The ADHD “Epidemic”

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According to the most recent Center for Disease Control (CDC) statistics, 11% of all children ages 4-17 in the United States have been diagnosed with attention deficit hyperactivity disorder (ADHD). 1 out of every 10 children has been deemed to have a mental disorder! What on earth is going on with our children?  Some would argue that with increased pressures on adults to generate income, these children might not be receiving the proper care and parenting. Others might say that perhaps there is some kind of genetic problem that is causing ADHD. While both of these points may be valid, I challenge you to look at these statistics from a different angle. Before we can even begin to think about what might be causing ADHD, let’s look at what ADHD even is in the first place.

In the United States, the gold standard for diagnosing mental disorders is a document prepared by the American Psychiatrist’s Association (APA) known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The most current installment of this handbook was updated in May of this year and is known as DSM-5.  If a child has ADHD then he or she “presents with symptoms including being easily distracted, forgetful, daydreaming” and “excessive fidgetiness and restlessness, hyperactivity, difficulty waiting and remaining seated.” Pretty mild symptoms for a “mental disorder” wouldn’t you say?

vrn.vanderbilt.edu

vrn.vanderbilt.edu

In order for a child to be diagnosed with ADHD, 6 of 9 questionnaire-based criteria must be met (for adults it’s only 5). Check out the example of the diagnostic criteria over there on the left. My personal favorite is “Runs about or climbs.” Having 6 of those characteristics qualifies a kid for a trip to the psychiatrist’s office, which most likely will result in a diagnosis of ADHD. It is important to note that in DSM-5 ADHD is listed as a neurodevelopmental disorder.  Basically what this means is that ADHD is classified as condition that is caused by some actual biological problem in your brain. Well, if it’s a problem with your brain shouldn’t we be able to do some kind of brain scan to see if these kids actually have ADHD? And herein lies a major red flag with the diagnosis: it has no physical basis and is purely questionnaire-based. Therefore deeming a kid suitable for medical treatment depends solely on parents, teachers, and psychiatrists making a “judgement call.”

Having considered the way in which ADHD is diagnosed, let’s now look at how it is treated. By far (90%), the most common form of treatment for people who are “inattentive” or “hyperactive” is a class of drug known as a psychostimulant. You’ve probably heard of these medications referred to by their brand names: Adderall, Concerta, Ritalin, Vyvanse, etc. What some of you might not have realized, is that these drugs, in some form or another, are all amphetamines. This puts them in the same category as speed and ecstasy. It seems pretty paradoxical to put “hyperactive” kids on amphetamines doesn’t it? Alas, these drugs do seem to be effective in making kids more attentive in school but no one really knows why.

Amphetamines are known to be potent stimulators of a neurotransmitter called dopamine. Dopamine is the molecule most commonly associated with the “reward” or “pleasure” center of the brain. What this means is that when you do something like have sex or eat really tasty foods, dopamine is released in certain parts of your brain and you feel a heightened sense of pleasure. Dopamine also serves to reinforce certain behaviors. Think about it in terms of evolution: when you have sex, you get a surge in dopamine, you feel incredible, and you want to do it again (and again and again). This would be a fantastic mechanism to ensure that humans would reproduce, the ultimate goal of any species. Flash forward to 2013 and we now have the capability to hijack this system by using various substances to elicit the same effects. The reason why certain drugs (alcohol, caffeine, cocaine, heroin, amphetamines) are addictive is because they stimulate the release of dopamine.

