Category: Ritalin

Psychiatric Drugs: Wonderful Revolution or Ongoing Catastrophe?

Post author By Dr. Jeffrey Rubin
Post date May 17, 2018
7 Comments on Psychiatric Drugs: Wonderful Revolution or Ongoing Catastrophe?

Welcome to From Insults to Respect.

A while ago, as I began to think about what topic to write about for my next post, I received an email from Mindfreedom International (MI). It brought attention to a demonstration it was planning. As MI expressed it in part:

A mock funeral mourning those lost to psychiatry or who have had their spirits broken and struggle to survive is to be held as protesters deliver a public message to psychiatrists at the annual meeting of the American Psychiatric Association on Sunday, May 6, 2018. “First, Do No Harm” is the message that protesters hope will go viral and get people to think twice before getting involved with psychiatry.

Our coalition brings attention to the harm that psychiatry has caused for many people in the mental health system, psychiatric survivors, people of color, people with psychiatric histories, and people experiencing other forms of structural oppression. Uninformed or court-ordered psychiatric drugging; chemical and mechanical restraints, solitary confinement; forced and uninformed shock treatments….have caused irreversible damage to the minds, bodies, souls, and lives of people who voluntarily trusted their doctors or were brought to court to comply with their prescriptions over their objection….We will mourn the deaths and the ongoing forced treatment of our brothers and sisters.

Is there a way to move MI’s various conflicts with the psychiatric organization forward in a manner that leads to a more respectful relationship between the two?

My Views About Psychiatric Drugs

I became interested in the conflict about the use of psychiatric drugs very early in my career as a psychologist. I began to discuss the issues with psychiatrists as well as those who objected to this form of treatment. A broad outline of what I heard follows:

Advocates for the use of these drugs make the following claims: These drugs reduce emotional pain, correct abnormal brain patterns, and restore normal mental function. When used judiciously, they reduce hospitalization and may quickly alleviate symptoms of serious mental disorders such as depression and bipolar illness. Going off medication results in disruptive lives and devastating personal loss. Careers, relationships, financial troubles, and even life itself are all placed at grave risks without proper psychiatric medication management.

In contrast, critics of psychiatric drugs have made the following counter claims: The use of psychiatric drugs has unleashed the worst medically induced disaster in history. They have caused millions of people to become addicted to them, suffering debilitating, life threatening side effects. Rather than promoting mental health, these drugs are being used to promote social control and conformity. Reduction in hospitalization, moreover, occurred not because of the use of these drugs, but because of a deinstitutionalization policy that became known as “dumping.” Problems now being handled with psychiatric drugs can be more effectively, safely, and humanely handled with a variety of social support systems, counseling, mindfulness, healthy diet, and physical exercise techniques.

As I heard these conflicting claims, I initially thought that psychiatrists had principles of science on their side. With my graduate training in research methods and statistics, I thought that by doing a thorough job finding out the scientific research that backs up the psychiatric drug supporters I could explain in an easy to understand language why psychiatric drugs are necessary. With such an explanation, perhaps the conflict would be resolved.

My Ritalin Research Analysis

I began with researching Ritalin because I was working in Rochester, NY’s school system. This was from 1974 to 1979. It was a time when drugs were just beginning to be prescribed more and more to treat students who had teachers dissatisfied with their activity level or ability to pay attention. I had witnessed a time when schools managed to deal with such problems without the use of this drug and life went on reasonably well. With the rise in its use, some thought it was a wonderful advancement, while others were expressing great discomfort at this new trend.

So, off I went to a medical library to learn the scientific merits of this new approach. A brief summary of what I found follows.

Supporting the use of Ritalin were short-term randomized controlled studies lasting less than 12 weeks. Both inattentiveness-impulsivity and activity level were reduced, as assessed by parent and teacher rating scales, direct observations in natural settings, and various laboratory tests.

Not all of the findings were supportive. At the time I initially did my research, there was only one study that looked at the long-term results of Ritalin use. It compared children placed on methylphenidate, the generic version of Ritalin, with those who received no treatment. The children in the two groups were matched with respect to age, IQ, socioeconomic class and sex. After 3 to 5 years, no statistically significant differences were found between the two groups on the following outcome measures: emotion maladjustment, delinquency, Wechsler Intelligence Scale for Children, Bender gestalt visual-motor test, and academic performance.

