In 2006, Laurence Jerome, a Canadian psychiatrist, and two colleagues wrote a paper titled What We Know About ADHD and Driving Risk: A Literature Review, Meta-Analysis and Critique. It was published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry in August, 2006. The primary result of the meta-analysis was:
“Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers.”
The study is lengthy and well-referenced, but in keeping with standard psychiatric practice, it conceptualizes and presents ADHD as a “common psychiatric disorder” with symptoms of “inattention, impulsiveness and hyperactivity.” In other words, they present ADHD as something that a person has rather than as something that a person does. The problem with this approach is that it creates the impression that meaningful or significant correlations/effects have been found, where in fact all that has happened is an elucidation of the terms used.
For instance, the authors refer to a study by Fried et al. (2006) and state:
“Fried et al. (2006) evaluated driving behavior using the DBQ [Driving Behavior Questionnaire] and found that the ADHD group had significantly more lapses, errors and violations than controls.”
On the face of it, this looks like an interesting finding. It purports to be an important fact that has been discovered about people who have this condition. But in reality, lapses, errors, and violations are an integral part of the definition of ADHD. The DSM criteria includes: careless mistakes; difficulty remaining focused; mind seems elsewhere; easily distracted; forgetful; etc . . . One doesn’t get into this group in the first place without a history of habitual lapses, errors, and violations. The fact that these habitual lapses and errors carry over into a person’s driving behavior isn’t particularly surprising.
There are several other examples of this in Jerome et al., e.g.:
“A number of studies examined cognitive abilities associated with safe driving performance. Measures of both inattention and impulsivity were found to be higher in the ADHD groups as compared to controls.”
Here again, inattention and impulsivity are defining features of the condition labeled ADHD. All that has actually been found here is that people who are inattentive and impulsive are inattentive and impulsive! The study reports that people who carry a “diagnosis” of ADHD are involved in more collisions, and receive more traffic citations than controls. This is interesting, but again, hardly surprising for the reasons discussed above. One could look at all this simply as benign, meaningless verbiage, but in reality, the constant repetition of these factoids reinforces the notion that the label ADHD refers to a real illness, and that this “illness” has real sequelae, in the same way that kidney failure, for instance, usually entails edema and anemia.
Effects of Psychotropic Drugs
The authors discuss several studies on the effects that stimulant and non-stimulant drugs that are used to “treat” ADHD have on driving behavior. The results were mixed. The authors draw attention to some methodological problems in this area and also concede that “…all currently available studies are industry sponsored.”
Dr. Jerome, et al., posit a neurological deficit as the source of the impulsivity and inattention.
“Core functional impairments in executive function related to response inhibition, working memory and flexible strategic response help explain both general ADHD pathology and its specific manifestations in problem driving in this group.”
This paper, as noted earlier, was written in 2006. Note the cautious language in the quote above: “help explain…” Today, eight years later, there’s still no definitive neural pathology known to be causally associated with these problem behaviors, and the “illness” is still being “diagnosed” by subjectively assessing – and counting – the individual’s actions. In fact, and this is particularly compelling, the American Academy of Child and Adolescent Psychiatry in its current practice parameters for ADHD state unambiguously that unless there is a clear history of severe head injury, or other neural pathology
“. . . neurological studies . . . are not indicated for the evaluation of ADHD.” [Emphasis added]
At this point Dr. Jerome, et al., make the great leap of faith:
“…it was not the knowledge base of driving skills that differentiated the driving problems in ADHD youth so much as their inability to apply these rules at the appropriate time and under the appropriate circumstances. In other words the problem is an output problem; they can ‘talk the talk but they can’t walk the walk’.” [Emphases added]
Note the words “inability” and “can’t.” This is one of the fundamental problems in the “diagnosis” of ADHD and other psychiatric “illnesses” – the logically flawed leap from “doesn’t” to “can’t.” And this unwarranted leap is the basis for the conclusion that the individuals in question have an illness, and, in extreme cases qualify for disability. A person with kidney failure doesn’t and can’t produce urine. But a person “with” ADHD can, with proper training, learn to behave in a more attentive and less impulsive manner.
In former times, children who were routinely inattentive and impulsive were considered to be in need of training and discipline. By and large, school teachers and parents provided this. In fact, the training was usually provided before the matter even became an issue. Today these children are spuriously and arbitrarily labeled as ill, and are given pills. The pills suppress the problem behavior but in many, perhaps most, cases the underlying problem of self-discipline is never addressed. So these children grow up and, not surprisingly, they become inattentive and impulsive drivers, with a reportedly 50% increased risk of negative driving outcomes. The “diagnosis” of “illness” contains within itself the disempowering, and incidentally false, message that the individual was incapable of acquiring the level of discipline, attention, and self-control needed for successful classroom participation. Psychiatry has given these parents, and the children themselves, the false message that their brains are malfunctioning, that the pills will correct the problem, and that attempts to teach discipline and self-control in the normal manner are futile. With pharma-psychiatry’s successful expansion of this “diagnosis” to the adult population, the disempowerment has become a more-or-less permanent “disability.”
