ADHD and Psychiatric Name Calling
by Dr Jeffrey Rubin
Recently I published a post titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” Among the points that I had tried to make is that psychiatrists falsely claim that the names they use to describe patients are “diagnoses.” In actuality, all that they do is convert someone’s expressed concerns into medical jargon.
I soon followed with a post titled “Psychiatric Name Calling: Is it Helpful?” Having thus raised some questions concerning the whole range of psychiatric labeling practices, today I’ve decided to focus in on just one of its most popular so called diagnosis–ADHD.
ADHD: A Huge Loss to Society
Gambling institutions well know that it is not hard to disguise losses as wins. For example, it is common in modern video slot machines that players are encouraged to bet on multiple play lines and follow any winning combination with flashing lights and high-fidelity audio, even when the amount won is less than the amount wagered. There are, of course, some who catch on to this gimmick. As one man noted, “I eventually realized that if I kept on winning, I was going to go broke.” A similar disguise is occurring with the ADHD situation.
In the spring issue of The Journal of Mind and Behavior, I found a relevant article by Lincoln Stoller titled “ADHD as Emergent Institutional Exploitation.” It documents that an estimated $3.6 billion was spent annually on ADHD drug treatements with the hope that this would help those students with an ADHD label do better in school. The drugs do create some flashing lights and audio sounds of delight from short-term effects of the drugs. And yet in terms of real life important outcomes for the students who are being placed at risk of a number of serious side effects, in the long term the drugs lead to more losses than gains. I well understand that many fine, well-meaning and intelligent people strongly disagree with me on this. Let’s look at the research.
The NIMH Multimodel ADHD Treatment Study (see HERE) is the largest study ever carried out, involving 6 study sites, millions of dollars, nearly 600 elementary school children, ages 7-9, randomly assigned to one of four treatment modes: (1) medication alone; (2) psychosocial/behavioral treatment alone; (3) a combination of both; or (4) routine community care. The results were initially written up as a big success for the ADHD drugs because in the short term, those taking the drugs did appear to do somewhat better on some outcome measures. But by the end of 14 months of treatment, no significant differences were found between those who had taken the drugs and a similar group who did not take them in terms of improved behavior and academic achievement.
In a recent Canadian study, those who took the drugs actually did significantly worse than those who didn’t. And other studies (see this article for review) indicate that by the time ADHD-labelled students reach the age that most students graduate high school, they do no better if they had taken ADHD drugs than a similar set of students who had not taken the drugs. High school average, high school graduation rates and performance on achievement tests were the same for both groups. But for each student taking the drugs, side-effects were endured and thousands of dollars spent on prescriptions.
And so, at some point it makes sense to start asking if a temporary improvement in school, which washes away by 14 months, is worth $3.6 billion? The pharmaceutical industry, like gambling institutions, well know that it is not hard to disguise losses as wins.
A Recent New York Times Article
Not long ago in the New York Times an article by Dr. Richard A. Friedman appeared titled “A Natural Fix for A.D.H.D.” There, the author states, “people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.” To defend his position, Dr. Friedman points to the fact that in schools, which tend to be regimented, require a great deal of sitting time, and lack much choice at what someone wants to be doing at any given time, the attention problems are far more prevalent than with adults who often have some choice at what career they go into.
For example, a patient of his, a 28-year-old man,
was having a lot of trouble at his desk job in an advertising firm. Having to sit at a desk for long hours and focus his attention on one task was nearly impossible. He would multitask, listening to music and texting, while “working” to prevent activities from becoming routine.
Eventually he quit his job and threw himself into a start-up company, which has him on the road in constantly changing environments. He is much happier and — little surprise — has lost his symptoms of A.D.H.D.
My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.
Although Dr. Friedman does a good job questioning the value of viewing ADHD as a mental disorder, he does throw in a plug for using ADHD drugs on children. Thus he says:
What are the implications of this new research for how we think about and treat kids with A.D.H.D.? Of course, I am not suggesting that we take our kids out of school and head for the savanna. Nor am I saying that we should not use stimulant medications like Adderall and Ritalin, which are safe and effective and very helpful to many kids with A.D.H.D.
In actuality, the effectiveness of these types of medications are very much in question because, as I have already pointed out, their effects soon wash away as tolerance to them develops. Meanwhile a great deal of money has been wasted.