In addition to this, I found many studies documenting a number of common adverse effects of treatment, such as headaches, insomnia, anorexia, stomach pain, irritability, and weight loss. Suppression of the normal rate of growth was just beginning to be reported. The sudden development of a tic disorder that sometimes did not go away when treatment stopped was viewed as a rare occurrence, but troubling nevertheless. Other serious rare adverse events had been observed including some involving heart functioning such as angina and cardiac arrhythmias. Perhaps most troubling of all was the recognition that the safety of long term use of Ritalin had not been established despite many students being treated for years.

To make sure that my analysis of the available scientific evidence was complete, I sent a Freedom of Information Request to the Food and Drug Administration for the documents that it used to approve the use of Ritalin with children as a treatment for attention and activity problems. I soon received a fairly large packet of information, and upon reviewing its contents I became convinced that I had not overlooked anything of scientific merit.

In the end, I discovered that although the approval process of the FDA had in its documents the available scientific evidence in making its decision to approve Ritalin, the reviewers’ decision nevertheless relied more on their personal values. It seemed to me, and it still does, that different people looking over the same scientific evidence could, depending on their values, come to completely different conclusions about whether or not the drug should be approved.

For me, personally, with the full awareness of the scientific evidence, I would have voted against approval of the drug. Relevant to me was that after thousands of dollars had been spent by the parents of the child or their insurance company, there was no lasting positive effects, while treated children were suffering side effects. The additional facts, especially the one that indicated long term safety had not been established, seemed to me to make non-approval the obvious choice. And yet, according to the value judgments of those who sat on the FDA approval board, they ended up supporting approval.

What I Found Afterwards

Since then, more research has come out regarding the drugs used to deal with ADHD. It further supports the conclusion that there are no long term benefits from using these types of drugs. Moreover, additional harm from their use has been identified.

After what I learned about the ADHD drug treatments, my efforts to find out about psychiatric drugs expanded.

As time went on, I took a psychopharmacology course taught by Harvard professor Dr. Ross J. Baldessarini; did additional research to get the latest updates, not only on Ritalin, but on other psychiatric drug treatments; and participated in six debates on this subject.

I’ve come to the conclusion that as with Ritalin, when highly intelligent people become familiar with the scientific evidence, they still draw completely different conclusions from one another about whether or not it is morally okay to use the approved drugs as a treatment. The decision is not solely made on scientific evidence. Moreover, I’ve seen evidence that there are far safer non-drug alternatives.

Since I did my original research on Ritalin, I also learned something crucial about the reliability of the relevant research findings. Initially, I assumed the scientific studies were carried out in a manner that I could have confidence in. Since then, I’ve begun to seriously question this.

Many experts have written about the reliability of the research. For example, Marcia Angell, M.D., is a former editor in chief of The New England Journal of Medicine, and now is a member of Harvard’s Medical School. In her insightful book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It, she writes, “Is there some way companies can rig clinical trials to make their drugs look better than they are? Unfortunately, the answer is yes. Trials can be rigged in a dozen ways, and it happens all the time” (p. 95).

Conclusion

And so, even if we believe that the available research is accurate, it just so happens that an examination of it leads to very different moral conclusions by very intelligent people about the wisdom of using these drugs. The pharmaceutical industry’s influences on the body of research about the safety and effectiveness of these drugs make these types of conclusions ever more questionable.

For those interested in following the peer reviewed scientific research about the effectiveness and safety of these drugs, I highly recommend the Mad In America website. It describes the latest research in non-technical language while providing the links to all of the actual research articles so readers, if they so choose, can read them for themselves.

Members of MI have seen first hand people who have died and who have suffered terribly as a result of their involvement with the psychiatric profession. At the same time, psychiatrists also well know that there are many incidences of tragic outcomes due to their treatments, but they have come to believe that overall the benefits of their treatments far outweigh all of those tragedies. And the enormous financial benefits that come with being a psychiatrist are very likely to influence their views.

Civil rights activists worked for generations to make some progress in achieving their goals. Among the most successful of these advocates was Martin Luther King, Jr. When advocating for civil rights, he avoided throwing insults at those who resisted the changes he was after. Instead, he focussed on painting his dream in beautiful, hopeful phrases and demonstrating in nonviolent, but impossible to ignore, peaceful resistance.

In a country where many of our current politicians have taken to insulting anyone who disagrees with them, King’s approach may seem out of style. As for me, I personally think King’s approach is as timeless as stars twinkling in the heavens.

Tags ADHD, FDA, MindFreedom International, Psychiatric Drugs, psychiatric medications, psychiatry

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Research Update On ADHD Drug Treatments

Post author By Dr. Jeffrey Rubin
Post date March 23, 2016
No Comments on Research Update On ADHD Drug Treatments

In earlier posts, I have reviewed the research on ADHD drug treatments. The findings have led me to the conclusion that medicalizing the behavior pattern that medical doctors refer to as symptoms of ADHD causes far more harm than good. New readers can check out my earlier posts on this subject HERE, HERE, HERE, HERE, and HERE.

