‘ADHD’ and Dangerous Driving

Philip Hickey, PhD
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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.”

Neurology

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.

and

“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.”

and

“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.”

and

“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.”

and

“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.”

Discussion

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.”

and

“…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.

and

“… 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.

and

“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.”

and

“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.

* * * * *

This article first appeared on Philip Hickey’s
website, “Behaviorism and Mental Health.”

 

24 COMMENTS

  1. ‘ADHD’ and Dangerous Driving

    Dextroamphetamine is also widely used by military air forces as a ‘go-pill’ during fatigue-inducing mission profiles such as night-time bombing missions.

    http://en.wikipedia.org/wiki/Dextroamphetamine

    I was on Dexedrine and ya , driving fast was fun as hell on that stuff sharp as a tack focused on out front and watching for cops in the rear view at the same time.

    I go nuts when the light turns green and I am 15- 20 cars back and everyone just sits there, what the hell GO !!! Get TF of the phone, get your finger out of your *** and GO ! It’s funny when I am the first car at the light, I take off and I know someone else like me sees this but is stuck behind the slugs and has to wait for them to move.

    Dexadrine…

    Driving that train, high on cocaine,
    Casey jones is ready, watch your speed.
    Trouble ahead, trouble behind,
    And you know that notion just crossed my mind.

    This old engine makes it on time,
    Leaves central station bout a quarter to nine,
    Hits river junction at seventeen to,
    At a quarter to ten you know it’s travlin again.

    Driving that train, high on cocaine,
    Casey jones is ready, watch your speed.
    Trouble ahead, trouble behind,
    And you know that notion just crossed my mind.

    Trouble ahead, lady in red,
    Take my advice you’d be better off dead.
    Switchmans sleeping, train hundred and two is
    On the wrong track and headed for you.

    Grateful Dead – Casey Jones http://youtu.be/6VIECzlFVUM

  2. One reason they may be emphasizing this is because reduced accident is the only, and I emphasize ONLY, long-term outcome area where stimulant treatment has shown any advantage. Of course, if they did a study of “normal” people on stimulants at lower dosages, they’d find improved attention and fewer errors, too, so it’s not an impressive finding. But given that school grades, academic achievement test scores, dropout rates, college enrollment, delinquency rates, teen pregnancy rates, addiction rates, social skills, and self esteem are ALL at best unaffected by long-term stimulant treatment (and the Raine study in Australia showed dropout rates to be much WORSE for stimulant users), they have to grab onto the only straw they’ve got.

    The figure of 100,000 injuries and deaths presented seems absurd on the face of it, and I wonder where that figure comes from. The TOTAL deaths from MVAs in the US in 2009 was just under 36,000. It stretches credulity to think that enforcing stimulants on the <10% of drivers who might be diagnosed with ADHD would make even a tiny dent in that figure (pun accidental!)

    Bottom line, more propaganda. If this is the only area of improvement they can point to, their model of treatment is pretty lame.

    — Steve

  3. I think it’s only in the United States that when the light turns green people just sit there talking / texting on there phones and/or with a finger or two in there rear end instead of stepping on the accelerator . Maybe we should label these people as “sick” ?

    I have been to countries in Europe and also to Mexico. I noticed when the light went green in those places the whole stream started moving almost right away. They also don’t jam up the left lane.

    Ride in a Ferrari F12 Berlinetta on German Autobahn http://youtu.be/y4IVY_9I-BA

  4. Dr. Hickey, You keep it plain to see that the forceful repetition of psuedo-facts constitutes the deliberate (very successful) effort to indoctrinate us all with psychiatro-babble. The lay public is a prime quarry along with whatever professionals there are who rather would not have to give up on sound-bytes that they can charge for while justifying them as the mainstream understandings of modern medical problems and solutions.

    Idolizing reifications like PTSD and ADHD and OCD happens at the most integrated levels of psychiatric knowledge and information dissemination activities and in the highest centers of learning. I find it harder to discern how these learned pundits actually stand than to see that their arguments are vacuous proposals that clearly go no further than mimicry of cause and effect explanations.

    Your painstaking attention to this predominant feature of materialistic propaganda for orthodox diagnosis and treatment (and billing, billing, stifling the competition, and billing) is a big help in keeping our ideas clear between what possibly helps (like responsiblity and self-understanding) and what simply are matters of conforming to the role of a patient. What a sham it is that if we are agreeing with perceived authorities in clinical situations this means we are “better” and that we can say so with a docile expression and in compliance means that we were helped.