As far as his statement that these drugs are safe, among the common side effects are high blood pressure, chronic trouble sleeping, feelings like throwing up, upper abdominal pain, and head pain. Moreover, there are a number of far more serious problems that, although rare for any individual child, nevertheless, because of the current policies that lead to several million children being placed on these drugs, thousands of our youth end up experiencing awful tragedies.
The world benefits from having people with a variety of interests, skills and talents. Schools tend to push people into too limited an environment despite the diversity of people who come through its doors.
Additional Research
There is research that demonstrates that many students who are given the ADHD label do far better if they are given opportunities to run around a few extra times during the school day, but most schools are cutting out more and more recess time to squeeze in more seat time for learning. Many kids given the ADHD label tend to be the youngest in their class. Because everyone in a class is expected to do the same level of school work in any given class, the youngest begin to stand out, and are identified more as “ADHD” kids.
Other research indicates a strong association between an ADHD label and sleep problems. These problems occur in part because some people are not morning people and like it or not, school begins early.
Should being a person who doesn’t function as well in the morning be considered a disease? In some settings, the fact that there are people who would prefer to work a later shift is an enormous plus, but for those in school, name calling and drugging is viewed by the authorities as making sense.
Some people who have sleeping problems have other real problems that contribute to their sleeping woes such as parents fighting, stress from community violence, bullying, serious financial problems, and on and on. In such cases, doesn’t it make sense to view the students as having difficulty coping with difficult environmental conditions rather than having a mental disorder?
Are Genetics the Cause?
The pharmaceutical companies love to promote genetic studies that appear to demonstrate that ADHD is a real disease. Since they fund so much of the media’s advertisement business they greatly influence what gets coverage in newspapers, TV and internet stories. Results are initially exaggerated and splashed all over the headlines. Then, when the real facts start to appear, you have to dig into the bowels of research libraries to find them.
A great example of this occurred when a 2010 study was heralded as being the first to find direct evidence that ADHD is a genetic disorder. As Lincoln Stoller tells the story:
Thapar, who is one of the authors, is cited in a press release preceding publication of the article as saying: “Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children” (Walsh, 2010)…. Thapar implies that those who differ from the norm are necessarily inferior.
Once the study was actually published it showed that 85 percent of those labelled as having ADHD had no discernible genetic difference from those without ADHD. Shortly after the study was published, it was found that it did not control for differences in IQ. By removing from the study students who had IQs below 70, the results indicated that about 90 percent of students with ADHD in the study had no discernible genetic difference. Finally, in a subsequent paper, two of the original authors of the study stated, “gene variants still explain only a small percentage of the inherited component of ADHD.”
Although the original press released got a great deal of attention in the media, the press was silent as the more accurate information surfaced.
Conclusion
Because people have differences, whether genetic or otherwise, this does not mean they have a disease. For example, if great singers have a genetic difference than the rest of us, this doesn’t mean they have some sort of disease. And for those of us who perhaps have some genetics that has led us to sing less than average, we need not view ourselves as diseased. We can, instead, seek to find other situations in which we can make ourselves useful. The same holds true for those who find that in some situations their minds wander more than others.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
My wife has a Great Grandchild who has been diagnosed with A.D.H.D. This nine year old male child has been on various medications for about 2 years. I am not biologically related to the child, but he, for now lives with us, due to the fact that his parents are not capable of caring for him. The child exhibits Oppositional Defiant Disorder according to his diagnosis and is very hyper-active. He is seen by social workers, and a Psychiatrist. I haven’t observed significant improvement in the child’s behavior, since the onset of his medical regimen. He spent some time in a clinic, and while there some of his medications were stopped, however I don’t know all of the details. Your present post clarifies some misconceptions about A.D.H.D. Is it really possible that this so-called disorder is nothing more than a result of extreme stress, environmental surroundings, or a feeling of not being loved? If so, where do we go from here?
