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Saturday 25 October 2014

Ny bok: A straight talking guide to psychiatric diagnosis - From Norwegian Website - A New Book by Dr Lucy Johnstone



Ny bok: A straight talking guide to psychiatric diagnosis

Do you still need your psychiatric diagnosis? The answer for practical purposes is probably ‘Yes.’ In the current system, diagnosis is essential for accessing services and benefits and for covering your treatment costs. But do you need to believe in your diagnosis? Do you have to accept this particular attempt to explain your difficulties, and to take it on as part of your identity by becoming one of the ‘mentally ill’? In the words of the blurb for my book, one of the excellent ‘Straight-talking introductionto….’ series:

A revolution is underway in mental health. If the authors of the diagnostic manuals are admitting that psychiatric diagnoses are not supported by evidence, then no one should be forced to accept them. If many mental health workers are openly questioning diagnosis and saying we need a different and better system, then service users and carers should be allowed to do so too. This book is about choice. It is about giving people the information to make up their own minds, and exploring alternatives for those who wish to do so.

As far as I am aware, this is the first book to provide a concise, accessible and inexpensive summary for service users, carers and others which:
  • Summarises the complex debates for and against psychiatric diagnosis
  • Looks at the impact of psychiatric diagnosis at every level from the individual upwards
  • Outlines the alternatives to diagnosis, which in essence come down to various versions of finding your own story
  • Supplies a lists of reading, resources and organisations which can help you to think about alternatives for yourself if you decide to do so.

I believe that service users have the right to make up their own minds about how they wish to describe their difficulties – but in order to do this, they need to know about the evidence for this way of thinking, the strengths and limitations, and the alternatives. Some will decide that diagnosis is what makes most sense to them. Many or most will need to hang onto these terms in order to access services and perhaps avoid unhelpful conflict with mental health professionals. However, I do not believe it is professionally, scientifically or ethically justifiable to present psychiatric diagnosis to service users and carers as an undisputed fact or truth. The Chair of DSM IV has described the manual as ‘deeply flawed and scientifically unsound’ and the Chair of DSM 5 has admitted there are no biomarkers to validate the categories; the former NIMH (the National Institute for Mental Health in the USA) director has described DSM as ‘totally wrong, an absolute scientific nightmare’ while the current one confirms that its categories ‘lack validity’; and NIMH has embarked on a massive project to re-write the diagnostic manuals from scratch. We should no longer conceal these vital debates from service users and carry on as before.

It is time for people to be offered an informed choice about whether to accept, or at least whether to believe, a psychiatric diagnosis with all its subsequent consequences, both positive and negative. I hope this book will be a contribution to that process.

Lucy Johnstone
@ClinpsychLucy on Twitter

OLDY BUT GOODY - Letter of Resignation from the American Psychiatric Association - I am sure many APA members are considering the same course of action in the current climate,

Letter of Resignation from the American Psychiatric Association

4 December 1998

Loren R. Mosher, M.D. to Rodrigo Munoz, M.D., President of the American Psychiatric Association (APA)

Dear Rod,

After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization’s true identity requires no change in the acronym.

Unfortunately, APA reflects, and reinforces, in word and deed, our drug dependent society. Yet it helps wage war on “drugs”. “Dual diagnosis” clients are a major problem for the field but not because of the “good” drugs we prescribe. “Bad” ones are those that are obtained mostly without a prescription. A Marxist would observe that being a good capitalist organization, APA likes only those drugs from which it can derive a profit — directly or indirectly. This is not a group for me. At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted educational grants etc. etc. Psychiatrists have become the minions of drug company promotions. APA, of course, maintains that its independence and autonomy are not compromised in this enmeshed situation. Anyone with the least bit of common sense attending the annual meeting would observe how the drug company exhibits and “industry sponsored symposia” draw crowds with their various enticements, while the serious scientific sessions are barely attended. Psychiatric training reflects their influence as well: the most important part of a resident’s curriculum is the art and quasi-science of dealing drugs, i.e., prescription writing.

