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Thread: ADHD does not exist

  1. Team Rocket
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    #1

    ADHD does not exist

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

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

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

    Allow me to explain what I mean.

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

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

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

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

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

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

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

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

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

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

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

    Dr. Richard Saul is a Behavioral Neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is published by HarperCollins.
    What do you think? Does it make sense? Do you know someone who had ADHD and then later found out their symptoms were caused by a different condition? I have 2 cousins who were treated with stimulants all throughout childhood for ADHD and then as adults found out they were actually bi-polar. The experienced many of the symptoms he describes above, such as being extremely irritable and weighing basically nothing because they were never hungry.


    Links: the above-quoted article: http://time.com/25370/doctor-adhd-does-not-exist/
    The New York Times article that is mentioned about ADHD medicine use: http://www.nytimes.com/2014/03/12/us...rder.html?_r=1
    Last edited by rocket_lizz; 03-17-2014 at 12:01 PM. Reason: links
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    #2
    I don't think it doesn't exist, but I do think it's WAY over-diagnosed. DH was diagnosed with it when he was a kid but "grew out of it"...aka I think he was just a little boy that didn't want to sit still.
  3. "If you don't like my attitude, quit talking to me"
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    I have said for years that ADHD is over diagnosed. Before my child was diagnosed we went through nearly a year of ruling out things, investigating each item on the list. When we first did the list, he was a yes to 11 of the 12 things, the 12th one was something that didn't apply to him. Even with testing positive or yes for 11 of those items, they still didn't want to diagnose him. I have a sibling with ADD so I already knew the signs. I can't tell you how many parents are like 'my kid has ADHD'.. when clearly they don't. Their child is just being a normal child. These are also the same parents that will give their child whatever medication just to calm them down. I knew a mom once who had a child with ADHD, and just because it was easy, just went ahead and gave her other 2 kids the same medication. Those other 2 kids 'appeared' distracted, although they weren't, so she self-diagnosed and gave those kids the medication. Its ridiculous.

    With so much over diagnosis of ADHD those who truly have are getting shafted.

    As far as bipolar vs ADHD, that's a thin line. My son went from ADHD to bipolar back to ADHD. The symptoms (in children) are highly similar. With the bipolar test, my son was yes for 6 out of 8 things. With the 2 things being sexual in nature and he was only 6 at the time. They treated him for bipolar, but it was later found that since the treatments had little to no effect it was determined he had just the ADHD not bipolar.

    More times that not, the ADHD label is given because that is the 'new' thing. Too many parents want a quick solution and are un-willing to do what it takes to make sure their child is being treated for the correct condition.

    i support his theory here, that there is no ADHD, but more in a sense of ADHD is over diagnosed and many who claim to have it don't.

    There are 10 types of people in the world, those that understand binary and those that don't
  4. MilitarySOS Jewel
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    #4
    Do you have a link for the quoted article?
  5. Team Rocket
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    #5
    Quote Originally Posted by CindyLouWho View Post
    Do you have a link for the quoted article?
    Oops! I'll get it. I always forget to include that part
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    #6
    I agree with it being grossly over diagnosed.
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    Quote Originally Posted by Yabos View Post
    I don't think it doesn't exist, but I do think it's WAY over-diagnosed. DH was diagnosed with it when he was a kid but "grew out of it"...aka I think he was just a little boy that didn't want to sit still.
    This. I think it is much rarer or less common than it is made out. I think parents, teachers and doctors are quick to label children that don't fit the perfect child mold.
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    #8
    Hm. My sister was diagnosed as a kid and now at 16 is having more problems to where they're jumping to bi-polar and semi-psychotic.
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    #9
    **Disclaimer - I skimmed the article because I don't have time to read it at the moment** (...and maybe because I failed to take my ADHD meds this morning. )

    From what I did read and the overall notion of ADHD not existing, I totally disagree. I wasn't diagnosed until my senior year of college when I was 22. After getting on medication, I was stunned that I had survived school (and succeeded, for the most part) without ADHD medication! It all made complete sense once I started taking it and seemed to really be the missing link that helped me to no longer struggle. So with that said, I am a firm believer that ADHD exists!

    However...I do agree that docs are so quick (too quick) to diagnose young children with it. There's a very thin line between being an active, hyper child and actually having a disorder.
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    #10
    Over diagnosed and too quick to jump to medications as a result? For sure. Non-existent? Nah. Maybe there are better ways to classify it so we may eventually see ADHD replaced with a new term and new criteria but obviously there are people who have those symptoms who are legitimately helped with the therapies and medications used to treat it.
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