Briefly, the main side effects of the commonly prescribed drugs for so called “ADHD” are:

Sleep problems
Decreased appetite
Delayed growth
Headaches and stomachaches
Rebound (irritability when the medication wears off)
Tics
Moodiness and irritability

Fears have been raised about potential long-term effects of stimulant drugs on the heart and on the child’s developing brain. But the available data on these outcomes is limited, so the true effects are still unknown but legitimately worrisome.

On June 15, 2009, the FDA put out the following warning: “The FDA reported on a study reviewing 564 healthy children taking stimulants who died suddenly. They notified the public that there might be an association between the use of stimulant medications and sudden death in healthy children.”

In my earlier blog posts, I also reviewed research studies that indicate that almost immediately after taking these types of drugs, many children will complete more academic work and get more of the items correct. Parents also tend to report behavioral improvements. But these effects begin to wane. According to the best available evidence, by a little over a year, any perceived improvement, when objectively measured, had completely disappeared. The available studies indicate no lasting benefits for those who use them in terms of academic achievement, social outcomes, and high school graduation rates. In the end, thousands of dollars have been spent and the drug treated children, having suffered the various side-effects and been subjected to serious risks are no better off than children who had similar behavior challenges but did not take any of the ADHD drugs.

So, after I carefully weighed all of this information, I concluded that children would be far better off if we rejected the ADHD medical model. Since my last post on this subject was published, three new relevant research studies have been carried out. Let’s take a look at them.

First Study

On March 3, 2016, News4Jax, out of Jacksonville, Florida reported that “ADHD medications associated with diminished bone health in kids.” Here’s what they had to say:

“ORLANDO, Fla. – Children and adolescents who take medication for attention-deficit hyperactivity disorder (ADHD) show decreased bone density, according to a large cross-sectional study presented today at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons .

“This is an important step in understanding a medication class, that is used with increasing frequency, and its effect on children who are at a critical time for building their bones,” said senior study author Jessica Rivera, MD, an orthopaedic surgeon with the U.S. Army Institute of Surgical Research.”

This study recently appeared in the online edition of the Journal of Pediatric Orthopaedics.

Second Study:

On March 12, 2016, the New York Times published an article titled, “Is It Really A.D.H.D. or Just Immaturity?” There we learn of a study published in The Journal of Pediatrics indicating that the youngest students in a classroom are more likely to be given a diagnosis of attention deficit hyperactivity disorder than the oldest.

“Researchers in Taiwan looked at data from 378,881 children ages 4 to 17 and found that students born in August, the cut-off month for school entry in that country, were more likely to be given diagnoses of A.D.H.D. than students born in September. The children born in September would have missed the previous year’s cut-off date for school entry, and thus had nearly a full extra year to mature before entering school.”

The authors of the study concluded, “Our findings emphasize the importance of considering the age of a child within a grade when diagnosing A.D.H.D. and prescribing medication for treating A.D.H.D.”

These findings support similar results of an earlier study in the United States, which found that roughly 8.4 percent of children born in the month before their state’s cutoff date for kindergarten eligibility are given A.D.H.D. diagnoses, compared to 5.1 percent of children born in the month immediately afterward.

Third Study:

On March 13, 2016, The Sydney Morning Herald published the latest article describing a study that provides further evidence that drug treatment provides no lasting benefits for students classified as having ADHD. The study was funded by the National Health and Medical Research Council in Australia and carried out by the Murdoch Childrens’ Research Institute. It has been following 178 children with ADHD for three years to identify what factors make a difference to the development of children with the disorder. One of the chief investigators of the project is pediatrician Daryl Efron. He reported that,

“The 13 per cent of children in the study who were taking medication such as Ritalin to treat their ADHD were doing no better or worse than their unmedicated peers at age 10. Medication doesn’t alter the long-term outcomes of kids [with ADHD].”

Analysis

The kind of attention that you have to use in school is difficult for many people. This certainly was true for me, and I was not one of the youngest students in my grade. The teachers had us sitting way too long, and some subjects, such as spelling and grammar, were not as interesting to me as it was for some of the other students. And so I became awfully restless.

