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May 2014 Archives

Ten thousand 2-3 year old toddlers are on stimulant drugs for ADHD.

It was shocking enough to discover that 20 percent of teenage boys get labelled as having ADHD and 10 percent are on stimulant meds for it; that 11 percent of all kids aged 4-18 get the diagnosis of ADHD and 6 percent the drugs; that stimulant prescriptions and pharmaceutical company profits are skyrocketing around the world; and that ADHD guidelines encourage making the diagnosis and starting the drugs in kids as young as four.

Then it got worse: An adventurous group of cowboy child psychologists invented a new and untested diagnostic category (with the ridiculous name 'Sluggish Cognitive Tempo') that would be a wonderful target for additional inappropriate stimulant use.

It is also particularly outrageous that so many of the thought leaders promoting the excessive use of stimulants have such close ties with pharmaceutical companies. Honor dies where conflict of interest lies.

But the latest news tops all in raw shock value. The Centers For Disease Control And Prevention has just estimated that 10,000 US toddlers, aged 2-3, are being given stimulant drugs for behaviors that have been mislabeled as ADHD. This falls outside the already overly inclusive guidelines that start kids at the too-early age of 4.

Treating babies with stimulants is based on no research, is reckless, and takes no account of the possible harmful long-term effects of bathing baby brains with powerful neurotransmitter drugs.

Many people thought I was being overly optimistic when recently I predicted that the ADHD fad had finally peaked and that we would gradually return to more appropriate levels of diagnosis (perhaps the previous 3 percent instead of the current 11 percent).

My optimistic prediction was not based on naivete about drug companies' greed or physician carelessness. My hopes rested on the possibility that there would be a backlash of parental and professional protest as it becomes clearer and clearer how absurdly overused is the ADHD diagnosis and the stimulant medication.

The CDC report will certainly fuel that outrage and help stimulate a backlash, but at what price to the babies?

I have been blogging and tweeting a lot about ADHD lately because I believe that change is in the air.

This is the worst of times for ADHD diagnosis because statistics show it is wildly over-diagnosed and over- treated. This is possibly the best of times for ADHD diagnosis because I think we have reached the tipping point and feel hopeful that the ADHD fad will soon begin to fade.

We humans are suggestible creatures comforted by the safety of the crowd and prone to groupthink. Most often going with the herd is the smart and safe bet, but follow-the-leader can cause big problems when the herd is running off the cliff.

The history of psychiatry is littered with the periodic recurrence of fad diagnoses that suddenly achieve prominence and then just as suddenly fade away. Human distress is always hard to explain and sometimes hard to tolerate. Diagnostic labels, even false ones, can gain great and undeserved popularity because they seem to explain the otherwise unexplainable and provide hope that describing a problem will lead to improving it. And once you have a diagnostic hammer, everything begins looking like a nail.

The tripling of ADHD rates in the last twenty years and skyrocketing use of stimulants are sure signs of a fad. The forces promoting it are, and will continue to be, formidable:

•The drug companies will not give up their $10 billion dollar a year stimulant cash cow without a fierce fight. They have the motive and the means to massively and misleadingly market ADHD and will try to expand its customer base by making it as ubiquitous in adults as it already is in kids. And Pharma is one of the most powerful lobbies in Washington- it has successfully bullied our government to allow direct-to-consumer drug advertising that is banned in almost all other countries.

• ADHD diagnosis occurs inappropriately in part because it is the ticket to the legal acquisition of stimulants, which can then be easily diverted for recreational use.

• ADHD provides a medically legitimized way to obtain stimulants that can be used for performance enhancement in perfectionistic adults and children who don't really have ADHD.

• Some of the influential experts who specialize in ADHD are blind to the risks posed by its over-diagnosis and over-treatment and (with heavy drug company support) spread the false gospel that more diagnosis means better diagnosis.

• The largest patient advocacy group related to ADHD receives one third of its funding from drug companies and parrots the party line.

• Teachers may also encourage the excessive diagnosis of ADHD particularly when working in school systems that are chaotic (with classes that are too large and insufficient gym periods to let kids blow off steam)

Given this Goliath of support promoting the ADHD fad,why am I making the long shot bet that it will now begin to fade.

• The percentage of kids being diagnosed (11% overall and 20% of teenage boys) is so absurdly high that reasonable people can no longer accept that the label is being applied with anything approaching sufficient care and caution.

• The astounding rate of stimulant use (6% overall and 10% in teenage boys) shocks us into the realization that we are creating a generation of drugged kids.

• Studies show that stimulants are much less effective than we originally thought in improving long term school performance.

• Some of the leading experts who developed the concept of ADHD and did the best research are speaking out about their surprise and dismay about the way it is now being misused.

• The press is now on the case with frequent exposes of careless ADHD diagnosis and stimulant misuse. Alan Schwarz of the New York Times deserves special mention (and a Pulitzer prize) for his vivid, in depth reporting, but this story is now receiving extensive international coverage and has long legs.

Ultimately, though, my hopes rest mostly with parents. They have previously played a passive role in promoting the ADHD fad- going along with doctors' recommendations in an effort to help their kids. My bet is that parents will now play an active role in curtailing the ADHD fad- protecting their kids from unwarranted diagnosis and potentially harmful medication treatment.

No parent should give pills to a child after a diagnosis of ADHD that was made on single visit of just a few minutes. Accurate diagnosis takes time in each session and usually many sessions. Watchful waiting and environmental changes should precede the diagnosis and will often make it unnecessary. Stimulant drugs should not be used for performance enhancement because in the long run they don't enhance performance and we don't know what harm they can do to the maturing brain.

The ADHD fad will fade because all dumb psychiatric fads eventually fade. As Abraham Lincoln put it: "you can fool all of the people some of the time and some of the people all of the time, but you can't fool all the people all the time."

There will soon be a tipping point when parental common sense, sobering research findings, and media exposure will overwhelm the marketing and political might of the unscrupulous drug companies and the careless prescribing habits of physicians. I am hoping and predicting that we are now just about there.

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