This is an excerpt from Mary's book, No More Ritalin, Treating ADHD Without Drugs, Chapter 2, The ADHD Industry. Mary is the founder of the Block Center, a medical facility for adults and children located in the Dallas/Ft. Worth area, which provides effective approaches to routine "psychiatric" problems without the use of harmful psychiatric drugs.
THE ADHD INDUSTRY
Jason started crying the moment he was born. He didn't stop for two years. The first time he was placed in his mother's arms for feeding, his projectile vomiting reached across the hospital room. When Jason went home from the hospital, he never slept - It was not that he simply had his nights and days mixed up. The child literally never slept! The slightest noise would wake him. And when Jason was awake, he was crying.
Weighing over ten pounds at birth, a fair-skinned, towheaded, blue-eyed child, Jason began his early years with ear infections, asthma, pneumonia, skin rashes, constipation, and severe colic. As Jason grew, the problems grew, too.
In preschool, he spent much of his time in the hallway . . . penance for bad behavior. Jason hit, kicked, and bit the other children and threw things across the room. He picked the worst-behaved kid in the class to be his best friend, and surely that child's mother said the same thing about her son's choice of Jason.
Because Jason could not restrain himself from running out in front of cars, climbing up to high places and jumping off, and other reckless behaviors, Jason's mother greatly feared that he would suffer a tragic, possibly even fatal, accident.
Jason was very, very bright. He taught himself to read at the age of three. There
were times when his rages would subside and his parents could see a sweet, lovable child.
Yet those times were not often enough. He was shuffled from doctor to doctor, from
pediatrician to psychiatrist, from psychologist to counselor. They said that Jason's
problems were his mother's fault because she did not discipline him appropriately, or she
was spoiling him. Many predicted that Jason would end up in a psychiatric hospital, or
worse, in prison.
Doctor after doctor told his parents that Jason suffered from ADHD, Attention Deficit Hyperactivity Disorder, and that the only treatment available was the popular drug, Ritalin (methylphenidate HCI). Even Jason's teacher suggested that his parents do "what all the other parents are doing" and put him on Ritcdin.
Although the situation was desperate and miserable and often frightening, Jason's parents refused to accept the dire future predicted for their child: a lifetime of drug treatment and psychiatric care. So they began looking for a physician who would help them find the answers to his problems. Jason's parents brought him to my office.
There certainly seem to be many more children diagnosed with ADHD today than twenty years ago. Today, ADHD has grown into an industry.
Doctors, pharmaceutical companies, psychologists, psychiatrists, neurologists, pediatricians, family practitioners, tutors, and schools all own a piece of this industry. Once a major American industry exists, it just keeps on growing.
With the industry driving the market, the goal is no longer to fix the problem, but to continue to treat the symptoms. This process generates money for those in the industry. If you fix the problems creating the symptoms, all of the revenue-producing drugs and services would go away. There would be no need for them.
Take the tobacco industry as an example. There is such strong marketing promoting smoking, and so much money being made from tobacco use, that it is nearly impossible to make any positive inroads toward improving the health and safety of our population. This is the case even though there is scientific evidence that tobacco is detrimental to the health of our society.
Symptoms now described as ADHD have been around forever. There are many different names that have been used for the same symptoms we now refer to as ADHD. The name of the disorder appears to change about every five years. It seems strange to me that this disorder gets a new name so frequently. Most diseases in medicine retain their names. Cancer has always been called cancer and hypertension has always been hypertension. Why do the symptoms of ADHD get a new name every five or so years?
I have a theory about why this might be occurring. I don't believe the medical community has a complete understanding of this disorder. It is given a name based on the current knowledge. When the medical establishment learns something different about the disorder, they give it another name. These changes occur periodically, so the diagnosis periodically gets a new name.
ADHD is a psychiatric diagnoses, a fact that surprises most concerned parents. According to the basic diagnostic manual used by the psychiatric profession (the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, or DSM-IV), ADHD stands for Attention Deficit Hyperactivity Disorder. The DSM-IV defines ADHD as follows:
Look closely at the actual wording of the DSM-IV diagnosis. The symptoms of ADHD are highly subjective. The chance that your child will or will not receive a diagnosis of ADHD depends upon the point of view of the individual making the evaluation.
If the evaluator believes that a child should be seen and not heard and should be able to remain seated for long periods of time, then the child is more likely to receive an ADHD diagnosis.
However, if the evaluator thinks that children should be allowed to act like children, speaking out and moving about, then the child is less likely to receive such a diagnosis. The child must have at least six of the symptoms to receive the diagnosis. However it shouldn't matter if a child has one symptom or twelve symptoms. If her or his behavior interferes with life at home or in school, the child needs help. Giving the child a label and a drug is not what I think that help should be.
The symptoms of ADHD have always been present in children. It does appear that this label is now being applied to more children than ever before. While it has been stated that about three percent of children manifest the ADHD symptoms, six percent are actually on medications for ADHD.