In my opinion, I did not have a medical illness. Out on the streets of Brooklyn, I was as healthy as a horse as I got into handball, basketball, and stickball games for hours and hours during my free time. Nevertheless, I am certain that if my parents had taken me to a doctor in this modern world of ours, I very likely would have been given an ADHD label and placed on one of the ADHD drugs.

Even if the drugs actually did lead to some positive lasting outcomes, their potential harm in terms of physical problems and thousands of dollars of wasted money should be weighed against these positives. But the research has repeatedly demonstrated that there are no lasting benefits. And so, I’m continuing to urge parents to remain cautious as they become bombarded by the drug treatment options they surely will be facing in our pharmaceutical dominant society.

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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.

Tags ADHD, ADHD medication, ADHD Treatment, Ritalin

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Treating ADHD: If Not Drugs, Then What?

Post author By Dr. Jeffrey Rubin
Post date January 7, 2015
3 Comments on Treating ADHD: If Not Drugs, Then What?

Some children, when asked to attend to certain tasks, do so for shorter periods than most. Some are also more energetic. Such children are often said to have Attention Deficit/Hyperactivity Disorder (ADHD).

Although many doctors recommend placing children believed to have ADHD on drugs such as Ritalin and Adderall, many parents refuse to go that route. The evidence that the drugs do not lead to lasting improved academic and social outcomes are major reasons (see my post titled “The Myth of Ritalin’s Effectiveness” for a review of the effectiveness studies). Other major reasons have to do with concerns about known negative side effects and possible long term harm to such young developing brains.

Parents who have a child viewed as having ADHD typically face two challenges–disciplining their child and responding to concerns from their child’s teacher. For parents who choose the drug approach, they may come to believe that at least by drugging their child something is being done to deal with the challenges. They may thus become less motivated to take some other steps because what can be done is being done. If the child misbehaves, the parent may come to believe that the cause is due to the drug not doing what it’s supposed to be doing. Maybe the child needs to go back to the doctor to get the dose tweaked, or another drug needs to be added or substituted.

But for parents who refuse drug treatment, they don’t get confused about all of these drug issues and a clearer path lies before them. As a school psychologist for many years, I’ve walked with parents down this non-drug path on numerous occasions, and here are some suggestions that I found most helpful.

My Four Favorite Suggestions for Parents Concerned about a Child’s Attention Span or Energetic Behavior

1. Search the internet with the following search terms–“ADHD without drugs.” If you do so, you will find many suggestions on how to address your concerns. A daily running program and meditation were just a couple of excellent ideas that I found quickly in a recent search of this sought. Many of the suggestions indicate that they have research support demonstrating that they are effective (see for example APA’s article titled “Easing ADHD without Meds“). What I particularly like about having parents search the internet in this way is that they get to select from a wide range of ideas the ones that make the most sense to them. Moreover, there are always new ideas coming out, and these types of internet searches are regularly updated.

2. Get a copy of The Kazdin Method for Parenting the Defiant Child by Alan Kazdin. Dr. Kazdin is director of the Yale Parenting Center and Conduct Clinic and is a former president of the American Psychological Association. His approach has been well tested in solid research programs with impressive results.

If you can’t afford to buy Dr. Kazdin’s book, you can get a copy at your local library. If your library doesn’t have a copy, walk over to the the librarian and ask to get it through inter-library loan. If you have trouble reading books, it is also available on CD. Listen to these CDs while you are driving, cleaning the house, and washing dishes. You’ll find a goldmine worth of information.

3. Ask your child’s teacher to provide you, each week, a list of the main topics that will be covered in class the following week. Then view at home with your child a lesson on each topic on the Kahn Academy website.

This website is a resource that provides free lessons on all the topics that teachers teach in school. By having your child review each lesson before hearing it for the first time from the teacher, when the teacher actually presents the lesson in school, your child will now be at least somewhat familiar with the topic. This is called “priming” and it has been demonstrated to increase the interest level for learners and increase the likeliness that the topic will end up being mastered. Moreover, once you show your child how the Kahn Academy website works, your child, before each test, can go back to the lesson and make sure he or she has really mastered it.

If you do not have the time to do this with your child, see what you can do to get someone at least four years older than your child to carry out this activity. You may have to pay a young teenager a little, but it will be better than paying for pills.

This approach leads to real learning. Once your child starts to make better academic progress in school, he or she will feel better about school in general.

4. “Casino for teaching calculation fluency” is a card game that I have found works great for kids who have difficulty learning math skills in the usual manner. You can find the rules for the basic casino card game on line by typing in your search engine, “Casino card game rules.” Once you learn the basic rules it will be easy to learn how to apply the game to improve a wide range of math skills.

