ADHD: More of It, Better Diagnosis, or Both?

Kelly Brogan, MD, ABIHM
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“[DSM-V] is a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment – a bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.”
                            – Allen Frances, DSM-IV Taskforce Chair

Accountability. This is an important corrective force, and one that brings the karmic balance of every action into effect. Psychiatry, at large, is coming under correction after decades of collusion with industry and media. Based on the passion of crusaders like Robert Whitaker, the epidemics that psychiatry has created are being exposed, and the finger is now pointed back at psychiatry itself. Yes, those “healers of the soul” (can you believe that’s what the original meaning of psychiatrist actually derives from?) have to begin to take responsibility for their part in overdiagnosis and overtreatment of vast swaths of the population.  The guild of psychiatry, as Whitaker calls it, has accomplished its malfeasance through the following means:

  • Embracing impressionistic and entirely subjective diagnostics (there are no scientific or physiologic tests for diagnosis)
  • Explosive numbers of DSM diagnostic categories, determined by “experts” with often undisclosed conflicts of interest
  • Primary treatment with medication, which itself begets more treatment with more medications, and greater disability according to Whitaker’s data analysis
  • Cozy relations with pharmaceutical reps, service as Key Opinion Leaders influencing public perceptions around biological psychiatry, ghostwriting, and data manipulation in the service of outcomes supportive of pharmaceutical sales
  • Support of direct to consumer advertising teaching the public about convenient myths that serve medication sales and the medicalization of mental illness

Extra, Extra, Read All About It

What has been less explored is the collusive role of the media in generating public beliefs about mental illness and its best treatment.

I dare say that journalists have gotten either very lazy, very scared, or both. It is a rare journalist – like Jeremy Hammond,  or Sheryl Attkisson – who actually digs deep for the truth on a matter. Most interview only the most accessible mainstream mouthpieces, look no further than industry-influenced professional associations, and parrot orthodox catch-phrases that only serve to manipulate public fear rather than clarify the nature of a given dilemma.

What happens when there is a disconnect between the available science (or even acknowledgement of its ambiguity) and what is being represented to the public on the glossy pages of a magazine, or in the scrolling typeface of their iPhone’s daily news app? How is this corrected? Who is responsible?

Hereinlies the beauty of the internet. The truth is available. If you look, you will find it, and you will know it when you do. It is the democratization of information.

Responsible Reporting

Lacasse and Leo have been working to bridge the gap between public consciousness and available science, and I have relished every word they’ve written. In 2005, they published a paper that I would only read after 4 more years of conditioning in the conventional model. It is called Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature and it explores the serotonin meme, one that was not, is not, and should not be regarded as a meaningful scientific explanation for depression, despite Zoloft’s commercial references to chemical imbalance.

More recently they have been working (since 2000) to shine a bright light on the ADHD epidemic, and published a brilliant expose entitled The New York Times and the ADHD EpidemicWonder what the deal is with ADHD? Feel like it’s overdiagnosed and overtreated, but also that it’s a real issue?

A subtle but powerful inditement, they suggest that the relationship between media outlets like the NYT and industry may be responsible for “teaching” the public that there is science to support ADHD as a discrete brain disease with safe and effective treatments. In their selection of expert opinion and neglect of important research, the Times has painted a very skewed picture of the epidemic.

Lacasse and Leo state:

Critics of the Times often cite their supposed liberal bias. If anything, the Times’ reporting of mental health issues would seem to be the opposite case, as they have tended to side with the corporate interests of the pharmaceutical companies … at least prior to Schwarzs arrival, it appears that the Times was too deferential and not skeptical enough of those academic experts whose prominence was in large part due to their pharmaceutical company connections. The pharmaceutical company marketing plans go far beyond simple advertisements. We live in an era where many experts list their main employer as a medical school, and their side job” as a pharmaceutical company consultant, yet they make hundreds of thousands of dollars more in consultant fees than their medical school salary.

ADHD: What’s the Deal?

With 10,000 toddlers medicated for ADHD according to the CDC, and 11% of boys on stimulants, we should have more answers than questions on the nature of this illness, don’t you think? The psychiatric guild would have you believe that all of these children have genetically-loaded brain diseases. In fact bereavement, problematic homes, and complex psychosocial dynamics like those in foster care are not exclusion criteria for diagnosis – those kids apparently still have a neurologic deficit requiring medication treatment.