    It obviously is always enough to satisfy the vast majority of clinicians to let matters stand just at that, and if shown a happy face very few will ever inquire after the deeply concerned one that they used to hear from.

    I truly hope that many, many psychologists will begin to follow this line of reasoning that you develop more readily, and more commonly state their concern, in regard to people who need and want their services, about the impediments presented by letting clients subsist on the pseudo-knowledge of specific, autonomous, materially active brain processes getting identified and treated under the names of these aggregative categories of psychological dysfunction that are not based on the discovery of neurological abnormalities.

    I recall the arch-biomedico-ideologue Ronald Fieve, M. D. revealing his position on the bipolar diagnosis in light of an ostensibly ongoing disagreement with the deceased Lawrence Kubie in the first pages of Moodswing. Kubie had pointed out (from beyond the grave, I guess), in a letter to Fieve, the really undetermined functional status of a true disease entity for mania or depression. I was grateful to learn of it, despite Fieve’s intending to marginalize the opinion. Still, it is so far and few between for comments like that from professionals in mental health.

    At least as important as inexistence is the fact that we are so very unlikely to ever get around to locating brain dysfunctions and brain deficits that we can group together and fit into neat columns headed by such labels as the series of DSM’s posit, since the organismic complexity, fragility and vitality of the living person’s brain prevent true, rational optimism about such great, out of this world leaps in the detection of physical abnormalities. What is the record to date? O%, right?

    For example, I believe that something less than optimal at a physical level causes most of the undesired features that I experience and can gesture toward by saying “depersonalization” or “derealization”. This is better than having no words at all, but is not much better than saying “unhappy” or “bad mood” as far as the lack of qualification about just what is and is not the problem… and for whom, since the character of the distress and impact on persons must be as diverse as any of our other reactions are and can be.

    Furthermore, I wouldn’t get surprised that as many differences in brain state could lead to these “symptoms” as can lead to our various negative emotional experiences, if not more. And it is patently obvious, not merely on the face of it, that most everyone who ends up looking at themselves and worrying or believing that their problem is a psychiatric illness confronts some sort of traumatic consequence in respect of this concern they have taken, whether already thrust up into their face or left looming in the distance until they “get caught”. Honesty about this should be encouraged in every aspect of care and media promotion, and not written off as stigma due to superstition, since the compliance model and the disease model and the compassionate excuse model for involuntary treatment are the main engines of stigma, far outstripping any prevailing superstitions including the long list of myths already promulgated by the industry for its own benefit. In clinical situations, all types of staff show themselves ever so pleased to have the rhetoric of these myths approved of by the doctors and kept close at hand.

    One of the smartest conceptions of mental and emotional problems is just the basic fact that these are something that can happen to you in life, as Robert Whitaker says. Human beings can experience madness, but how could this ever be more medical than psychological at the personal level of things?

    The eugenicist and penalization and social control aspects of orthodox psychiatric opinion proliferate no matter what the crisis or opportunity is that faces the profession. Meanwhile, throughout the behavioral health field, most practitioners, no matter how well known or “right” they are, sit out the war, looking away from the problems ever so diligently. Why the continuing widespread neutrality and condoning, I have to wonder, from trade journals to waiting rooms?

    • travailler-vous,

      Thanks for your detailed and insightful comment. You are absolutely correct in pointing out that ordinary words like “unhappy,” “bad mood,” etc. are more helpful than the DSM’s “diagnostic” terminology, which is designed to lend credence to false notions that the problems are illnesses.

      Also, the neutrality question is critical. As psychiatry’s spuriousness and destructiveness is being increasingly exposed, we are reaching the point where the other behavioral health professions need to be asking the question: Can we ethically go on collaborating with these people?

      Best wishes.

  5. I remember hearing the peculiar concept that amphetamines “calm down” the ADHD sufferer and work the “opposite” in the ADHD brain. I don’t remember where I learned this or the source but other people accepted this as common factual knowledge as well, and still do. I also heard the comparison of Ritalin and other psych drugs to insulin for diabetes. Marketing and propaganda seem to make this all possible.
    Would Russell Barkley be in favor of all unmedicated, but ADHD labeled drivers, having their DL’s taken away? Or, anyone with an ADHD designation, medicated or unmedicated, having their DL pulled because of unverifiable monitoring of their “amphetamine” impairment?