Basically, the game is played as follows. The dealer deals four cards to each player and four cards face up in the center (these center cards are laid out separately so that all are visible). The aim is to capture cards from a layout on the table, by playing a card from your hand which matches in number a table card or the sum of several table cards. When it’s your turn, if you can’t capture any cards, you have to throw into the center, face-up, one of the cards from your hand. The cards that each player captures are accumulated in his or her pile. The player who ends up with the most captured cards (in the simplest form of the game) is the winner. After each player plays the four cards that are originally dealt, each player is dealt four more cards. The game is over when all the cards in the deck are used up.

To win, a player must learn to do basic addition. Consider this example. Suppose it is my turn and I have in my hand a 9, and on the table, face up, is a 6 and a 3. If I know 6 plus 3 equals 9, I can use my 9 to capture the 6 and the 3. The more cards I capture, the more chances I have of winning. If I am a bit clumsy at addition, this game can motivate me to increase my fluency.

Once your child has learned to add smoothly, you can change the rules of the game to learn more advanced math skills. For example, you can make the new rule as follows: the only way to capture cards is by using subtraction; or multiplication.

The game can be played in groups of 2, 3, or 4. Besides a deck of cards, it will help to learn math if you will get an abacus. Any student having trouble with learning basic arithmetic should be taught how to use an abacus, and should get a great deal of experience using it. It visually displays how our system works, with the ones line, the tens line, and the hundreds line. The manipulations are fun, and they begin to make conceptual sense after regular use. You can buy an abacus on line for just a few dollars and they come with directions.

The abacus is used as follows. Suppose Sue, who is playing Casino with Jill, attempts to use a 7 in her hand to capture a 6 and a 2. She can use the abacus to see if 6 and 2 equals 7. In a short period of time, Sue will learn to add without the abacus.

An interesting psychological aspect of playing this game is that even when it is not the turn of the other players, all the other players are motivated to do the calculation of the person whose turn it is in order to make sure she or he does not cheat. Moreover, whenever a player can’t make a capture, and therefore throws a card from her or his hand onto the table, all the other players start to make calculations in their heads to figure out how the new card can be utilized. Consequently, there is an enormous amount of additional calculations going on than one might think by watching the player whose turn it is. This is a large reason why this game is so effective.

Now, once your child learns the basic rules of the game, usually within a half hour of playing time, the rules can be changed so that your child begins to work on learning fluency of the math facts at his or her level. So, if Sue is learning to be fluent in learning single digit addition facts, the group plays the game in the standard manner.

If Sue is learning fluency in mastering two digit addition facts, the game is changed so two decks of cards are combined. Both decks get a little doctoring. The parent takes out the four jacks from one of the decks and crosses out their J, and writes beside it the number 11. In a similar fashion, queens, and kings have respectively, the numbers 12, and 13 written on them, replacing their Q and K. For the cards in the second deck, their numbers are changed so that they are given numbers that range from 14 to 27. Both sets of cards are shuffled together, and the game is played like the basic version of the game but there is far more addition facts that can be employed in order to capture cards.

For students learning fluency in mastering single digit subtraction facts, the same rules are applied as the single digit addition form of the game but players can only capture cards by applying a subtraction fact. For example, if Fred has a 2 in his hand, and there is an 8 and a 6 faced up on the table, if he recognizes that 8 minus 6 equals 2, he can capture with his 2 both the 8 and the 6.

For students learning fluency in mastering two digit subtraction facts, the same rules are applied as the two digit addition form of the game but players can only capture cards by applying a subtraction fact.

In a similar manner, the game can be played as well so it is designed to teach fluency in basic multiplication or division.

$math is fun$ Math is often a stumbling block for children who have trouble paying attention to topics that bore them. By making learning these skills fun, these skills are quickly learned. When your child then goes to school, his success in math class will greatly improve his or her overall school experience.

Okay then, those are some ideas to help children thought to have ADHD. There are of course far more options to discover.

Until you join us again, have a great week.

Jeff

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Tags Adderall, ADHD, ADHD Treatment, Alan Kazdin, Kahn Aademy, Learning strategies, Ritalin, The Kazdin Method for Parenting the Defiant Child

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The Myth of Ritalin’s Effectiveness

Post author By Dr. Jeffrey Rubin
Post date December 21, 2014
25 Comments on The Myth of Ritalin’s Effectiveness

In a recent post titled ADHD and Psychiatric Name Calling, I reviewed studies documenting how much is currently being spent annually on ADHD drug treatments. Here are some new numbers provided by Healthline: What are we getting for this? In this post I hope to clarify this issue. As you read it, you will see phrases in blue. By clicking on each, you will be taken to the actual research article that documents my statement.

