Absent Dad Hyperactivity Disorder

NSW is now the place for parents to get hard drugs for their children as taxpayer-subsidised prescriptions of Ritalin soared  43% to 162,692 in 2007.

The Royal Australian College of Physicians has controversially recommended training teachers to look for evidence of ADHD in students. Schools love this proposal as it will mean more money.

However, Dr Linda Graham, a senior researcher in the Faculty of Education and Social Work at Sydney University, said the approach would encourage teachers “to act as proxy-diagnosticians by looking for evidence of particular deficits, perhaps missing vital signs which may indicate other difficulties at home or with learning“.  She added that the proposal would either lead to drastic funding cuts for students with serious disabilities or that “special education budgets would skyrocket.” 

Medical experts are increasingly worried that doctors are “too readily” labelling children with ADHD and prescribing Ritalin, potentially putting them at risk of dangerous side effects.  When a similar trial was initiated in the U.S, diagnosed cases of ADHD increased by 600% as schools grabbed the extra cash.  Looks like Dr. Graham may have a point.

Methylphenidate (branded by Novartis as Ritalin) stimulates the brain by increasing levels of dopamine. Though still relatively new, it has already been shown to cause hallucinations, mood swings, nervousness, stomach aches, diarrhea, headaches, decreased sex drive, weight loss, gum and skin bleeding and high blood pressure.  

In short, i would sooner ask my children to drink bleach than take Ritalin.

I can already hear the sounds of ambitious tort lawyers preparing huge class actions.

36 thoughts on “Absent Dad Hyperactivity Disorder

  1. It’s rort, pom. Almost the entire class was on it when my kid was at a NYC school. Schools push it because it gives the teachers less work and the medical establishment pushes because it is seeing to be doing something, although to be fair a number of Docs are speaking up against it.

    This looks like the stolen generation for whites in terms of tort potential.

    I’m not even sure there is such an illness as ADD.

  2. It cannot be disputed that Ritalin is useful in some situations. There are high quality double-blind clinical trials that prove it. At issue is whether the drug is being used as soma for children.

    “..there is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a week-end, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon…” [Brave New World]

    According to the prescribing guide MIMS, treatment with Ritalin should only be initiated by specialist doctors with experience in the use of the drug. It also says, “If symptoms do not improve after dose titration over a one month period, the drug should be discontinued.”

    Any school, teacher or doctor that ignored such advice would be a sitting duck for a lawyer.

  3. I think Ritalin probably has its place just like anti-depressant drugs. Although I think it is most likely over-prescribed.

    A friend of mine is prescribed Ritalin and in the past I’ve tried a couple when out on the town – In my experience, it’s strong stuff! I definitely wouldn’t give it to kids unless they really needed it.

    I’ve heard that ADHD somehow relates to the balance functions of the brain. If my limited knowledge is correct, poor balance can be used to diagnose ADHD, and improving balance via exercises can improve ADHD.
    Sounds a bit far fetched, but I’d definitely look into this before medication. – Of course exercises and self improvment generally are a lot more difficult than unscrewing the cap on a pill bottle.

    I also wonder how ADHD correlates to poor parenting. Although “poor parenting” would be difficult to accurately investigate in a population study, I suspect ADHD incidence would be higher in kids that have a lower quality of parental care, indicating upbringing as at least a partial cause. And if environment is a cause as opposed to genetics, then it is much more likely that the condition can be reversed by correcting the environment as opposed to medication.

    I think it’s also important to notice the two fundamental problems here resulting in negative unintended consequences:
    1) State run education 2) Subsidies for pharmaceuticals.

  4. It’s rort, pom. Almost the entire class was on it when my kid was at a NYC school. Schools push it because it gives the teachers less work and the medical establishment pushes because it is seeing to be doing something, although to be fair a number of Docs are speaking up against it.

    This looks like the stolen generation for whites in terms of tort potential.

    I’m not even sure there is such an illness as ADD.

    No, it does exist but there is massive over diagnosis that has arisen in part because teachers are too often expected to provide input. There are plenty of clinical studies demonstrating distinct changes in neurobiology, specifically dopamine function.

    Yes, balance does seem play a part, even balance training has helped. This implicates the cerebellum but no-one really takes the cerebellum seriously. People still refer to it as fine tuning motor functions. It is involved in a great many functions.

    In the US parents push for Ritalin not just because of behavioral issues but it is a known cognitive enhancer and many adults use the drug or analogues of the same for that effect. In essence, put simply, it acts like amphetamines, which are great for enhancing memory and attention but only when used very judiciously. The difference is that amphetamines act by increasing dopamine output, Ritalin acts by impeding dopamine reuptake, as does cocaine … .

