Fibrosis.
  
  8 months ago report
4. mark mc dougall
  
  educator
  
  In reply to Richard Windsor
  
  I thought the ADHD were the ones in the hole?
  Ritalin provides a dissolving/short term platform to see out of that hole but the hole continues to get deeper and wider amidst this.
  Thats the issue.
  
  8 months ago report
john mills

john mills is a Friend of The Conversation.

artist

Psychiatry is the most evil of professions out there without a doubt, they can kill without recall, without having to answer to anyone, and they do. Its as simple as this, your sick, no I'm not, yes you are, no I'm not, gorillas, straight jacket, injection, electrocution,vegetation, release. (but that's only if they haven't killed you in the process of their care, and considering they kill one a day in their care nationally you stand a pretty good chance of becoming that one a day that they kill…
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Psychiatry is the most evil of professions out there without a doubt, they can kill without recall, without having to answer to anyone, and they do. Its as simple as this, your sick, no I'm not, yes you are, no I'm not, gorillas, straight jacket, injection, electrocution,vegetation, release. (but that's only if they haven't killed you in the process of their care, and considering they kill one a day in their care nationally you stand a pretty good chance of becoming that one a day that they kill, ) are you sick now, yes, are you going to take the poison, yes, how many bags , three sir. And apparently sixty odd percent of Australians think that's OK, so that's just an example of the gullibility of Australians, and how evil psychiatry is, its making society sick, and evil, with them(psychiatry), and society cant even see it, in fact society is diving in head first, and buying sick, hook line and sinker, all, insecure people, vulnerable, needing encouragement and nurturing, guidance, to a better self, to a better way ,less caught up with their psychology, emotions, thinking, etc, cognitive guidance, the finding out, an awakening if you like. As in waking up to sanity, as opposed to waking up as a medicated vegetated reject with an illness, a tag and a script to line the pockets of a pseudo imagine r, with an excellent memory, and a whole sick selling industry to hold up and support, basically, a glorified chef, with poisons for their recipes. And we the puppets of society are the tasters, well at least sixty odd percent are, just don't forget, the Rosenhan experiment, or this http://www.youtube.com/watch?v=UDlH9sV0lHU, or, http://www.youtube.com/watch?v=-C42_gnJ3a8, or https://www.youtube.com/watch?feature=player_embedded&v=VYC-EJ18IT0, or http://www.youtube.com/watch?v=3f6LLV3fkXg&feature=related, or, http://topdocumentaryfilms.com/how-mad-are-you/ etc etc.

8 months ago report
Robert Peers

General Practitioner

ADHD is caused by maternal exposure to common steam-treated polyunsaturated food oils--which also cause Alzheimer's disease (after a lifetime's exposure). The low vitamin E level in such oils oxidises the highly polyunsaturated neuronal and synaptic membranes of the foetal brain, inhibiting brain development, and damaging dopamine nerve terminals. The brain is smaller, and develops later than usual. ADHD children who stop any exposure they may have to these common seed oils, and who take fish oil capsules, improve significantly, in my clinic. ADHD--and Alzheimer's--will disappear when a law is passed, requiring safe levels of vitamin E in all refined polyunsaturated vegetable oils. Refs on request.

8 months ago report
1. Yoron Hamber
  
  Thinking
  
  In reply to Robert Peers
  
  My understanding is that ADHD is like a umbrella of different attention disorders, loosely connected through the descriptions of how to describe its symptoms? But I've seen that there's a new research about fish oil in Gothenburg (Göteborg) by DR. Mats Johnson and Christopher Gillberg at the 'barnneuropsykiatriska kliniken (BNK)' in where the study done on 75 children/youngsters (8-18 y) in where 47 % showed a marked improvement in their ability to concentrate etc. So yeah, definitely worth trying if you have a kid with those problems.
  
  http://www.bt.se/familj/i_fokus/fiskolja-hjalp-for-adhd-barn%28858727%29.gm
  
  In Swedish so you need Google translate, or similar.
  
  8 months ago report
Dean Ashby

Company Owner at Ezestore Storage Sydney

I have met a few of my wives friends, who have children who were diagnosed with ADHD, though at varying degrees. Some were easily diagnosed, with others had a hard time doing so. One of my staff at the self storage facility in Northern Beaches (who recently moved from Manly), was sharing the same to me for her second child. Though the ADHD was a mild case, but if there is lacking support from the medical industry as well as support groups, she would not be able to cope with the demands of it, and eventually will require her to quit and let her husband support them. But she survived with the proper and sufficient support she received, and she still continued to work for me.

3 months ago report
Michael Maloney

Supercheap Self Storage

I do not remember having a lot of children being diagnosed with ADHD before or even during my time. I recall that my mother would just tell us to sit still and be quiet for a while so that she could concentrate on her tasks. One of my brothers would be very restless without talking so much. He could not sit still. I remember him going thru every room of our house, rummaging thru stuff, even the storage room that my dad kept locked all the time. It is because the room is a storage area, and all the…
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I do not remember having a lot of children being diagnosed with ADHD before or even during my time. I recall that my mother would just tell us to sit still and be quiet for a while so that she could concentrate on her tasks. One of my brothers would be very restless without talking so much. He could not sit still. I remember him going thru every room of our house, rummaging thru stuff, even the storage room that my dad kept locked all the time. It is because the room is a storage area, and all the boxes were stacked and there was greater chance of danger of falling on someone. So, my dad was afraid that these would fall on my brother. I know my parents were very patient with him and because of that, he turned out to be alright. My parents did not need any medical diagnosis to tell them that they should treat my brother differently. They just knew that they had to exert more effort on being patient with him. I guess, in today’s time, my brother would be categorized as having an ADHD and my parents would be asked to treat time in a very clinical manner.

2 months ago report

A childhood epidemic

Diagnosing ADHD

Variation in diagnoses

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