For students placed on Ritalin or other stimulant drugs, in short term studies teachers and parents report some improvement in behavior. However, even in the short term, the vast majority of research indicates that there is no improvement on academic functioning. At the end of 14 months, drug treatment was not superior than no-drug treatment on the following measures: classroom observed behaviour, parent- and teacher-rated social skills, parent-rated parent–child relationships, peer sociometric ratings, and academic achievement. By the end of three years there was no significant effects of the drugs on any measure. stomach and head pain And yet, parents who undeniably care about their children, regularly expose their children to the side effects of these drugs, as well as potential long term risks. Why? Because they are convinced that the helpfulness of the drugs outweigh those negatives.

What is it about these drugs that create the myth that the drugs are really helping their children? To understand how this myth is created, it will help if we first take a quick look at how people come to believe smoking cigarettes helps them to deal with stress, and drinking caffeinated coffee helps them to be more productive.

The Myth that Cigarette Smoking Reduces Stress.

In a study published in the American Psychologist, researchers found the following:

Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.

This paragraph just provides a summary of the research article that leads to its conclusion. In my view, the whole article lays out a very convincing argument that the relief from a drug withdrawal reaction that occurs each time a person ingests the drug can create the illusion that a drug is helpful. Moreover, I believe that this same argument can also be used to explain how a stimulant such as Ritalin can appear to be helpful even when it is not. Before we get to Ritalin, however, let’s first turn our attention to America’s favorite stimulant, caffeine.

My Personal Experience with Caffeine

When I was 18, I started college. My first class began at 8 a.m. Ugh! That meant waking up around 6 a.m. so I could wash up, have breakfast, and take the hour train ride.

Sitting down for breakfast, I decided to have my first cup of coffee. Both my parents drank coffee in the morning and throughout the day, too. I had heard that it gave you a boost when you were tired, and man, I was tired.

My first sip tasted rather bitter, so I dumped a couple of teaspoons of sugar in. Much better. Then came a little pleasant “up” sensation, but it was accompanied with a little stomach distress. Oh, well. Off I went and it wasn’t long after that I was drinking coffee regularly.

coffee3 As I entered into my twenties, I began to notice that in the morning before I got my first cup, I was irritable and struggling with sleepiness. With the first sips, ahhhh, relief.

In addition to my morning cups, I’d have a cup typically around 10 a.m., a cola with lunch, which has some caffeine in it, and a couple of cups after supper with dessert.

During my thirties, I began to develop headaches. I attributed them to stress.

coffee2 By the time I was forty, the headaches became so bad that I went to a physician who prescribed some pills. I don’t like taking pills, but the headaches were so bad that I thought maybe I should give them a try.

Before filling the prescription, I looked up information about it and found the prescribed pills were made entirely of caffeine. Then, I looked at the side effects and found that one of them was headaches. This surprised me.

Since I was already consuming caffeine throughout the day, and a side effect of caffeine was headaches, I thought maybe instead of taking the pills, the first thing I should try was to stop consuming caffeine.

Wow! Giving up coffee was not easy. For several days I went through a very rough period of headaches, feelings of depression, difficulty sleeping, and my brain seemed to be meandering through thick mud.

In retrospect, perhaps I should have tried tapering off coffee, reducing each week one cup at a time. But I did make it through the morass, and in a couple of weeks I was fine. And ever since, I no longer get any headaches.

More surprising is that when I wake up in the morning, by the time I wash up and sit down for breakfast, I’m every bit as awake as I used to become when I had finished my morning coffee. It is now clear to me that the exhausted, irritable feelings that I used to have before I gave up coffee was due to a caffeine withdrawal effect from going a whole night without having any. Throughout the day, I now find that I have a smoother ride and I am every bit as productive as I used to be when I was a coffee drinker.

The Myth of Ritalin’s Effectiveness

Ritalin, and most other drug treatments for “ADHD” are stimulants. And just as I came to mistakenly believe coffee helped me to be more productive, I think Ritalin’s effects lead to the same mistaken conclusion. And just like I didn’t attribute the side effects of caffeine to my coffee drinking, I think parents don’t realize how much of their child’s sleeping problems, headaches, late afternoon miseries are due to the drugs. And when parents try to withdraw their children from the drugs to see if it is really helping, as the withdrawal effects begin to become worse and worse, parents come to think that this is how their children naturally are when they don’t take the drugs.