Hi Marv. It sounds like you have quite the challenging task on your hands. Obviously I don’t know anywhere near enough to offer any advice that I feel comfortable. In general, I like to begin a discussion about this type of concern by asking, when is the child least likely to be acting in a way that is of concern to you, and when is the child most problematic. I also tend to encourage that the child get a great deal of physical activity which is usually healthful in any case and improves sleeping. Sorry I can’t offer anything more specific right now. My Best
Indeed, the situation is very challenging! This is all about the mystery of the human brain. That in itself is the REAL challenge. The child’s symptoms, (as far as outbursts are concerned) are subdued usually in the morning. He attends a special education school during the day, but I can only rely on feedback from teachers. Sometimes the news isn’t good, if you know what I mean. He is most problematic at night as far as behavioral problems. He is taking Melatonin at bed time to improve his sleep. I still believe he is overmedicated which refers to those bogus studies that you mentioned. I would love to see how he behaves if his weened off medication. Anything you can suggest would be welcome. Thanks!
Hi Marv. Tell me how he acts when he is getting one on one attention. Many kids I worked with, when they were with someone one on one, usually were fine. I had a great deal of positive feedback when I suggested to parents expressing a similar concern as you that a neighborhood kid at least 4 years older than who he or she would be a buddy to was paid a little money to do something fun for an hour or two a few times a week when the adults needed a little respite. The extra attention that the kids were often hungry for, meant a great deal to them. And if the pair worked first on something that required some exercise and then on a skill that was valued (chess, musical instrument, art) the plan even worked better.
Reblogged this on ChironLightMuse.
When the child is having a conversation with his therapists, he presents himself with a calmer effect, especially if one therapist is present. At times the therapist needs to reprimand the child for not listening to what the therapist is explaining to him, regarding annoying behavior. Whenever I go to a store, once in a while I will take the child along. He doesn’t act up with me, as opposed to being with others. He goes outside after returning from school, but doesn’t engage in physical activity, such as sports. There are not many kids of his age to play with. I don’t know the details of his school physical activities, but I assume he is more active in that setting. He needs more friends, and to seek a way to relieve tensions in safe and pleasant setting. Please opine.
Hi Marv, thanks for filling me in on some more of the details of your young change. Again, I don’t even remotely have enough information to feel very comfortable about offering advice on this individual concern. However, a main focus for any young fellow ought to be to help him to develop a skill that will garner respect. People often think that a person should only seek to develop a skill that he or she has talent in, but there is an impressive body of evidence that it is the amount of deliberate practice that leads to above average skill level. And the level of skill that is reached does’t have to be at a level of Carnegie Hall. Once he reaches a level that can challenge others who share an interest in that talent, as they interact with, he will feel a sense of acceptance and respect that would mean a great deal to him and he will have less motivation to try to achieve some things that are important to him in less desirable ways. Couple this with some increase exercise (take a two mile walk together, or something of that sought) and, if at all possible, pay a teenager a little something to spend some one on one time a few times per week and have them work together on developing the boy’s chosen talent. This strikes me as sound, healthy advice to work on.
What information can I furnish to determine advice?
Marv, I provided some tentative advice–seek to find some valued skill that your charge wants to become good at, set up some process where he will begin to develop that skill by daily deliberate practice, and get him some mentor at least 4 years older them him to give him the attention he perhaps craves, along with the exercise his body needs to stay healthy. Any more advice would require my meeting the child, getting to know him and the family situation over several months. Obviously, this blog is not set up for that type of relationship. I do think that the blog can be helpful if you sat down with the boy twice a week, and began with my first post, and moved forward to the next one, and then the next one, etc., at your own pace, thereby working together to learn how to respond to criticism, provide criticism, understanding the nature of conflict, anger and respect. Role-playing the different scenarios provided in the posts can help this process, and then reversing the roles. I don’t know how old the boy is, but if he reads well enough (typical 12 year old), my first novel, A Hero Grows in Brooklyn could help him think more deeply about some of his troublesome behavior.
Hi there.
I am someone who was misdiagnosed with autism at four years old.
My parents took me for diagnosis because they needed a psychiatrist “aka the enabler” to diagnose me with a false illness so they can take no accountability of their bad parenting and use me as the scapegoat when something bad pops up in the family’s upbringing. I was acting out as a young child, because my shaky relationship with my parents, and their verbal abuse and name calling made me loose myself at times.
I was put on drugs young as ten because of some snarky comment regarding how my behavior was caused by “demons possessing my mind” which was my way of mocking Christian’s believing bad behavior was caused by Satanic possession. My mom is a Protestant Christian and she took my snarky comment way too far. To cure my “Satanic Behavior” I was taken to west LA to be treated because my mom willingly listen to the Autism Society of America South Bay division head Rita Rubin’s advice.