These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts — rather we are there to realign our patients’ neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter — whatever its configuration. So, our guild organization provides a rationale, by its neurobiological tunnel vision, for keeping our distance from the molecule conglomerates we have come to define as patients. We condone and promote the widespread use and misuse of toxic chemicals that we know have serious long term effects — tardive dyskinesia, tardive dementia and serious withdrawal syndromes. So, do I want to be a drug company patsy who treats molecules with their formulary? No, thank you very much. It saddens me that after 35 years as a psychiatrist I look forward to being dissociated from such an organization. In no way does it represent my interests. It is not within my capacities to buy into the current biomedical-reductionistic model heralded by the psychiatric leadership as once again marrying us to somatic medicine. This is a matter of fashion, politics and, like the pharmaceutical house connection, money.

In addition, APA has entered into an unholy alliance with NAMI (I don’t remember the members being asked if they supported such an association) such that the two organizations have adopted similar public belief systems about the nature of madness. While professing itself the “champion of their clients” the APA is supporting non-clients, the parents, in their wishes to be in control, via legally enforced dependency, of their mad/bad offspring: NAMI with tacit APA approval, has set out a pro-neuroleptic drug and easy commitment-institutionalization agenda that violates the civil rights of their offspring. For the most part we stand by and allow this fascistic agenda to move forward. Their psychiatric god, Dr. E. Fuller Torrey, is allowed to diagnose and recommend treatment to those in the NAMI organization with whom he disagrees. Clearly, a violation of medical ethics. Does APA protest? Of course not, because he is speaking what APA agrees with, but can’t explicitly espouse. He is allowed to be a foil; after all – he is no longer a member of APA. (Slick work APA!) The shortsightedness of this marriage of convenience between APA, NAMI, and the drug companies (who gleefully support both groups because of their shared pro-drug stance) is an abomination. I want no part of a psychiatry of oppression and social control.

“Biologically based brain diseases” are certainly convenient for families and practitioners alike. It is no-fault insurance against personal responsibility. We are all just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible. Now, to begin with, anything that has an anatomically defined specific brain pathology becomes the province of neurology (syphilis is an excellent example). So, to be consistent with this “brain disease” view, all the major psychiatric disorders would become the territory of our neurologic colleagues. Without having surveyed them I believe they would eschew responsibility for these problematic individuals. However, consistency would demand our giving over “biologic brain diseases” to them. The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant. What we are dealing with here is fashion, politics and money. This level of intellectual /scientific dishonesty is just too egregious for me to continue to support by my membership.

I view with no surprise that psychiatric training is being systematically disavowed by American medical school graduates. This must give us cause for concern about the state of today’s psychiatry. It must mean — at least in part that they view psychiatry as being very limited and unchallenging. To me it seems clear that we are headed toward a situation in which, except for academics, most psychiatric practitioners will have no real, relationships — so vital to the healing process — with the disturbed and disturbing persons they treat. Their sole role will be that of prescription writers — ciphers in the guise of being “helpers”.

Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. To its credit it says so — although its brief apologia is rarely noted. DSM IV has become a bible and a money making best seller — its major failings notwithstanding. It confines and defines practice, some take it seriously, others more realistically. It is the way to get paid. Diagnostic reliability is easy to attain for research projects. The issue is what do the categories tell us? Do they in fact accurately represent the person with a problem? They don’t, and can’t, because there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder. So, where are we? APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax — as practiced today? Unfortunately, the answer is mostly yes.

What do I recommend to the organization upon leaving after experiencing three decades of its history?

To begin with, let us be ourselves. Stop taking on unholy alliances without the members’ permission.
Get real about science, politics and money. Label each for what it is — that is, be honest.
Get out of bed with NAMI and the drug companies. APA should align itself, if one believes its rhetoric, with the true consumer groups, i.e., the ex-patients, psychiatric survivors etc.
Talk to the membership — I can’t be alone in my views.
We seem to have forgotten a basic principle — the need to be patient/client/consumer satisfaction oriented. I always remember Manfred Bleuler’s wisdom: “Loren, you must never forget that you are your patient’s employee.” In the end they will determine whether or not psychiatry survives in the service marketplace.