So, if we agree that we are overdiagnosing, as most in mainstream psychiatry are willing to acknowledge, and we don’t have an objective test for diagnosis, then how do we tell ernest parents who just want a quick fix that their children are actually abusers of stimulants rather than legitimate psychiatric patients? How do we know if the problem is the school, the family, or the child? What if the problem is actually real, but not genetic nor a stimulant deficiency?

Something IS Really Wrong

Here’s the thing. This is a Both/And situation. Psychiatry, Industry, and Media have created an epidemic. But there is also an epidemic. This is where the wastebasket function of psychiatric diagnosis comes in. When conventional lifestyles and associated medical and pharmaceutical interventions create problems that go unrecognized as legitimate by orthodox doctors, psychiatry is all too happy to give these patients a home.

Our children are undeniably sick. But why? Why is it that over 9% of children have asthma, almost 6% have food allergies9.5% have ADHD, over 200,000 kids and teens have type 1 diabetes1 in 68 has autism and 1 in 6 has a developmental disability according to 12 year old statistics, 17% of black children have eczema and almost 13% of white, and over 300,000 children under 15 have epilepsy1 in 1000 children develop arthritis?

I’ve written, and I stand by:

When you take a woman who has been eating processed food, taking The Pill, antibiotics, and maybe even a PPI, exposed to xenoestrogens, endocrine disruptors, and friendly-bacteria-slaughtering pesticides and you grow a baby in that womb, there is a good chance you have created a time-bomb. Throw in 70 doses of 16 neurotoxic and immunosuppressive vaccines by age 18, some formula, and genetically modified and processed baby food, 4 years of plastic diapers, and Johnson’s 1,4-dioxane babywash and…Houston, we have a problem.

Our children are suffering from the cocktail effect. A newly-minted phrase for the unexpected synergy of toxic exposures that leads to their buckets overflowing. It necessitates a different approach to behavioral, cognitive, and mood symptoms. We must first nurture a non-toxic lifestyle, and meet these children where they are by investigating the why of their symptoms. If pathology remains after this layer of changes, then we must first, do no harm.  It might look like this with strategic nutrition, better physiologic assessments, and smart supplementation. Children are also intensely sensitive to energetic interventions making yoga, homeopathy, and energy medicine safe and effective, and always my first choice for my own children.

First Do No Harm

First doing no harm will never look like prescribing children amphetamines, violence-inducing antidepressants, and antipsychotics. We must reallocate our fear where it belongs – we should be afraid, but not of our children’s behavior, behavior that is often an expected response to the lifestyles we expect them to conform to, and the toxicants we ply them with. We should be afraid of contracting with a pharmaceutical model that has only ever been proven to generate more problems and worse outcomes. We should be afraid of chemically altering our children. Of applying a heavy hand to their evolution as individuals. We should be afraid of what happens when we allow ourselves to be courted by the illusion of convenience; of the simple, quick fix.

Because there is no such thing.

There is no free lunch. There is only rebalancing; and that takes work, attention, and belief in the power of the body and mind to heal. The results of this approach are nothing short of transformative. When we heal through natural medicine, there’s no tradeoff. There’s only liberation and a fresh set of eyes through which to see the truth.

* * * * *

(This blog is adapted from a version
on Kelly Brogan’s website.)

14 COMMENTS

  1. “if we agree that we are overdiagnosing”… It’s not that we’re overdiagnosing, it’s that there is no reliable ADHD illness; thus any diagnosis of ADHD is fraudulent in that particular sense.

    “What if the problem is actually real, but not genetic nor a stimulant deficiency?” – The problems of these inattentive kids are real but in a different sense. I work with kids as a teacher. I’ve met many kids who are a bit hyperactive, some of whom I’m sure are getting “treated” for supposed ADHD (two parents even told me this, that their kids “have ADHD”… I don’t let them know my real opinion, because it would get me in trouble).