On medications for over eleven years that did absolutely nothing but was a tool my own parents could use to manipulate my feelings as well control me on what I can and cannot say. After eleven years of medication hell and parents that refused to listen to me on my concerns and conversations regarding my medications ineffectiveness, I got off cold turkey with no hesitation.
I am angry as well infuriated about society as well how psychiatric crimes are given a pass in society, despite countless proof of lists regarding psychiatric malpractice happening on a daily basis. I don’t believe parents when they state victims being held hostage by a psychiatrist with a handgun to their heads, demanding Billy to be diagnosed or their brains will be blasted out. This isn’t literal, it’s just a metaphorical way of saying the parents had no say because the psychiatrist was using slick mind games and threats to get the child a diagnoses. What ever happened to the American constitution and common sense?
Parents who get their children diagnosed with mental illness are either narcissists or individuals suffering from munchausen syndrome by proxy. Because what logical minded individual would buy into psychiatry as science? I’m getting sick and tired about how society portrays the parents as innocent, Bambi eyed victims being held at gun point by the evil psychiatric mobster cult. Because, even if the parents didn’t have an actual clue, they knew in their own way what they’re getting into.
So here is my question because you spoke to Dr. Szaz a while back. In LA, the homeless population is really high. And CCHR acts as if they are doing something good for the homeless people with mental illness. What good do they mean? Are they trying to get fundraisers from the head of NIMH, Dr. Thomas Insel, to work with highly respected nueroscientists to find out the ligimate causes of mental illnesses so majority of these people can be actually cured and live normal lives? What about professional support groups that help ex mental health patients eliminate barriers that actually decline rights for them to own properties, control finances from their businesses, etc.? What about anti-psychiatry groups demanding the U.S. Supreme Court to reform medical malpractice laws and eforcing background checks on all doctors and medical staff to reduce the cases of violations being done against patients will? Where is that? Oh wait, they don’t care about ex mental health patients greater good! It’s all about egos!
How about that? It’s been over fourty years since CCHR’s exsistence, and where is the supreme courts enforcement on medical professional background checks and abolishment of psychiatric practices in America? How about small business organizations, partnerships, and unions owned and run by ex mental health patients?
Yet still, ex mental health patients and anti psychiatric groups still fumble around and make excuses about why they as a sub culture cannot progress. While homeless ex mental health patients are roaming the streets, starving to death and begging for hand outs, CCHR still does nothing but promote ex mental health patients are nothing but helpless victims that need to be saved. With what? That is my question I want answers for.
How much does CCHR really care about ex mental health patients?
Because if so, wouldn’t psychiatry been out of business by the end of the 1970’s? And ex mental patients were given rights to have their own businesses and the previous barriers that actually hindered them were eliminated?
I question if CCHR was just a sham to victimize psychiatric patients instead of actually helping them progress and be independent from the system because they wanted to be helped?
Hmmmmm…. Strange.
Hi Erica,
Thanks for expressing your concerns. I like the idea about small business organizations, partnerships, and unions owned and run by ex mental health patients? I don’t know much about the CCHR group. I wonder if Mindfreedom can be helpful to promote this type of approach,
Jeff
Forwarded this to the discussion, “Gifted vs ADHD vs Work performance” in the LI-group called “The Psychology Network”
Btw: CSM? Yes!