The role that the initial “diagnosis” and subsequent drugging played in transforming what used to be an eminently remediable problem into a permanent disability is seldom addressed or even acknowledged. The psychiatric fiction has to be maintained: these individuals were “sick” as children and are still “sick” as adults. Their inattention and impulsivity are still “symptoms” of the same debilitating “illness.” Psychiatrists for the past sixty years have insisted that they are discovering real illnesses. They remain self-servingly blind to the fact that, firstly, they invented these illnesses, and secondly, that their active promotion of these “illnesses” has created a culture in which personal effort and self-discipline are routinely marginalized in favor of the spurious and inherently disempowering notion of pharmaceutically correctable impairments.
Jerome, et al., do give passing acknowledgement to the need for “psychological strategies,” but it is clear that they conceptualize the matter as a medical problem with a pharmaceutical remedy:
“Experimental studies indicate that stimulants and to a lesser extent non-stimulant drugs used to treat ADHD improve areas of driving performance.”
These, incidentally, are the same industry-sponsored studies mentioned earlier.
“In particular the question of adherence to medication regimens over time to improve driving skills is likely to be a critical question based on our knowledge of poor long-term medication adherence for young adults with ADHD.”
“The individual attending physician has an opportunity to reduce morbidity and mortality for the individual ADHD patient as well as contribute to improved public health for the driving population at large by making the roads safer one driver at a time.”
“A number of jurisdictions including Canada and UK now require physicians to report ADHD drivers thought to be at risk of problem driving to the Ministry of Transportation.”
“The question of medico-legal liability is in its infancy with no established case law for physicians found negligent of failing to adequately treat ADHD patients with the appropriate medications to reduce driving risk. Whilst the available literature does not yet provide clear evidence that stimulant medication should be the standard of care for problem drivers long term, it is probably only a matter of time before this question will be debated in a legal arena.”
At the present time the pharma-psychiatric system is being widely exposed as the spurious, destructive, disempowering fraud that it is. Organized psychiatry is responding to these criticisms not by cleaning up its act, but instead by increasing its lobbying activity in the political arena.
In particular, they are actively promoting the notion of involuntary community “treatment” with coerced “medication.” Under this system, which is established by law in more than 40 US states, a judge can order an individual to attend the local mental health center and to abide by the center’s “treatment” plan. The plan usually entails a requirement to take psychiatric drugs, sometimes the long-lasting injectable variety. Here’s how Jeffrey Lieberman, MD, President of the APA, describes the program:
“There’s also other forms of psycho-social treatment that are very, very helpful. Sometimes people who have schizophrenia don’t want treatment, or don’t feel they need treatment, or just plain forget about treatment. In those cases, with what’s called assertive community treatment, a case manager or somebody that’s assigned to work with that person will go out to find them, will go to their home, you know, ‘You haven’t come to the clinic, you haven’t come to the office, you haven’t shown up, what’s going on here, you need to get your medication, you need to go through your rehabilitation,’ so they’ll get after them.”
This all sounds very cozy and friendly, and you know – come on down to the mental health center, you know, we care about you, etc., etc… But within the silk glove, there’s the mailed fist of confinement and coerced drugging. Readers can check out the other side of the story at National Coalition for Mental Health Recovery, PsychRights‘ page on OutPatient Commitment, and by searching for assertive outpatient commitment on Mad in America. Dr. Lieberman is talking about people labeled with schizophrenia, but it doesn’t take too much imagination to see how the concept could be adapted to a wide range of other “diagnoses,” including ADHD.
As of yet, the ominous prediction in the final Jerome et al. quote above has not come to pass. But is the day approaching when individuals “diagnosed” with ADHD during childhood will be subjected to special screening when they apply for a driving license? Might their licenses be made contingent on their ingestion of psychoactive drugs? After all, impulsive, inattentive drivers constitute a danger to themselves and others. If, as psychiatry claims, their impulsivity and inattention are the result of a “mental illness,” then doesn’t it make sense that they be committed? Isn’t it in their own interests and the interests of the public at large that they be coerced to take their “medications”? Such a move would be consistent with psychiatry’s long-standing expansionist agenda and with pharma’s objective to sell more drugs.
And lest my concerns be considered groundless speculation, here are some interesting quotes.