    Ritalin has its risks but when it works it works wonders. It does, however, impede IGF1, a critical growth hormone and this inhibition has implications for cerebral maturation and other conditions. However the data supporting the contention for deleterious effects from the same is scant.

    Modern day psychiatry, after decades of completely useless psychotherapy, has swung too far into biological reductionism, typically castigating behaviorist types because if something is biologically based they assume it will always require a biological intervention. This is nonsense and represents a profound misunderstanding of cognitive processes.

  5. John:

    I’m sure it has it’s uses. However these days they’re sticking a large % of classes on that stuff when all you have is over active kids.

    It’s over prescribed by leaps, which is really the problem we’re talking about.

    There are lots of quacks out there.

  6. The problem JC is not quacks but the mental health profession writ large. Essentially the same problem has occurred with antidepressants. All too often prescribed when plenty of others less invasive measures are available, like getting out and doing some exercise. Doh!

  7. Well put. My farther was a GP and his suggestion when a specialist put my son on this stuff was that I take the specialist to court. My son was lucky, I had independent advise.

  8. john

    interesting comments. are you suggesting that i should take some Ritalin if i need a bit of a pick-me-up after a heavy night on the cans?

  9. A shame that you haven’t read the actual draft Guidelines document

    Calochilus – do you think the fact that the draft document is 256 pages long will deter Joe Public?

  10. [i]If something is biologically based they assume it will always require a biological intervention.[/i]

    If something is biologically based, then wouldn’t you expect biological tests before prescribing a drug? Otherwise their methodology has a contradiction.

  11. If something is biologically based, then wouldn’t you expect biological tests before prescribing a drug? Otherwise their methodology has a contradiction.

    In relation to cognition and behavior the contradiction only exists in those who think we understand the relationship between neurobiology and behavior. No one doubts the serious nature of depression or schizophrenia yet the data on that is often all over the place. There is still no reliable test for depression, though glucocorticoid resistance, in some studies, is present in 40% of depressives. That is about the best you an hope for. Whoops, just read this last week: strong correlation with Toll receptors, these are receptors associated with inflammation. Not make sense? Learn the lesson, not much does there. However, if you have read Horrobin and understand something about how inflammation(Toll receptors are inflammation drivers)impacts cognition, and then reads a 2002 paper: Cytokines and Depression: the Need for a New Paradigm(many cytokines activate Toll receptors), you begin to realise just how bloody little we know about what is going on upstairs.

    Yes, Ritalin is now a significant black market drug pommygranate.

    The draft recommendations make sense. For example, they state that neuroimaging and neuropsychological studies are of limited or no benefit(Grade D). No surprises there, as I mentioned above the same argument can used in relation to some other mental illnesses.

  12. Whoops, wrong thread

    Wow, pleased to see this in the draft

    The precise mechanisms involved in the neurobiology of ADHD are not fully
    understood. The dominant current paradigm suggests that disordered fronto
    striato-cerebellar brain circuitry

    Cerebellar = cerebellum. Hmmm, that clinical psychologist in Canada kept ranting at me about the neglect of the cerebellum. Good to see that is changing. Hence my earlier ref to the same above. It is also important to note that they also assert there is a neurobiological basis to this but at present it is poorly understood.

  13. Yes, Ritalin is now a significant black market drug pommygranate

    Always has been. John. It was around at the same time LSD was a big thing. Ritalin heads could focus on a manhole cover all day and still be enthralled at dusk.

  14. Strange thing about LSD JC, a number of clinical trials have found it can be very useful in treating alcoholism. Just one trip, under the right conditions. Related results are now being found with other like drugs. Strange and very difficult to understand. Now I must get up early and go gold top hunting …

  15. FREE HELP FOR THE EDUCATIONALLY CHALLENGED

    http://www.TheEasyEssay.com is a free site that has had excellent results in teaching the learning disabled how to better communicate.

    http://www.TheEasyEssay.com, an automated information organization program is also of use for business reports, inter-office communications, special and rehabilitative education, as well as speech organization.

    It has been taught to individuals from eight to eighty and been used from elementary education to post graduate work and is excellent for SAT, ACT, and FCAT preparation.

    The program allows for each individual to progress at his or her own rate.

    We have also received excellent reports relating to ADHD and Special Education.

    A noted side effect of the program is that users begin to communicate logically.

    As an aid in research, the site is linked to Google®.

    For longer papers it can automatically expand into a 17 paragraph thesis.

    The Easy Essay is usable in any language.