I was born December 8, 1956. I was a stressed out child who knew by age 3 to stay the hell away from my mother. I was never unable to sit for lengths of time, but when I hit high school, I hadn’t yet been diagnosed with Hashimoto’s thyroiditis or Epstein-Barr virus. My health/sex ed. teacher at University High School in West Los Angeles, diagnosed me with having ADD because I fell asleep in his class more than a few times and, evidently, he attended a few “classes” at UCLA on the new psychological illness called ADD/ADHD. ADD/ADHD had not yet been “named” as a real disorder and yet, my health teacher convinced me I had ADD. The truth is, there was no air-conditioning in our classes and sex ed bored me. To this day, (and I have had two children without caring what the parts of my womb are called. THE REAL TRUTH IS I HAD THE BEGINNING OF SEVERE DEPRESSION AND WOULD HAVE SLEPT MY LIFE AWAY IF GIVEN THE CHANCE. I do not know how old you are, but when my brother and I went through the California public school system, we were number one in the nation. We hovered between first and tenth and never above tenth. BUT
NOBODY TAUGHT ME OR CHRIS, my brother who was three years older than me, how to study. WE NEEDED PROGRAMS LIKE AVID WAY BACK THEN. Being ripped out of 6 different elementary schools did not help us but my mother was a high school dropout and my father was a top manager for the original Vonderay (Von’s Markets) family and he was never home. The students who did well were those with a parent at home, who went to the PTA meetings, helped out in the classroom and stayed in touch with their children’s teachers. Our mom could care less about public education so we never learned how to study, how to conduct ourselves in polite society, how to behave in any situation that may have presented itself to us so we blundered through and both of us had inherited manic depression from my mom, and in my case, (my brother had a different father) and manic depression on my father’s side. When I began teaching, Dr. Rubin, my teacher’ aides did ALL THE DIAGNOSIN FOR ME AND EVERY SINGLE ONE WAS AN IDIOT. If they were not telling me that this kid has ADHD and that kid has ADD. then, at the end of the year, all the teachers met together and this is what I heard: When I taught 4th grade, the 3rd grade teacher told me what awful students of hers I was getting. When I taught 6th, it was the 5th grade teachers scaring me to death. They all had ADD/ADHD and were awful kids. I never found that to be true in but only a handful of students. I was in elementary from 1993 then moved to middle school in 2005. I taught 8th first and 7th last and ran out of there and got a Single-Subject, English credential and became a high school English teacher and loved my job. Do you know that I had my first truly ADHD student in my first of the day ninth grade English class? MY VERY FIRST AND MAYBE MY ONLY ADHD STUDENT. His name was Justin and our desks were the kind that wee attached to the desk part so the chairs and desk came attached and what held them together were bolts put on them with hydraulic-powered tools that were impossible for any normal person to unscrew and yet, every single day, Justin dismantled his desk and all pieces would fall to the ground and in his most apologetic way, he would promise to have his desk put together at the end of the period and HE ALWAYS DID. That child was probably an inventor or future engineer and when I look back on Justin, had I been a smarter teacher, I would have supplied him with an erector set and let him have at it because he wasn’t motivated to read fiction. He was reading all kinds of manuals. These are the people who are doing your job and pediatricians’ jobs and psychiatrists/MDS jobs: Teacher’s aides, teachers, mothers who donate their time at school and a sundry of other people who are NOT QUALIFIED TO EVEN WORK WITH STUDENTS. I have only diagnosed students in my head because I am only expert in my own mental illness: manic depression, and when I saw this: THE BIPOLAR SPECTRUM in some psychology article, I was livid. This is NOT A SPECTRUM DISORDER but it will become one if enough idiots right a few psychology journals claiming that it is. I had a hard enough time accepting the “AUTISTIC SPECTRUM” and what worries me is this: if a first grader is given a diagnosis of ADHD because he is a boy with energy and he just cannot sit still (that sounds like a normal six year old boy to me), some aide with label him, convince his parents who will take him to a doctor who accepts the diagnosis and puts the kid on Ritalin. The parents are not told that YOUR SON’S DIAGNOSIS WILL FOLLOW HIM ALL THE WAY UP TO 12TH GRADE AND HE WILL ALWAYS BE CONSIDERED SPECIAL EDUCATION AND IF THIS STUDENT FINDS OUT, HE WILL FEEL LIKE THERE IS SOMETHING WRONG WITH HIM AND HE WILL NEVER BE SMART. Up in the Antelope Valley. where that blond, blue-eyed Jesus reigns, priests and pastors and, perhaps the 3 or 4 rabbis are also doing the diagnosing. Robin Williams had my illness: manic depression. He had a wonderful teacher who understood that Robin would never be able to sit for any real length of time so he would open up his back door and let Robin run like the wind. Today, starting in kindergarten, children sit and work on laptops for longer and longer periods of time while their recesses are being shortened conspicuously. Nobody seems to remember Piaget’s proven theory that a 5 year old has an attention span that is about 6 minutes long and yet, today, they work endlessly on laptops without any real teaching or relief from the boredom of too much free time on computers. What do you thinK?