From Oren Mason, MD, a blogger physician, co-owner of Attention MD, and associate professor at Michigan State University. He specializes in the “…diagnosis and management of attention deficit disorders and related conditions” (Ritalin Saves Truckers’ Lives. Soccer Moms’, Too, February 2014):
“There is a public health issue when inattentive or impulsive behaviors occur on busy, public streets and highways.”
“…we could potentially prevent 100,000 injuries and deaths every year with consistent use of ADHD medications.”
Incidentally, according to Dollars for Docs, Dr. Mason received $208,459 from Eli Lilly for speaking, consulting, travel, and meals between 2009 and 2012.
And from Brian Krans, an assistant editor at HealthLine News (Could Ritalin Be the Way to Keep Truckers Safe on the Road? January 2014):
“Another new study says that undiagnosed attention-deficit hyperactivity disorder (ADHD) may be the cause of many safety issues for drivers on the road.”
Note how ADHD has become the cause of the problem behaviors, rather than just another name for them.
“… research shows that medications like Ritalin and Adderall may be beneficial to help them increase reaction time [presumably should read decrease], reduce accidents, and ultimately save lives.
Interestingly, Healthline.com runs a good many ads for ADHD “medications.” They are clearly marked Advertisement, but the font is very small.
“So, should truckers be screened for ADHD instead of self-medicating with harder drugs?”
There is an implication here that ADHD “meds” will reduce the incidence of truckers driving under the influence of speed. In fact, Ritalin and most other ADHD “meds” are stimulants and are widely abused. RitalinAbuseHelp.com states that
“Ritalin is taken by recreational drug users for its cocaine-like high.”
“Ritalin is taken by workers such as truck drivers to stay awake for long shifts.” [Emphasis added]
Here are some more interesting quotes:
From the American Academy of Pediatrics’ 2011 practice guidelines on ADHD:
“Given the inherent risks of driving by adolescents with ADHD, special concern should be taken to provide medication coverage for symptom control while driving. Longer-acting or late-afternoon, short-acting medications might be helpful in this regard.”
And from the American Academy of Child and Adolescent Psychiatry’s ADHD Practice Parameters:
“Single daily dosing is associated with greater compliance for all types of medication, and long-acting MPH [methylphenidate] may improve driving performance in adolescents relative to short-acting MPH…”
And from psychologist Russell A. Barkley, PhD, Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina in Charleston, and author of numerous books and studies on ADHD, quoted in this New York Times article from 2012:
“Medication [for drivers who have ADHD] should not really be optional…”
And Dr. Barkley is an eminent man. I know this because on his website it says that he is “…an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults . . .” I also know that he is conscientious and caring. His website states that he “. . . has dedicated his career to widely disseminating science-based information about ADHD.” If proof is needed of his dedication to disseminating information, one need only open the “books” tab on his website. He has 16 different titles for sale at prices ranging from $14.41 for some paperback book versions to $131.75 for his rating scale books. One can also subscribe to his newsletter ADHD Report for $105 per year.
Dr. Barkley is well-regarded by the pharmaceutical industry. Dollars for Docs reports that between 2009 and 2012, he received $120,283 from Eli Lilly alone, for consulting, speaking and traveling. In February of this year he conducted a five-day, multi-city lecture tour of Japan sponsored by Eli Lilly. And according to his CV, in 2004-2005, he was awarded a grant of $99,750 from Eli Lilly to study the “Effects of atomoxetine on driving performance in adults with ADHD.”
Dr. Barkley has also reportedly served as a consultant/speaker to Shire, Medice, Novartis, Janssen-Ortho, and Janssen-Cilag.
Dr. Barkley played a significant role in the relaxing of the age-of-onset criterion from 7 to 12 in DSM-5. As early as 1997, he and the equally eminent Joseph Biederman, MD co-authored Toward a Broader Definition of the Age-of-Onset Criterion for Attention-Deficit Hyperactivity Disorder (Journal of the American Academy of Child and Adolescent Psychiatry, September 1997). In this article they state, apparently without the slightest hint of irony:
“We can see no positive benefits of the recommended AOC [age of onset criterion] except that it would certainly limit the number of children (and probably adults) with diagnosed ADHD. Some special education districts or managed health care companies who might wish to restrict the access of those with ADHD to their services could conceivably see such a restriction as advantageous, but this is purely financial self-interest.”
So, all things considered, when Dr. Barkley tells a New York Times reporter that medication for drivers with ADHD “should not really be optional,” perhaps we should be concerned.
Over the past 60 years, pharma-psychiatry has demonstrated, time and again, that there is no human problem that they can’t exploit for their own benefit and, in the process, make ten times worse. I will be watching this latest foray into road safety with trepidation.
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This article first appeared on Philip Hickey’s
website, “Behaviorism and Mental Health.”
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.