  16. Perhaps a good place to start in helping these children is to look for possible causes. This is done for many conditions but is rarely considered for the child who has been labeled as “ADHD.” But there are many things that have been identified as triggers for ADHD symptoms. These include: exposure to heavy metals like lead and mercury, food and/or envirnomental allergies, sensory deficits, vision deficits, side effects of medicine, vitamin deficiencies, mineral deficiencies, essential fatty acid deficiencies, and most of all — reactions to petroleum based food additives such as synthetic dyes.
    The Lancet study from 2007 has convinced many former skeptics that perhaps thousands of parents were right…that their children behaved differently after they ate brightly colored synthetic foods.
    For more than 30 years the non-profit Feingold Association of the US has been helping families run a simple test to determine if the worst of the additives are triggering the reactions they see in their children. There’s a great deal of information at http://www.ADHDdiet.org.

  17. Good points Jane, and the comments re food additives are particularly relevant. It should lead to massive class actions against the relevant entities because there has been sufficient data on that and many parents have seen it with their own eyes. EFAD – essential fatty acid deficiencies, can severely impact on cerebral maturation and many studies indicate sub clinical EFAD across the population.

    Your comments re nutrition and contaminants are also very relevant, ADHD types have, on average, smaller brain sizes, loss of prefrontal function, markers indicative of neurological insult.

    How’s this for spooky though, I read a rat study many years ago which showed the caesarean type births resulted in prefrontal functions similiar to ADHD types. And just to get really confused, a study released today showed that caesarean births give rise to significantly higher type 1 diabetes rats in humans. Very weird.

  18. This set of symptoms was taken from MiMS, which in turn was summarised at http://www.mydr.com.au/default.asp?Article=2221

    Inattention symptoms

    * Finds it hard to concentrate
    * Makes careless mistakes
    * Does not seem to listen
    * Avoids difficult tasks
    * Becomes distracted easily
    * Is disorganised and forgetful
    * Does not follow through on instructions, can’t finish work

    Hyperactivity / impulsivity symptoms

    * Tends to fidget or squirm
    * Gets up during class when not supposed to
    * Runs about or climbs in inappropriate situations
    * Has difficulty playing quietly
    * Often interrupts others
    * Finds it hard to wait for a turn
    * Often ‘on the go’ or acts as if ‘driven by a motor’
    * Talks excessively
    * Blurts out answers before questions have been finished

    Perhaps these could be summarized with a catch-all symptom:

    * Tends to act like a child !!!

    tim c

  19. Perhaps a good place to start in helping these children is to look for possible causes.

    Jane – some other possible causes;

    boys being boys
    weak parents
    absent parents
    poor diet

  20. For all you doubters about the reality of ADD, please tell me why it is a common problem post brain injury.

  21. John — pointing to brain injured patients and inferring things about child behavior from it is essentially useless for things like ADD. Its common because when various areas of the brain that control attention, like the cingulate, get damaged, it not surprisingly cause symptoms of attention loss. However, simply showing similar symptoms in two disorders doesn’t mean the underlying cause is the same (e.g., your car doesn’t work because of rust, mine doesn’t work because something is broken).

    I think the problem is that ADD is a disorder whose symptoms are generally on a contiuum, and it inevitably gets diagnosed with things like the DSM. This leads to lots of problems. The first is that there’s no clear line when to decide a symptom as defined in the DSM happens to be a real symptom or not. Your loud behavior is my attention deficit disorder. Second, the DSM is basically a manual of symptoms based on observation rather than underlying theory, yet it gets used the bible in some areas (medicine). Third, and unrecognized by the DSM, it’s generally believed there qualitatively different forms of ADD, and this goes unrecognized (and hence what best could be done to solve these problems does also). Fourth, there’s almost no money to made for behavioral interventions, whose efficacy is often far better than drugs, thus they don’t get done. Fifth, there’s few long term studies of what the effect of giving kids with varying levels of symptoms drugs has on their longer term outcomes.

  22. Mark, Conrad,

    I’m simply pointing out that it is a read condition. Yes, doctors over diagnosis it far too much and yes it is a continuum type condition, but the fact remains it is a real condition and it is very silly for people to deny it just because of a few anecdotal examples.

    Conrad,

    One of the strange things about ADD and TBI is that irrespective of brain injury site ADD can emerge, this may relate to shear stress and DAI; particularly if the cerebellum is involved. FWIW, I also believe that schizophrenia is an “umbrella diagnosis”. Brain injury of any type can induce symptoms unrelated to the site of injury. These include depression, HPA axis dysregulation, circadian dysregulation, and often psychosocial issues. These symptoms can even arise with so-called mild brain injury. TBI is also a big risk factor for dementia.

    BTW, the guidelines clearly specify behavioral over drug interventions. I have been a strident critic of excessive focus on drugs in psychiatry in general. There is money in drugs but not in behavioral interventions. So I am pleased to note that both the medical profession and the research community has been screaming blue murder at the pharmas for many years now. Too many dishonest studies coming out of their labs.

