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ADHD ADHD medication ADHD Research Attention Priority Difference

What’s Better, ADHD Or Attention Priority Difference?

Welcome to From Insults to Respect.

Recently, I came upon an article in The New York Times by Ellen Barry titled, “Autism, A.D.H.D., Anxiety: Can a Diagnosis Make You Better?” She begins by telling us about a woman in her early 50s who, upon getting a diagnosis of attention deficit hyperactivity disorder, “described it as a profound relief, releasing her from years of self-blame — about missed deadlines and lost receipts, but also things that were deeper and more complicated, like her sensitivity to injustice.” Other people Ms. Barry met who were given a “diagnosis” of autism spectrum disorder also experienced it as relief. Simply putting a name to it seemed to help.

Negative Effects Emerging

However, Ms. Barry notes that evidence is emerging that over the long term, diagnosing these conditions doesn’t help. “Yes,” she says, “there is a positive effect of lowered self-blame. But there is a negative effect as well–a greater pessimism about recovery.”

Defending her position, Ms. Barry describes a study that looked into this negative effect. The study identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had a diagnosis at age 9 showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept.

Other research found that those who were treated with A.D.H.D. medication, in the long run, did no better academically while suffering a variety of negative effects from the prescribed drugs such as becoming addicted to the drug, along with head and stomach aches,

Last year, a study found that even a medium strength daily dose of Adderall, the most commonly prescribed drug to treat A.D.H.D., more than tripled a patient’s likelihood of developing psychosis or mania. A high dose increased the risk by a factor of five. And yet, another study found that the height suppression found in earlier studies, which were thought to be temporary, found that nine years after treatment, the height gap remained. The subjects’ A.D.H.D. symptoms, meanwhile, were no better than those who had stopped taking the medication or who had never started.

Benefits To Realizing The Characteristics That Lead To An A.D.H.D. Diagnosis Are Often Not Permanent

Recent researchers have been discovering that A.D.H.D. behavior characteristics can be highly responsive to the environment. When the surroundings of a person with an A.D.H.D. diagnosis better matches the person’s interests and talents or home life improves, the behavior pattern that led to the “diagnosis” often improves as well.

We need people with different interests and talents to fill the various roles society values. Someone who enjoys painting houses might find sitting all day in front of a computer screen very boring, while others enjoy a job that has them engaging for hours on a computer. Fortunately, we have a need for both types, and conceptualizing one or the other as having a pathological condition does not appear to be helpful in the long run. Much better is to provide narratives that demonstrate people who find they are inattentive in certain settings, such as the typical school classroom, may very well do much better in some other environments better suited to them. More and more, research is demonstrating this is true.

In 2016, Arielle Lasky and other members of her research team published a paper that describes their discussions with subjects who had been given a diagnosis of A.D.H.D. as children, but were now in their mid-20s. Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.

The work environments where the subjects were thriving varied. For some, the appeal of their new jobs was that they were busy and cognitively demanding, requiring constant multitasking. For others, the right context was physical, hands-on labor. For all of them, what made a difference was having work that to them felt “intrinsically interesting.”

One subject, who was studying film in college, said that his ability to thrive in his chosen field made him question the years he spent being treated for A.D.H.D. “Originally, when I was first diagnosed with it, it was explained to me as attention deficit, just a lack of attention,” he said. “An ability not to have an attention span for very long. But I can have an attention span for extremely long for the things that I care about.”

A hairstylist told the researchers that her inability to concentrate in school vanished when she began studying hair. “If you sit up there and give me a lecture on a haircut, I will remember everything you said, word for word,” she said. “Stuff that I’m into, I am so immersed in it. But in school, it was awful.”

A young man who was training to be an auto technician said that in his new career, his A.D.H.D. was no longer an issue. “It’s just that I had to figure out what I wanted to do,” he explained. “I want to work with cars. I don’t get bored doing that. If people with A.D.H.D. are directed into areas where their strengths and interests lie, I’m pretty sure that they can naturally just go about dealing with it, instead of having to give people medications.”

Instead of characterizing A.D.H.D. as a  medical disorder, which tends to lead people to believe they are defective, perhaps suggesting to them that they may have an “Attention Priority Difference” might be better. For some children, a different school, or a different kind of school, might produce the same profound shift that we are finding in recent research studies.

In a 2021 review paper, researchers found 14 studies in which receiving an A.D.H.D. diagnosis seemed to create a sense of “empowerment” by “supporting a sense of legitimacy accompanied by understanding and sympathy as well as decreased guilt, blame and anger.” In 22 other studies this team found, “a biomedical view of difficulties was shown to be associated with disempowerment. By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation.” An additional 14 studies found that the diagnosis increased feelings of stigmatization. “The diagnosis can create an identity that enhances prejudice and judgment, which are associated with even greater feelings of isolation, exclusion and shame.”