Now, there is more to this story than I can reveal in a single post. For example, other factors that lead to parents thinking these drugs are more effective than they actually are is the clever advertisement of the drug companies. Moreover, in some cases, children, as they become older, typically mature at a certain pace. Thus, some children viewed as having ADHD problems completely grow out of these problems without any drug treatment. If this growth in maturity occurs shortly after a child begins to take the drugs, the improvement from natural maturity growth can be easily attributed to the effects of the drugs. When this happens, parents rave to their family members and friends that Ritalin saved their child, and they push other parents to do what they did–get their children on Ritalin.

And so, this is how I think the myth of Ritalin’s effectiveness is created. An initial improvement in behavior once the drug treatment begins; a slow tolerance develops to the drug so it becomes less and less effective, but this occurs over a period of time during which the child is naturally maturing. As a result, some parents don’t notice that the drug is becoming less effective. When parents do notice the decreased effectiveness of the drug, they often take the child to the doctor to get an increased dose. Again there is a boost in apparent improvement. As tolerance to the drug once again begins to occur, more time goes by, and of course there is more growth in the child’s natural maturity. This may lead to less attention problems, but the improvement is attributed to the drugs, rather than improved maturity. Whenever parents try to see if their child can do just as well without the drugs, the withdrawal reactions convince them that their child really needs the drug. Negative side effects of the drugs are attributed to other causes. Couple all of this with the clever advertisement campaign of drug companies, and we end up with a pretty impressive myth.

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Tags Adderall, ADHD, ADHD Treatment, caffeine's side effects, Coffee's side effects, drug treatment, DSM, mental illness, Myths, parenting, psychiatry, Ritalin

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ADHD or Attention Priority Difference?

Post author By Dr. Jeffrey Rubin
Post date December 8, 2014
14 Comments on ADHD or Attention Priority Difference?

A few years ago I worked as a school psychologist. One day the mother of a 12-year old boy, who we’ll call Pete, explained to me that upon the urging of one of his teachers, she took him to his pediatrician to be evaluated for ADHD. The pediatrician asked this mother a few questions, diagnosed Pete as having ADHD, and then wrote him a prescription for Ritalin. After reading the possible side effects of the drug, the mother became concerned and spoke to Pete’s father.

Pete’s father and mother were divorced. Pete lived with his father on weekends, and the rest of the time he lived with his mother. Upon hearing about the prescription for Ritalin, Pete’s father was very much opposed to his son taking any drug for treating this concern. And so, now the mother wanted to know what I thought should be done.

I explained that before I could make any recommendations, I would have to carry out an evaluation. As a student in the district that I served, there would be no cost to the family. Pete’s mother agreed to the evaluation.

First, I requested that the mother, father and each of Pete’s teachers fill out standardized questionnaires. The results indicated that Pete’s physical education teacher, art teacher and his father viewed his activity level and ability to pay attention as falling within the average range. Pete’s mother and academic class teachers generally saw him as having some problems paying attention. His math teacher, who had been the one to urge Pete’s mother to take him to the pediatrician, rated Pete’s ability to attend to his assignments as being way below average.

After looking at the results of the standardized questionnaire, I spoke to Pete’s father. He confirmed that it was his impression that Pete had no difficulty with either his activity level or paying attention.

“Do you mind describing a typical day that you have with your son?” I asked.

“Well, let’s see. Last Saturday, when we woke up, we went to play golf.”

“Do you walk the course, or ride in a cart?”

“We walk.”

“Pete doesn’t mind?”

“Not at all. He loves doing physical stuff like that.”

“After golf, then what did you do?”

“We went back to my place, I made some sandwiches, and then I read the newspaper while Pete worked on his drawing. He loves to draw, and he’s pretty good. Then we went in the backyard. I have a basketball hoop set up there and we shot around for a while. Then we started to get supper together.”

“Does Pete help you with that?”

“Yes.”

“Does he get distracted in any way when you two work on supper?”

“Not at all. He’s very helpful. Then we ate supper, went down to the basement and played ping pong for maybe an hour. Then we went upstairs and watched a movie.”

“When he watches a movie with you, does he appear to have difficulty sitting through it?”

“Not usually. Occasionally, the movie strikes him as boring. After the movie, he went to bed.”

“Does he have any trouble sleeping when he stays with you?”

“No. We do a lot of physical stuff that tuckers him out, and he ends up sleeping soundly.”

I then spoke with Pete’s mom. Consistent with how she filled out the standardized questionnaire, she confirmed that it was her impression that Pete did have difficulty paying attention.

“Do you mind describing a typical day that you have with your son?” I asked her.