    These children’s problems of inattention are real, but they originate in my opinion mainly from the way the child relates to their parents, peers, and the broader world. Some of the kids have serious mood-regulation and impulse control problems that make me feel as if they are going to get labeled something like “borderline” when they are an adult. But as kids, they get labeled ADHD or conduct disorder instead. On the other hand, none of these diagnoses are really valid or discrete. The problems are really manifestations of the child having a lot of “splitting” going on and insufficient soothing introjects because of a lack of safe loving relationships with busy, neglectful or even abusive parents.

    With these kids I try to have a mix of indulgence and firmness in helping them learn to have some limits and internalize me as a better “parent figure”. Even though I’m not really a therapist, a teacher is in a sense a parent figure / therapeutic influence.

    Also, I think modern life with its stresses, busi-ness, and electronic distractions makes things more difficult for these kids, especially boys. I am always shocked when 9 or 10 year old boys tell me about how they play are allowed to play Call of Duty (a VERY violent game) 8-10 hours a week. The idea that genes or brain chemistry is causing a unique ADHD illness is just bullshit.

    Psychiatrists should be honest that they don’t know what supposed ADHD is or if it exists as a reliable illness, and that their meds are just tranquilizers to quiet the child down, not treat any known illness.

    • I also work with underprivileged children that are having difficulties in school, and see the adverse effects the drugs have on some of the children. It breaks my heart. And I agree, children need to be allowed to be children, and love and caring really makes a difference. You can take a child who is having a fit, give him the freedom to get up, walk, throw a paper airplane a few times, and he will be happy. Drugs are not the answer, giving children the freedom to be playful children is.

      Thank you for speaking out against the massive drugging of our children, Kelly.

    • What is also real is that classroom expectations have always been developmentally inappropriate in the lower grades, and are becoming more so over time. When I went to Kindergarten, we did a lot of pre-reading and psychomotor activities, like singing songs, identifying letters and letter sounds, counting to ten, finger painting, throwing balls, building with blocks, etc. No one thought that a Kindergartner should be learning to read. Certainly, the concept of being BEHIND in school was completely foreign. Now kids are expected to learn basic reading skills by the end of Kindergarten, they’re given worksheets and even HOMEWORK in some places, their free play time has been reduced bit by bit to a tiny proportion of the day, and they are expected at times to stay focused on things that most adults would find dull, let alone a 5 year old. We need to acknowledge that part of the “ADHD” epidemic is setting unreasonable expectations for kids and blaming them when they don’t measure up.

      A recent Canadian study showed that waiting a year before admission to Kindergarten reduced ADHD diagnosis rates by over 30%! So a THIRD of ADHD is just plain starting too soon, and probably even more would drop off if we waited yet another year for them. In France, they don’t start school until 7, but by high school, their kids have surpassed US kids in every academic department. And France has one of the lowest ADHD diagnosis rates in the developed world.

      We need to stop “treating” kids for being young and immature. They deserve the time and respect to be allowed to develop normally rather than being pathologized for being unwilling to sit still for things they’re not developmentally ready to do.

      —– Steve

  2. People no longer rear children, no, why should they when they can label and drug them? The chemical nanny, in some cases, has supplanted the physical nanny. The media has developed a very cozy relationship with Big Pharma, and to such an extent that the truth is being suppressed in the interest of profiteering. Anybody got a spare couch for media personnel because the impartial news services are so much more partial than they once were when they were at least making a pretense of being impartial? It was something that set us apart from countries run by autocrats and the military. You’d think some media mouthpieces might be a little troubled about this almost criminal role they are playing. Driven by commerce, the media is peddling a toxic environment, and there are a great many people suffering from this toxicity. Re-balancing, for sure, a little detoxifying might help as well. This diagnostic labeling of childhood, together with the toxic chemical babysitting, has to be addressed, confronted, and in good measure, ended. Thank you for this post. Maybe it will help people take more responsibility for those things that they need to take responsibility for, such as the raising of their offspring.

  3. Having taken many of the ADHD drugs myself , like all the different ones it boggles my mind how anyone could think giving these powerful ass drugs to little children in a good idea.

    I think the best way for parents to decide if giving their children ADHD drugs is to get the prescription, adjust the dose for adult body weight and to take the drugs themselves before giving it to the child. Both Mom and Dad should do this.