    • And by what possible objective criterion would you determine that someone “needs stimulants” in order to drive? Since there is no objective way to assess this, I am not sure on what basis they’d be able to make this decision legally. I can smell the lawsuits from here…

      That nonsense about the “paradoxical effect” is still around, but was thoroughly disproven back in the 70s by Judith Rappoport, who was incidentally a big supporter of medication for ADHD. Barclay and his ilk stay away from talking about it, because they know it’s not true, but they also know the myth is still around, just like the “chemical imbalance” story. I think they try to get the concept into the popular culture and then just don’t talk about it, and pretend they never said it, or that it is “outdated information” if someone brings it up. It’s a pretty slick system.

      — Steve

    • zoriolus,

      Your memory is accurate.  For years psychiatry maintained that stimulants had this “paradoxical” calming effect on people who had ADHD.  It was even put forward as “proof” that their brain chemicals really were unbalanced.

      “…like insulin for diabetes” was also a standard psychiatric mantra.  It’s still heard form time to time.  I just Googled the phrase and got 117,000 hits.

      Now that the chemical imbalance nonsense has been thoroughly debunked, by non-psychiatrists, psychiatry is distancing itself from the concept.  For example, see Ronald Pies’ latest endeavors in the “keep-psychiatry-blameless” department.

      I think Dr. Barkley’s comment that “medication shouldn’t really be optional” suggests that he would favor pulling licenses in the “unmedicated” group.  Verifiability, of course, is another matter.  See the chilling story from Australia that I received in a comment from Nanu Grewal on my website yesterday.

      • I read the Sunshine Coast Daily article about the Hornby twins and Health Officer Cleary’s analysis. Higher doses are better than low doses when prescribed by an “expert physician”. This issue isn’t as theoretical as I thought since the authorities in Tasmania are discussing the therapeutic range of Dexamphetamine. It seems like the only way to have a constant blood level would be a pump, a patch, or an IV and I wouldn’t be surprised if Barkley and Associates have that base covered.

        • I have a friend who has tried probably every drug there is, legal and not and has lived in this kind of social circle for a while. He also has a degree in neuroscience and I remember our discussion over a beer about psych drugs when he said something like this: “There is no difference between legal and illegal drugs. They do something to your brain but what it is is hard to say and they do different things to different people. I say guys who were jumping high and screaming on the same pill that made the other person sleepy.” The conclusion was there is nothing intrinsically bad about psychoactive substances – it’s who uses them, how and what effect you want. Some drugs are better researched than others but it’s still a Russian roulette.

  6. “Might their licenses be made contingent on their ingestion of psychoactive drugs? ”
    Please, don’t give them ideas…
    On the ADHD epidemic: in where I lived there has been a growing dyslexia/dysgraphia epidemic – it was caused by the new legislation which posed new relaxed rules for making mistakes on tests for the people diagnosed. In the “old days” if one had any of these problems they had to sit down and learn until they could read and write properly. After the rules were changed not only people with genuine problems but every kid who was too lazy to do their homework had an easy way out.
    It’s similar with the ADHD. There are people who have problems similar to described in the magic checklist but if that warrants to be called a mental illness is questionable and that is certainly not 10-25% of the children. More importantly drugging of kids is at the very least a big potential risk for their future development.
    I happen know a person who was diagnosed with adult ADHD with some “typical” symptoms like high caffeine use, attention issues and problems driving. He didn’t take drugs as a kid and managed to live a happy and productive life as far as I can tell until 30+ years. He decided now to take the stimulants and while they indeed help him with driving and got him of the coffee I am not sure if they really are so beneficial in other areas if life. But he’s an informed adult and it’s his free choice.

  7. I take dexamphetamine for ADHD.

    I would never in a million years have predicted that I might make this choice as I did, in my 40s. I didn’t really know ADHD was a “thing” here in the UK before I was already in my 40s. I was all over psychology like a rash, for the first 4 decades of my life and, if I had known Critical Psychiatry was a “thing”, I’m sure I would have been entirely opposed to the idea of stimulant meds like most people here. (I have co-morbid blatant hypocrisy disorder and am utterly shameless into the bargain. 😉 ) Honestly, I still do a double-take sometimes. I don’t see myself as “sick” though, and my relationship with Big Pharma’s Little Brother (a relatively cheap supplier of niche generics to the UK NHS) is what I would call “open-ended”, so there’s that too.

