Healthy Skepticism Library item: 8997
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Kamper A.
Taking the drugs out of ADHD
News.com.au 2007 Mar 12
http://www.news.com.au/story/0,23599,21362912-5007146,00.html
Notes:
IMPORTANT CORRECTION: Dr Spitzer has been misquoted in this report. In the BBC documentary on which it was based, he did NOT say 30% of children have been misdiagnosed with a mental disorder.
Please see “Fact Deficit Disorder” Media Watch, ABC TV (Australia)
http://www.abc.net.au/mediawatch/transcripts/s1882075.htm OR HSL Ref 9675 http://healthyskepticism.org/library/ref.php?id=9675
Full text:
AN about-face by the godfather of attention deficit hyperactivity disorder has renewed debate about medicating children, writes Angela Kamper.
US Professor of psychiatry Dr Robert Spitzer has been a saviour for thousands of parents around the world who want answers for their child’s frequent outbursts of clumsiness and bad behaviour.
While others just called them brats he gave parents a label for the erratic symptoms, placing attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD) and other conditions on a chart they could all follow.
The groundbreaking classification table, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III), meant doctors could diagnose with greater confidence and prescribe medication that would produce instant results.
Now, more than 25 years since his global revelation, Dr Spitzer’s own attitude towards doctors using his chart has taken a dramatic turn.
He says 30 per cent of children diagnosed with a mental disorder don’t actually have it and are instead showing perfectly normal signs of being happy or sad.
“Many of these conditions might be normal reactions which are not really disorders,” Dr Spitzer said.
He also acknowledged that some parents could pressure doctors to diagnose and prescribe drugs.
“We don’t know to what extent that’s been happening inappropriately,” he added.
His latest views have renewed debate over the diagnosis of children and use of prescription drugs as well as questions whether DSM-III, designed to be more specific and objective, still has major flaws.
About one in every 100 Australian kids are on medication for ADHD.
The two main stimulant drugs are dexamphetamine and methylphenidate, or Ritalin. Some are also on the adult depression drug Risperdal.
Many scientists argue ADHD is a genetic disorder that continues into adulthood.
However others say it is an excuse – developed from a culture that is too eager to medicate any supposedly antisocial behaviour.
Glynis Howard, medical services manager for Sydney’s Dore Achievement Centres, which use a drug-free alternative approach, says you cannot diagnose a child based on filling out a form with the right criteria.
“The whole picture needs to be taken into account,” she said.
“You need to look at the child’s environment or things that have recently occurred that may have caused the disorder.”
The registered nurse says a death in the family, parents separating or even an allergy can trigger some of the supposed symptoms.
“His (Dr Spitzer’s) comments are very significant for us,” Mrs Howard said. “When we started what we were doing it was really taboo. We were treated like outcasts but now people are starting to see the results and question things.”
The Dore method, which has been available for five years, addresses the issue by taking the child through ten-minute daily exercises which stimulate the cerebellum in the brain instead of using drugs.
The process is believed to increase the child’s ability to process information more rapidly.
Mrs Howard said the centre, which has no government funding, has more than 10,000 children on its books and boasts an 80 per cent success rate.
“It’s alarming when you see these kids – it amazes me that they have been given this medication,” she said. “About three out of 10 kids can go off this medication and stay off it.”
Don Ulich says his 12-year-old daughter Kristina has returned to mainstream school having used the Dore program.
Kristina was diagnosed with Asperger’s syndrome – a type of autism-dyspraxia – and ADHD. She had a short memory span, difficulty expressing herself verbally, poor co-ordination and difficulty making friends.
When first diagnosed she was more than four years behind other kids in her school year. But after six months on the program her parents noticed a dramatic improvement.
“In her most recent assessment she was learning at the same rate as the other kids in her year,” Mr Ulich says.
“We didn’t want to put Kristina on any drugs so we’re very happy with her improvement. We’ve noticed a dramatic change in her confidence, having friends, participating in sport and generally opening up.”
Sydney Children’s Hospital paediatric psychiatrist Florence Levy says we have to be careful how we medicate – and there must be guidelines.
“I’ve always been a conservative medicator. I believe there certainly has to be a rule for medication and it has to be carefully administered,” Dr Levy said.
She also argues we cannot generalise between Australia and the US because in NSW only paediatricians and psychiatrists can diagnose a child, while in the US, most GPs are permitted to diagnose.
“Diagnosis is not restrained in the way it is here,” she said.
Dr Levy does not discount the Dore program but says she needs to see more evidence before making any comment.
She admits medicating is a much cheaper alternative for parents instead of using methods like Dore.
“I haven’t seen any evidence that any of it works,” she said.
Despite the debate over his controversial chart, Dr Spitzer says he is not too concerned about children being misdiagnosed.
“By and large the treatments for these disorders don’t have serious side effects,” he said.
“I mean some do but they’re not that serious, whereas the failure to treat can often be very hard on the child and on the family.”