Sunday 19 October 2014

12 les parents peuvent protéger leurs enfants de trop nombreuses pilules - Huffington Post Article by Professor Allen Frances and Dave Traxson

Méfiez-vous des pilules poussant par les compagnies pharmaceutiques et les médecins.
Publié le 2 Octobre 2014 en  Allen J. Frances, MD  en  économie normale

Nous tournons nos enfants dans poppers pilule. Le taux de  TDAH  a triplé en 20 ans seulement - il est maintenant diagnostiqué chez 11 pour cent de tous les enfants âgés de quatre à 17 et sont médicamentés en six pour cent d'entre eux. Et les pourcentages deviennent vraiment fou pour adolescent boys- 20 pecent sont diagnostiqués et 10 pour cent sont médicamentés.

Il ya aussi des preuves convaincantes que la plupart de ces «TDAH» vient de diagnostic négligent. Comment expliquer autrement que la date de naissance d'un enfant est le meilleur prédicteur de savoir si il obtient la étiquetage le plus jeune enfant de la classe est presque deux fois plus susceptibles que les plus anciens à être diagnostiqué avec le TDAH. Exubérance diagnostic égaré a tourné à l'âge approprié immaturité dans un  psychiatrique  maladie et le traite avec une pilule plutôt que de laisser l'enfant grandir.

Les compagnies pharmaceutiques sont ravis. Leur chiffre d'affaires annuel de TDAH médicaments  a exploded- il est maintenant 50 fois plus qu'il ya 20 ans, à près de 10 milliards de dollars par an. Ne serait pas la plupart de cet argent sera mieux dépensé pas sur les pilules, mais plutôt de réduire la taille des classes et de fournir plus de périodes de sport afin que les enfants agités pouvaient se défouler?

Il ya pire. Stimulants prescrits sont maintenant un médicament préféré des abus dans les collèges et lycées. Visites à l'urgence en raison de surdoses ont quadruplé au cours des dernières années que les pilules de TDAH offrent un accès facile à la vitesse légale.
Et il devient ridiculous- effrayant 10.000 tout-petits de moins de trois reçoivent des médicaments pour le TDAH. Comment cela peut-il avoir un sens?

La pilule pour enfants poussant ne se limite pas à l'ADHD. Après avoir saturé le marché des adultes pour les antidépresseurs, les sociétés pharmaceutiques ont commencé à recruter des enfants. Les enfants sont clients idéaux à long terme parce qu'ils commencent tôt et peuvent rester sur les pilules pour la vie. Une étonnante quatre pour cent des  adolescents  sont déjà sur les antidépresseurs en dépit du fait que ces médicaments sont moins efficaces et plus risquée dans ce groupe d'âge.

Les antipsychotiques complètent la  commercialisation  cauchemar. Ils sont prescrits de façon lâche et sans indication claire pour toutes sortes de  l'enfance  problems- comportement, même si elles peuvent se transformer en zombies enfants, promouvoir massif de l'obésité , et augmenter le risque de diabète et de maladies cardiaques. Certains enfants prennent une combinaison de cocktail ensemble de différentes pilules avec additifs effets secondaires et les risques.

Les compagnies pharmaceutiques ont pénétré avec succès, puis saturé le marché pour enfants en utilisant un marketing agressif pour les médecins et une campagne de publicité directe aux consommateurs massif (à noter que cette pratique honteuse est autorisé uniquement aux États-Unis et Nouvelle-Zélande). Ils ont vendu le message trompeur que les problèmes psychiatriques étaient sous-diagnostiquée chez les enfants, facile à diagnostiquer, causée par un déséquilibre chimique, et facilement traitée avec une pilule.

La commercialisation a été principalement destiné aux médecins de soins primaires qui font aujourd'hui l'essentiel de la prescription de médicaments psychiatriques. Ils écrivent souvent certificats rapide et inutile après une très brève visite, voir l'enfant à son pire jour. Les enfants changent beaucoup de mois en mois sans intervention et les patients les plus difficiles à diagnostiquer. Le médicament doit être utilisé en dernier recours seulement pour la plus claire, la plus atteinte, à des troubles et les plus persistants. Au contraire, les médicaments sont souvent prescrits carelessly- presque comme des bonbons.