    Dosage for Treatment of ADHD

    The recommended starting dose of Vyvance is 30 mg once daily in the morning in patients ages 6 and above.

    Lets see Mom And Dad down 90mg or maybe 120mg and take a feel of those effects and then see if they still decide to drug the child.

  4. While there are probably many factors, both environmental and social that are leading to kids seeming more fragile these days, a large aspect of the use of the ADHD diagnosis has to do with a mismatch between normal variations in children’s make-up and the expectations and pressures of our society and school system. There is no true evidence supporting ADHD as a disease. As I explain to people who have applied this diagnosis to themselves, people have different brains with varied abilities. Some people are good at focusing on one thing at a time, and others are good at multi-tasking. If we look at our evolutionary heritage, as hunters, we would have needed to to pay attention to many different stimuli, and then focus primarily on one for brief periods of time. This is how most boys are, with considerable variation in different traits. Our school systems, and to a large extent our family systems expect children to sit quiet and focus on tasks that may not be oriented towards holding interest. On top of that, as people here have pointed out, modern technology, including video games, may accentuate the brain’s ability to only pay attention to intense stimuli.
    Children do not have malfunctioning brains. We have a malfunctioning society and mental health system.

    • Norman,
      …And we have a MH system that has propagated the notion that our kids have defective brains… letting the schools off the hook completely.

      I find your shifting responsibility for the ADHD sham toward the prey [society] of psychiatry most annoying. Sometimes it sounds as though you believe our *society* created psychiatry and/or its predatory nature.

      Ay yi yi!

  5. You want to replace psychiatric medications with ‘strategic nutrition’, ‘better physiologic assessments’, ‘smart supplementation’, yoga, homeopathy, and ‘energy medicine’. These may (or may not) be safer than psychiatric drugs, but you’re still labelling and treating kids. So-called functional medicine wants a piece of the pie, too. NO: Just leave kids alone, or help families and communities to support them in loving, human ways!

  6. “NO: Just leave kids alone, or help families and communities to support them in loving, human ways!”

    There is a world of difference between good nutrition, healthy eating (e.g., organic, non-GMO, gluten free, sugar free, hormone free, antibiotic-free, etc.), detoxifying one’s environment and body and good healing or calming practices such as yoga or energy medicine, on the on the hand, and plying children (or adults) with psychoactive drugs on the other. During the last 50 years or so, the nutrient content of our food went way down, and toxins in our environment and everything that we use, including personal care products, went way up. This has taken its toll on our health, including mental health.

    • I said that alternative approaches might be less harmful (they’re not always harmless). They still involve diagnosing and ‘treating’ children, however.

      There is a huge market in alternative ‘natural’ approaches for children, for autism spectrum disorder for example, and I don’t see any evidence that they’re doing anyone any good (except those selling them).

  7. Not everything that is alternative, holistic, natural, homeopathic, etc. is legitimate. There are plenty of charlatans out there preying on desperate and vulnerable people, and I would never suggest otherwise. People still need to do their research, validate the claims made for the treatment and make knowing, informed choices about the treatment itself and the individual provider. Just do your homework. I do, however, believe that for psychiatry to survive, the typical practice needs to look more like Dr. Brogan’s practice.

  8. Kelly,

    Curious about your lead in quotation by Allen Frances.

    ““[DSM-V] is a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment – a bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.”
    – Allen Frances, DSM-IV Taskforce Chair”

    Are you aware of the pivotal role he played in opening markets for pharma? Between the DSM IV ( 70 new disorders to match up with drugs) and TMAP,( the carved in stone guidelines that make first line treatments, prescription drugs. Thanks to Allen Frances’ contributions , there is a *one way* street to labels and drugs– no chance for cohort groups to challenge this fraudulent model; no simple task to re-educate the medical community, state based child welfare and criminal justice systems, teachers, parents– *the public*.

    Here is a link to excerpts from a talk given by Dr. Paula Caplan — an eyewitness to Allen Frances’ spurious transformation from parma golden boy to pharma and psychiatry critic.

    https://youtu.be/K12jE7TH7zQ

    History tends to repeat itself…