coloringIn light of all this, let’s think about why amphetamines make children more attentive and what might be the consequences. If you’ve ever taken (insert your favorite ADHD medication here), then you know that no matter what you are doing, you enjoy it immensely. Take a kid who normally who would have turned their multiplication tables into a paper airplane, give them some Adderall, and now they’re sitting there churning out calculations like a Ph.D. mathematician. Hey, these medications really improved this kid’s attention! Well of course they did. If you give someone a surge of dopamine (like amphetamines do), then they are going to like anything they are doing, even if it’s learning how to write in cursive (fuck cursive). However, there is a giant issue with this solution to the attention problem. Amphetamines and other dopamine-enhancing drugs can be extremely addictive. If you’ve ever met someone who has taken medication for ADHD for a significant amount of time then you know what I mean. When they forget to take their Vyvanse, they practically become different people–they can barely hold a conversation. Let’s summarize what we have so far: in this country, we use a questionnaire-based diagnosis to treat young kids with amphetamines, a very powerful and potentially addictive class of drugs.

addyAnother big problem with the diagnostic criteria and research into ADHD is that they are heavily influenced by the very companies that sell the medications. A recent report showed that, of the 141 people tasked with preparing DSM-5, 75% have some kind of financial ties to the pharmaceutical industry. Now, I’m not saying that these first-degree conflicts of interest necessarily impacted these task members judgement, but it certainly raises a valid concern. For obvious reasons, we absolutely cannot let the companies who sell ADHD medications have an influence on how ADHD is diagnosed. The 2 major changes to the diagnosis in this year’s DSM-5? Decrease the number of criteria adults have to meet to be diagnosed (6 to 5) and increase the age at which kids can be diagnosed (from 6 to 12). The result of these changes? More fucking ADHD. It is absolutely imperative that any decisions regarding the treatment or determination of such mental disorders come from unbiased scientific research. Unfortunately, much of scientific research is not unbiased. Look at Harvard child psychiatrist Joseph Biederman, one of the leading psychiatric researchers in the world, as an example. He was recently exposed for failing to disclose $1.6 million in consulting fees from pharmaceutical companies. Obviously, we can’t have our scientists getting paid by groups who have a vested interest in the outcomes. Nowhere is the influence of industry felt stronger than in the field of mental disorders like ADHD. 

Despite all of the issues with diagnosis, treatment, and research of ADHD, I think there’s an even more fundamental issue here: the attempt to turn kids into mini-adults at too young of an age. Is it really that bad if kids are “hyperactive” and inattentive? Aren’t kids supposed to be running around and playing, taking in the wonders of the world? I do not have kids of my own, but everyone knows that children have a special, refreshing kind of energy that gets lost in the transition to adulthood. All they want to do is play and experience everything possible about this wonderful world. Think about what we are doing when we say a kid has ADHD. We are taking that incredible energy and funneling it into what society expects of that kid; to sit quietly and do as they are told. This is completely against our human nature to explore and be active. As Joe Rogan put it, we are basically taking these kids and telling them: “if you don’t sit down, be quiet and memorize the alphabet, then we’re going to put you on meth.” Another interesting thing to think about: in light of the obesity issues that this country faces, wouldn’t it be good if kids were more hyperactive? We’re sending disturbingly mixed messages to children about our expectations for them. As a community, we need to seriously evaluate how we want to raise the next generation of human beings.

Now, I want to be clear. I’m not saying that ADHD isn’t a real disorder. We all know people who have serious issues with attention and it truly is detrimental to their lives. However, this apparent ADHD “epidemic” really seems to be an artifact of over-diagnosis more than anything. As a society, we must demand that, before we treat children with amphetamines, there is unbiased scientific research which shows  1) you can point to a biological problem in the brain as a cause of ADHD, 2) medications work to fix this physical problem and 3) these medications have no long term detrimental effects on health. Right now, we do not have that evidence. It is essential that we keep this in mind before concluding that a child who can’t sit still in class has a mental disorder.

-Sigmund

Aside: One of our authors here at TGL was diagnosed with ADHD at an early age. Because his parents were skeptical about the nature of the “disorder” and the medicines prescribed, they decided to forgo any prescriptions and see what would happen. While he still has the tendency to think of monkeys clapping cymbals when he’s writing, he’s since been more than successful in a scientific career requiring high levels of attention and focus. Question what you are told to give your children and really make sure their mental condition is serious before you decide to let it be treated.

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