La pilule pousser, maladie belliqueuse,  craignent  induire la publicité a eu pour but de  les parents , les enseignants et les enfants. Il est partout à la télévision, l'Internet et l'impression et le plus souvent se termine par "Demandez à votre médecin!" Si vous le faites, il est amorcée par des vendeurs de drogue à écrire un scrip ou vous donner un échantillon gratuit.
C'est très bien pour les bénéfices, terribles pour les enfants. Les avantages à long terme de médicaments prescrits de façon inappropriée sont discutables, le risques à long terme réel. Nous sommes en effet en train de faire une expérience incontrôlée bain cerveaux immatures avec Chimiques puissante sans savoir quel sera leur impact final.

Parce que les parents sont la meilleure protection contre cette surabondance de médication pour enfants, j'ai demandé à Dave Traxson de donner son avis. Dave est un psychologue de l'éducation pratique, un membre de la Division de la commission de psychologie de l'éducation de la British Psychological Society, et un militant infatigable contre la sur-prescription de médicaments psychotropes pour les enfants d'âge scolaire. Voici ses conseils pour parents à protéger leurs enfants contre un excès de diagnostics et de traitement de médicaments:

1) Si le comportement du TDAH n'est pas grave et ne se produit pas dans tous les milieux, alors médicament peut bien être inapproprié. Essayez «attente vigilante» instead- à-dire voir si des améliorations se produisent naturellement ou à des changements dans  l'environnement , de l'exercice, les attentes,  l'alimentation , les horaires, les routines et la parentalité. Conseil et formation à la relaxation peuvent vraiment aider et devraient être jugés devant des médicaments.

2) Augmenter l'activité physique peut aider les enfants agités. Les inscrire dans une  équipe sportive, la natation, le yoga, les arts martiaux, danse ou tumbling - quoi que ce soit de laisser l'enfant se défouler et d'acquérir la discipline .

3) réaliser qu'il ya un large éventail de la normale quand il s'agit de l'activité et de concentration.Pas toute différence est un signe de maladie.

4) Les enfants diffèrent également dans le rythme de leur développement. L'immaturité n'est pas une maladie.

5) De nombreux organismes consultatifs médicaments à travers le monde disent éviter médicament si votre enfant est âgé de moins de cinq ans.

6) Les enfants et les pilules psychotropes pour plus de deux ans doivent avoir un «congé thérapeutique» pour voir si elles en ont encore besoin.

7) Si vous êtes inquiet au sujet de la toxicité cumulative d'un «cocktail de médicaments» demander l'avis de deux à votre pharmacien et votre médecin. Les autres avis le mieux.

8) Si vous ou l'école de votre enfant avez remarqué des effets secondaires indésirables, consultez votre médecin et aussi vous informer par recherche sur Internet (par exemple, entrez «Fiche d'information - effets secondaires du Ritalin»). La fiche d'information vous permet de démarrer et fournit également de bonnes références supplémentaires.

9) Si votre enfant a des niveaux élevés d'anxiété, de psycho-stimulants peuvent accroître les niveaux d'agitation.

10) Ne vous inquiétez régulièrement sur ​​la  sagesse  de votre action à coopérer avec les médicaments de votre enfant pour des problèmes de comportement - puis une bonne règle empirique »est de discuter de la situation avec un éventail de personnes en qui vous avez confiance et à réfléchir sur les moyens d'action.

11) Quand votre école insiste pour que votre enfant soit médicamenteux, d'abord, ne pas être railroaded. Ils sont inquiets de la plupart calmer la classe; vous devez vous soucier plus sur le bien-être de votre enfant.

12) Lorsque vous faites une décision bien informée de retirer votre enfant d'un médicament en raison de préoccupations au sujet des effets secondaires etc toujours le faire sous surveillance médicale et sur la base de renseignements fournis par des sources fiables. Médecine doit toujours être démarré avec soin, mais devrait toujours être retirée avec précaution.

Merci Dave pour les bons conseils.

Les parents doivent savoir que les médicaments psychiatriques sont en cours de façon sur-prescrits pour les enfants et que les changements de sens commun dans le style de vie et la parentalité sont beaucoup mieux que une fuite en avant à pilules. Il est, par exemple, aucune preuve que les pilules améliorer la réussite scolaire à long terme et toutes les raisons de craindre des complications à long terme.

Cela ne veut pas dire pilules ne sont jamais nécessaires. Ils peuvent être utiles, parfois indispensables, pour la coupe claire et les cas graves quand tout le reste a Échec de dernier recours, pas une panacée négligent.