Conclusion

Admittedly, the  A.D.H.D.medical model provides parents and students a simple explanation for their children’s problems that can bring about relief and reduce blame, at least in the short term. However, the Attention Priority Difference model can do this as well and more accurately reflects the latest scientific understanding that a student’s environmental context can dramatically alter the concerning behavior. Rather than our society spending millions of dollars on drugs that people have become convinced is a quick fix to these problems, the Attention Priority Difference idea can offer for many a valuable alternative. It can motivate schools to provide more varied classroom activities that are designed to better match the various interests and talents of their students who are bored with the traditional approach that has students sitting at their desks doing seat work for unbearably long hours.  And it can give these children a vision of their future in which things might actually improve — not because their brains are chemically refashioned in a way that makes them better able to fit into the world, but because they find a way to make the world fit better with whom they are.

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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

Categories
ADHD ADHD medication

ADHD Medications and Risk of Heart Disease

Welcome to From Insults to Respect.

As you no doubt know, a wide variety of people are being classified as having ADHD and prescribed psychiatric drugs. The pharmaceutical industry, with its enormous wealth, promotes the use of these drugs. Supporters of this drug approach often cast a disrespectful eye toward their critics while arguing that research supports their position. Meanwhile, a large group of scientific minded individuals, without the resources of the pharmaceutical industry to promote their position, are doing their best to inform the public of a completely different set of conclusions. To move this disagreement in a positive direction, every now and then I take a look at the most current research.

For example (see HERE), a few years ago I reported on a study that suggested that:

Children and adolescents who take medication for attention-deficit hyperactivity disorder (ADHD) show decreased bone density, according to a large cross-sectional study that appeared in the Journal of Pediatric Orthopaedics.

More recently, I reported on a study that provided the latest replication of other studies indicating that ADHD drug treatment provides no lasting benefits for students classified as having ADHD on academic achievement and social functioning. After the drugs’ short-term stimulant boost, tolerance to the drugs occurs and any perceived benefits wane. The illusion that the drug continues to be helpful even after tolerance to the drugs occurs when people try to get off the drugs. The uncomfortable withdrawal effects they begin to experience lead to mistakenly thinking that they perform much better when taking the drug. It takes time for the body to be weaned off these drugs before they can begin to return to performing as well as they were doing while they were habitually taking the drug.

Although the drugged ADHD students didn’t do any better by the time they graduated high school than the non-drugged ADHD diagnosed students, many endured uncomfortable drug side effects, such as sleep problems, headaches, stomach aches, and feelings of depression each evening when the drug wore off.

Thousands of dollars are consumed on purchasing the drugs that achieved some modest short term gains but have no lasting positive effects.

Today, we take a look at a new study that is even more concerning. Medical doctors are hired to improve their patients’ health. The earlier decreased bone marrow study raises concerns about this. The various negative side effects raises additional concerns. But this latest study really raises a red flag.

Published November 22, 2023, in the Journal of the American Medical Association: Psychiatry, is titled “Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases.” Following subjects for up to 14 years, the study concluded:

In this case-control study of 278,027 individuals in Sweden aged 6 to 64 years who had an incident ADHD diagnosis or ADHD medication dispensation, longer cumulative duration of ADHD medication use was associated with an increased risk of CVD [cardiovascular disease], particularly hypertension and arterial disease, compared with nonuse.

The study looked at all ADHD medications approved in Sweden during the study period, including stimulants (methylphenidate, also known as Ritalin) amphetamine (also known as Adderall), dexamphetamine, and lisdexamfetamine, as well as non-stimulants. Throughout the entire follow-up, each 1-year increase in the use of ADHD medication was associated with a 4% increased risk of CVD. Similar results were observed when the researchers examined children or youth and adults separately. Results from the study suggest that the CVD risk associated with ADHD medication is approximately 23% higher for those on ADHD medication for more than five years compared with nonuse. This association between cumulative duration of ADHD medication use and CVD was similar in females and males. The study’s conclusion states:

The results of this population-based case-control study with a longitudinal follow-up of 14 years suggested that long-term use of ADHD medication was associated with an increased risk of CVD, especially hypertension and arterial disease, and the risk was higher for stimulant medications. These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions on long-term ADHD medication use.

If Not Drugs, Then What

I discussed this topic extensively in another post (see HERE).  For now, I’ll just quickly summarize some of my favorite suggestions.

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.  healthymeditationA daily running program and meditation are just a couple of excellent ideas that I found quickly in a recent search of this sort.

Many of the suggestions indicate that they have research support demonstrating that they are effective (see for example the 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.

In a school setting, students classified as having ADHD qualify for an Individual Education Plan (IEP). Getting an extra period of recess time each day on their IEP can dramatically improve their behavior. Supporting this, according to one study, levels of inappropriate behavior were consistently higher on days when ADHD labeled students did not have recess, compared with days when they did have recess. Results also showed that the level of inappropriate behavior for all participants progressively increased over time on days when they did not have recess. However, this progressive increase did not occur on days when the participants had recess.

I also recommend going to the library to 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.

Another suggestion involves asking 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.

Kahn AcademyThis 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.

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.

OK, there are some thoughts on avoiding an unhealthy approach to dealing with the concerns that arise when a child is labeled ADHD. Feel free to express in the comment section below any disagreements with anything I’ve written or agreement, and if you have some suggestions for non-drug approaches, please let us know about this.

My Best,
Jeff

Categories
ADHD ADHD medication conflict resolution Ritalin

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.

boy-with-stomach-painBriefly, 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.”

school workIn 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.

chinese students“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:

school work bOn 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.

basketball-playersIn 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.