ADHD is the latest in a long line of names given to the diagnosis for this group of symptoms. Others include:
* Minimal Brain Dysfunction
I definitely prefer not to label anyone, but if I had to choose from all of the names used thus far, I would prefer "Attention Deficit Disorder with or without Hyperactivity." I believe that throwing the two diagnoses together as ADHD tends to confuse things. If the two disorders are classified as one, it will be much more difficult to find the underlying causes.
From a physiological perspective, I believe the two disorders stem from two very different underlying problems. The two disorders certainly manifest themselves differently, meaning that the afflicted children present very different symptoms.
Attention Deficit Predominately Inattentive is the term used in the DSM-IV to describe the child who is not hyperactive. I think the child who has Attention Deficit Disorder without hyperactivity or behavior problems usually has a "processing" problem. This child's problems usually show up in about the fourth or fifth grade, but can show up earlier. Because they do not misbehave, their problems often go unnoticed for years. They are often quiet, and though intelligent, just do not do well in school. These children cannot seem to take in the information that is presented to them even though they are quite bright. Processing, or how the brain takes in information and interprets it, may be the only problem. (Chapter 8, Learn-How-To-Learn, will explain how to deal with this problem.)
This diagnosis from the DSM-IV is often applied to the child who can't sit still, can't pay attention, and is often a behavioral problem according to the teacher and often the parents. Teachers, therapists, and medical professionals who believe ADHD exists will make a diagnosis in a variety of ways. Using the subjective symptoms listed in the DSM-IV, anyone can easily determine if a child meets the criteria. What is even more puzzling, however, is that in spite of the fact that there are these simple subjective diagnostic criteria, many therapists have begun to use some psychological tests for their evaluation. Testing for ADHD, in my opinion, has developed in recent years in a weak attempt to objectify an entirely subjective diagnosis. ADHD cannot be diagnosed objectively. At present, there is no biochemical marker established that is specific to the ADHD child. We can't draw blood, run a test, and say, "Your child has ADHD."
Instead, the testing that has been developed is supposed to determine if a child can concentrate and hold attention throughout certain activities. Once again, this conveys little, if any, objective information. Parents can spend thousands of dollars for one of these evaluations to get the same diagnosis or label that they could get for much less. After spending all that money for the label of ADHD, parents must then see a physician for medication. I prefer to look into the types of problems the child is having and then ask some meaningful questions. What is the underlying cause of the problem? Can it be determined? If so, can it be fixed?
Because there may be other psychological and learning problems to rule out, having an evaluation administered by a psychologist may be important. But when doctors hear that the child is having behavioral problems or attention problems, they will often just reach for the prescription pad. Other medical problems may be overlooked. A thorough medical examination and evaluation is very important. Too many children I have seen have not had such a medical evaluation. Today, with people using the HMO model of medicine, I know that even less thorough evaluations are being done. Too often, when a child is having ADHD-type problems, it is just assumed that it is ADHD, and medication is prescribed.
I personally do not know why it is important to diagnose ADHD, but it appears that the
diagnosis allows doctors to give a prescription of methylphenidate HCI (Ritalin) or some
other medication to treat the symptom.
To me it does not matter if the child has all eighteen symptoms or only one of them. If the child is having problems in any area of her or his life-school, home, sports, or other activitiesthe problem should be addressed.
This is one of the many reasons that I do not use the ADHD diagnosis in my practice at the Block Center. All it does is label the child with a psychiatric diagnosis and give permission to a physician to write a prescription for drugs. It can also give the parents and the child a reason or excuse for why the child is not successful.
So now we have an ADHD industry. The people running this industry are making a great deal of money from it. I would not object to money being made if the problem were actually being fixed or cured. Unfortunately that's not the case. Since the primary treatment of ADHD is drugs, let's take a hard look at drugs next.
Many children who have been diagnosed with ADHD have a similar infant history as Jason: colic, crying, insomnia, ear infections, and temper tantrums. Some of these symptoms relate to low blood sugar and some to allergies or hypersensitivities.
The underlying cause of Jason's symptoms, which had been diagnosed as ADHD, was actually food sensitivities and hypoglycemia, also known as low blood sugar. Modifying his diet corrected the behavior problem. The effects of low blood sugar on behavior will be discussed more thoroughly in Chapter 6. With Jason's behavior problems resolved, his personality changed dramatically. He is now a sweet, thoughtful, considerate young man. The teenage years, which his parents had anticipated with fear Prior to his treatment for hypoglycemia, were delightful. Jason's learning problems were treated with the Learn-How-To-Learn program, which is available through the Block Center (see Chapter 8). He eventually obtained exceptional grades and excelled in sports. Jason didn't have ADHD. He had hypoglycemia, food sensitivities, and learning disabilities.
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