“Well, yesterday, I got him up at 7 so he could catch the school bus on time. He complained the whole time he got ready. He hates the ride to school.”

“How long a ride is it?”

“An hour, and he says he doesn’t get along with the kids he rides with.”

“I see. He has to sit on the bus for an hour with kids he doesn’t like, then he’s in school sitting most of the time doing school work. Then he takes the bus home, sitting for another hour with kids he doesn’t like. For a boy his age who loves to do physical activity stuff, I could see how this could be hard for him.”

“Yeah, but other kids do it.”

“Most do. Please tell me what happened when he got home.”

“Well, I got home a little after he did. I started preparing supper, and that’s when I have him doing his homework. I sit him at the kitchen table where I can keep an eye on him while I prepare the meal. And he gets very distracted. He starts an assignment one minute, and I look over and I catch him doodling. Over and over again he gets distracted.”

“I see. After sitting most of the day, you have him sit and do his homework?”

“Yes. That’s when I can best keep my eyes on him.”

“How about the rest of the evening?”

“He’s fine then. Besides doing his homework, the only other time I have trouble with him is when I try to get him to clean up his room. He starts to do it, but when I look in a few minutes later, he has become distracted with something else.”

Next, I interviewed Pete. After some pleasant discussion I said, “Your math teacher says you have trouble paying attention in class. What’s up with that?”

“Aaaaa, he makes us fill out these worksheets doing the same problems over and over again. If I know how to do it, why do I have to keep doing 20 more of them? It’s so boring.”

“I see. Say, I hear that you like to draw. Would you mind drawing something for me.?”

Pete’s eyes light up. “Sure. What do you want me to draw?”

“Anything you like.”

Pete begins, and I notice he appears to become completely absorbed in the task. I start to try to distract him by making some extraneous sounds. He glances up to see what the commotion is all about, sees it’s nothing serious, and resumes work on his drawing.

A half hour later, he shows me what he has created. It’s an imaginative otherworldly drawing with spaceships and fascinating creatures. There is an excellent sense of shadowing. It’s far superior to anything I can create in the drawing department.

When I finished my evaluation, I informed the parents that in my opinion it is not in Pete’s best interest to view the concern that has been expressed about his attention as due to ADHD. A more apt description is to view Pete as having an “Attention Priority Difference.” School work was not a huge priority for him. He much preferred to draw and do more physically active tasks than is currently provided at school. These preferences may turn out to be his greatest values. He may someday find work that he truly loves in a field where his artistic interest and talent are crucial. And his interest in physical activity may keep him far more healthier than the many sedentary Americans who are at an increased risk of a number of real illnesses.

“Well,” said the mother, “will Ritalin help Pete with his Attention Priority Difference?”

To which I replied, “Consider an analogous situation. Suppose we identified a group of children who are not doing as well as most kids in physical education. Would it make sense to make up a pathological sounding term for these low-performing students, such as “Muscular Deficit Disorder” and then have doctors prescribe steroids for them?

“In my view, people have different interests and talents. This is a wonderful thing, not something that should be pathologized. We don’t just need every person in America sitting in ivory towers. We need, as well, artists, computer experts, magnificent athletes, hairdressers, and on and on.

“When I hear of a child placed on Ritalin, I become concerned about the child’s stomach, nerves, and brain. Drugs that have been said to be safe have turned out to be far more toxic than anyone ever dreamed of. I become concerned about the social misery that goes along with being singled out as a child that must take a pill to fix him. More than a few kids have told me that this became a dreaded experience.

“I believe that teaching children to turn to drugs when they are dissatisfied with their behavior or mood runs counter to a healthy lifestyle.

“I prefer to put forth a view that encourages us to teach our youth about the blessings of keeping our bodies in lifelong possession of its full youthful state by keeping their blood free of stimulants and narcotics. I wish to teach our kids that it is possible that the morning sun, air and dew can be sufficient powerful intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being—these are the directions I wish we would point to when we guide a child toward a more fulfilling life.”

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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 and social intelligence. To begin at the very first post you can click HERE.

Tags ADHD, ADHD Treatment, Attention Priority Difference, attention problems, DSM, paying attention, pediatrician, Ritalin

ADHD conflict resolution psychiatrists psychiatry Ritalin

ADHD and Psychiatric Name Calling

Post author By Dr. Jeffrey Rubin
Post date November 3, 2014
13 Comments on ADHD and Psychiatric Name Calling

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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Tags A.D.H.D., Adderall, ADHD, ADHD Treatment, mental disorders, mental illness, psychiatric disorders, Ritalin