    Ritalin has a significant impact on IGF 1, not good. Again, the guidelines now address this but the data on that has been around for many years but is ignored too often.

    Mark, I have a style of adult ADD. Not good in my case. Here’s a perverse twist to my case, my site of injury may have even increased my intelligence, or at least my working memory capacity.

  23. John,

    I’m well aware that you can get ADD like symptoms from many types of brain injury, rather than just attention related circuits. In the best case, all this is telling you is that ADD symptamology can be caused by many different processes — and hence there is going to be no single wonder drug to fix all ADD problems and nor should ADD be seen as homogenous. In the worst case (which is my preferance), its probably not telling you much about developmental disorders, aside from the fact that DSM type categories are categories of convenience, not categories based on theoretically categorical constructs.

  24. Yes Conrad,

    The same can be said of schizophrenia and depression. I read so many studies about the neurobiology of depression that I despaired of ever developing an adequate theoretical structure to explain it. The modulatory hypothesis has died on the vine and about bloody time.

  25. They’re all hypothesis graveyards as far as I can tell. A big problem is (was) that a huge amount of research is done by doctors that have tried to find taxonomies of symptoms, which doesn’t get you very far theory-wise. The other problem is that all a lot of them care about is neural-correlates, which means they’ll get no-where in my books — a lot of the problem is due to behavior that things like fMRI and EEG are not sensitive to.

  26. A recent bio-ethnological study showed that a small group of African tribes have a substantially higher rate of ADD than other populations in Africa and around the world. The tribes don’t view this as an illness, and researchers posit that it is beneficial in an environment where the survival of the people is dependent upon how vigilant they are at noticing potentially dangerous changes in their surroundings.

    Especially with behavioral disorders, medical professionals can be bad at acknowledging the relativity of a pathological behavior, deciding when a behavior is “pathological” or simply different and slightly unmanageable. Moreover, some medical professionals think very little about the potentially negative side effects of prescribing a medication or procedure that is billed as effective, and some even have big pharma sales rep soothsayers at their ears. There are more than enough lawsuits and violations of the FDA process to back up that latter point.

    Talk to any of these kids on ritalin, and they’re also miserable emotionally. Trust your doctor, but do your own research and ask lots of questions. Remember that lobotomies were billed as a simple and safe procedure that calmed recalcitrant children down, except for the small caveat that they often turned children into vegetative retards and stripped them of their humanity.

  27. Talk to any of these kids on ritalin, and they’re also miserable emotionally. Trust your doctor, but do your own research and ask lots of questions. Remember that lobotomies were billed as a simple and safe procedure that calmed recalcitrant children down, except for the small caveat that they often turned children into vegetative retards and stripped them of their humanity.

    It has become rather silly. Two weeks ago a huge ruckus over the number of doctors writing the ADD\ADHD treatment guidelines were found to have received buckets of money from drug companies. Really, anyone receiving money like that should not be relied upon to be objective. We need to get over this stupid idea that in spite of conflicts of interest people can retain objectivity and rationality. There is no evidence to support that contention and plenty to suggest otherwise.

    Conrad, I studied brain injury for a quite a while and we were surprised at how frequently attentional problems arose from even mild brain injury. As to “attentional circuits”, a long time ago I read about the Waddington\Shallice model. It don’t work, these days I’m more inclined to a Lashley mass action hypothesis but still guessing. Always guessing, except on TV and in the clinic, where too many proclaim too much on the basis of too little.

  28. John H. Do you have a source link for the story about the treatment guidelines for ADHD and the connection to drug companies? I’d like to read it and pass it on.

  29. Cheers for that. I don’t know much about the subject but it has always intrigued me why we have so many cases of ADHD and kids on ritalin these days. I’m sure there are several factors at play but I’m not surprised to hear that this is one of them.

  30. From the time ive spent on ritalin (or at least what the kids call “dexies” nowadays – unprescribed) its made me feel great.

    ADD was just something that didnt exist when I was a kid. Maybe I have it, maybe I don’t. All I know is that ritalin makes me enjoy myself more than I would than if I went to bed early due to fatigue.

  31. Yes Yobbo and you are a good example of what people forget: when the drugs work they work wonderfully well. I’m not against drug use per se but I am concerned about its over riding emphasis in the clinic. Ritalin simply boosts dopamine levels, it is even a good idea for the aging brain and in part because it inhibits IGF1. May sound paradoxical but reducing growth hormone in aging bodies can be a very good thing. Caloric restriction markedly inhibits IGF1 and does wonderful things for the aging brain. cf. Mark P. Matson: starve me and watch my brain run.

    Those who outright reject the use of these drugs are engaging in hysterical prejudice.

Comments are closed.