    “But a person “with” ADHD can, with proper training, learn to behave in a more attentive and less impulsive manner.”

    I can only speak for my own experience here but, fwiw, what you describe above, Phillip, just doesn’t entirely resonate with my own experience over at least two decades as a very motivated, psychologically-minded adult. There are certainly ways I have learned to compensate for and/or hide my inattention, and my difficulty with redirecting my focus at will. I’m naturally quite risk-averse, I don’t enjoy driving at speed, and I have no interest in fast cars, so I don’t have a hugely shameful traffic offence record, anyway. My driving is not the primary reason I take dex. And “speed” is not an outcome I have encountered at a low dose of dex. My goodness though, the things I noticed for the first time, once I started using dex, was alarming! The police cars parked in lay-bys for a start… I never used to see them until the lights were already flashing and the indicator was signalling me to pull over….

    I started wearing reading glasses (though not for driving) the same year I started dex, and my experience of taking dex has felt rather analogous to putting a pair of glasses on for the first time and “seeing” everything more clearly. And I had the pleasure of taking my driving test three times, over three years, so it wasn’t a lack of training and instruction there!

    I don’t pretend to understand the underlying mechanisms of either the origins of my condition, or the drug action, even though I could give Joanna Moncrieff a good run for her money any day on the questions I asked before I started taking the meds. I’m just making an informed-as-possible choices given the current state of an imperfect science in an imperfect world. It’s as weird as all heck to me after considerable study but, on balance, this a choice that does me more good than harm right now, and so I’ll keep it on annual review.

    I’m not a member of Barkley’s fan club and I don’t think anyone should be required or pressed to take any kind of psychotropic meds they don’t want. Bottom line, the law gets to decide whether I keep my driving licence and what penalties I have to pay if I fail to notice the speed limit change as auickly as everyone else on the road.

    In terms of the difference between “doesn’t” and “can’t” as you put it above, I experience the inattention and focus issues as being similar in nature to the problems I have always had with telling my left hand from my right hand. Certainly there are strategies I can learn to mitigate the impairment, but I don’t seem to have been able to train away the core difficulties yet.

    I have suffered with what DSM-V calls depression in the past, and my experience of that was very different. I can totally see low mood as being “treatable” by understanding the underlying factors, changing my behaviour, experiencing the healing compassion of others, etc. The inattention stuff is simply a very different kind of experience for me.

    I was a very intellectually bright child, so no-one either trained or disciplined me to pay attention at school, I just blundered my way through by the skin of my teeth, and I will never know now if early learning and teaching methods could have helped me. I’m still very motivated to review and adapt my own behaviour though, which is partly why I describe my relationship with BPLB to be open-ended. I am far from disempowered. If anything, the dex effect just has me wildly curious about what might be possible in terms of developing new ways of learning and coping for the future. I didn’t know what I was missing before. Now I have a perspective that I would still be thankful for, even if my dex was taken away permanently tomorrow.

    As far as the medication of children goes, I really scratch my head at the inference that adults who identify as having ADHD are going to join Big Pharma in chasing innocent children around the playground with a sedative cosh. In the online communities where I talk with other adults with ADHD, the conversation about kids tends to centre around attachment parenting, non-violent communication, and the best public spaces to run little legs around until bedtime. And how much we hate the Mickey Mouse Clubhouse theme tune. The usual parenting stuff, really.

    As someone with a strong interest in education, I have zero interest in disciplining the bejezus out of kids with attention or hyperactivity difficulties. No more than I would tie anyone’s left arms behind their back to make then write in the “right” way. I don’t think educators have any business recommending or getting involved in medicinal treatments either. My own journey of discovery over the last few years has been very humbling and I don’t feel in a place to judge with any certainty what might lie beneath another person’s difficulties.

    In schools we seem to have increasing numbers of kids falling by the wayside under the pressures of 21st century life for a range of possible reasons, and I think difficulties around distraction and inattention need to be reviewed in the broader context of the way we design and deliver curriculum, the way we build playgrounds and classrooms, and in the ways we help children to develop self-awareness and self-discipline. No cosh of any description needed.