Tuesday, January 26, 2021

Comments by amdmd

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  • Before we ascribe the definition and management of the entity(ies) most recently named ADHD to a pharma cartel, let’s review a bit of history and some basic principles.

    A “Defect in Moral Control”, described at the turn of the last century, identified a number of children who couldn’t consistently follow rules or succesfully complete series of sequential academic tasks. Corporal punishment, the mainstay of discipline at that time, intensified these behaviors. Many such children clustering in families, suggested a genetic inheritance pattern. Many other such children had histories of central nervous system insults, like meningitis, head trauma or prolonged seizures, suggesting subtle forms of brain damage.

    Mid-century, the chance observation some children with the “Defect” prescribed Benzadrine for headaches, and whose “Defect” abated on the medication, alerted scientists to the possibility brain chemistry could be favorably altered. The subsequent development of more effective medications with lessened side effects is, as they say, history,

    The designation “Defect in Moral Control” was next replaced with “Minimal Brain Damage”, then with Attention Deficit Disorder (with or without Hyperactivity). The key word to note is “Disorder”. A behavioral disorder is defined by its consequences on a child’s performance – specifically on age-related skills within the areas of physical, social and intellectual abilities, the reactions of others in the child’s environment and the child’s ability to abide by reasonable rules. The norms for each of these criteria vary with a child’s age and with the specific environment. But when performance in ANY of these areas is deficient for age and environment, a “disorder” is defined. Disorders may be managed by changing the environment, changing the levels of expectation by the adult guardians/authorities, changing the child’s brain chemistry, or a combination of these approaches.

    The diagnosis of ADHD begins with the recognition of the last “D” – disorder. The ADH part is then defined by any number of available measures, including characteristic behaviors (such as on Vanderbilt Scales), subtest patterns on tests of intelligence, or even on PET scans. At this stage, there is no influence by “pharma.”

    Once a management approach has been chosen, progress can be judged by monitoring the presence or absence of the defining criteria of “disorder.” Cessation of treatment is appropriate when the criteria of a disorder are no longer met. Ignoring any accurately defined disorder eventually becomes life-endangering, since children who cannot express age-appropriate skills, relate meaningfully to others or follow reasonable rules become either depressed or angry with eventual risk suicidal or homicidal behaviors.

    In summary, ADHD is real and not a figment of “pharma’s” imagination. Ignoring it is not an appropriate option. Effective treatment strategies include manipulating the environment, if possible, and adjusting expectations. Medication, prescribed by an experienced and knowledgeable practitioner, is usually a safe and effective component of treatment and offers the possibility for a child to successfully sequence complex tasks, focus on chosen tasks in distracting environments and choose rewarding behavioral options.

    Alan M. Davick, M.D.
    Behavioral-Developmental Pediatrician
    Author: ADHD-What parents need to know