Nelson Mandela a dit: "Il ne peut y avoir plus révélateur de l'âme d'une société que la manière dont elle traite ses enfants."

Nous devrions traiter nos enfants de moins compagnie pharmaceutique poussé pilules et avec plus d'amour,  la compréhension et l'exercice.

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SCIENCEDAILY POST - Single dose of antidepressant changes the brain - SEPT 2014

HYPERLINK TO ARTICLE : http://www.sciencedaily.com/releases/2014/09/140918121436.htm

Single dose of antidepressant changes the brain
September 18, 2014
Cell Press
A single dose of antidepressant is enough to produce dramatic changes in the functional architecture of the human brain. Brain scans taken of people before and after an acute dose of a commonly prescribed serotonin reuptake inhibitor reveal changes in connectivity within three hours, say researchers.

Single dose of antidepressant is enough to produce dramatic changes in the functional architecture of the human brain. Brain scans taken of people before and after an acute dose of a commonly prescribed SSRI (serotonin reuptake inhibitor) reveal changes in connectivity within three hours, say researchers who report their observations in the Cell Press journal Current Biology on September 18.
"We were not expecting the SSRI to have such a prominent effect on such a short timescale or for the resulting signal to encompass the entire brain," says Julia Sacher of the Max Planck Institute for Human Cognitive and Brain Sciences.
While SSRIs are among the most widely studied and prescribed form of antidepressants worldwide, it's still not entirely clear how they work. The drugs are believed to change brain connectivity in important ways, but those effects had generally been thought to take place over a period of weeks, not hours.
The new findings show that changes begin to take place right away. Sacher says what they are seeing in medication-free individuals who had never taken antidepressants before may be an early marker of brain reorganization.
Study participants let their minds wander for about 15 minutes in a brain scanner that measures the oxygenation of blood flow in the brain. The researchers characterized three-dimensional images of each individual's brain by measuring the number of connections between small blocks known as voxels (comparable to the pixels in an image) and the change in those connections with a single dose of escitalopram (trade name Lexapro).
Their whole-brain network analysis shows that one dose of the SSRI reduces the level of intrinsic connectivity in most parts of the brain. However, Sacher and her colleagues observed an increase in connectivity within two brain regions, specifically the cerebellum and thalamus.
The researchers say the new findings represent an essential first step toward clinical studies in patients suffering from depression. They also plan to compare the functional connectivity signature of brains in recovery and those of patients who fail to respond after weeks of SSRI treatment.
Understanding the differences between the brains of individuals who respond to SSRIs and those who don't "could help to better predict who will benefit from this kind of antidepressant versus some other form of therapy," Sacher says. "The hope that we have is that ultimately our work will help to guide better treatment decisions and tailor individualized therapy for patients suffering from depression."
Story Source:
The above story is based on materials provided by Cell Press. Note: Materials may be edited for content and length.

Wednesday 15 October 2014

Federal Drug Agency warns against drugs for child behavior problems - October 14th, 2014. - Psychological Interventions Preferred First.

FDA warns against drugs for child behavior problems

Psychotherapy is an important part of depression treatment, says an FDA Consumer Health Update.
Psychologists play an important role in the diagnosis and treatment of childhood depression, and medications should not be used to treat behavior problems sometimes believed to be related to depression, the Food and Drug Administration said in a recent consumer health update.
“The first step to treating depression is to get a professional diagnosis; most children who are moody, grouchy or feel they are misunderstood are not depressed and don’t need any drugs,” states the update, FDA: Don’t Leave Childhood Depression Untreated (PDF, 304KB), posted in September on the FDA’s website.
A depression diagnosis for children is harder than one for adults because signs and symptoms change as children grow and as their brains develop, the update points out. “Because we don’t like to label kids with lifelong disorders, we first look for any other reasons for those symptoms. And if we diagnose depression, we assess the severity before treating the patients with medications,” says Mitchell Mathis, MD, director of FDA’s Division of Psychiatry Products.  
The update also cautions that children who take antidepressants might have more suicidal thoughts, which is why labeling includes a boxed warning on all antidepressants. 

Friday 10 October 2014

"How Parents Can Protect Kids From the ADHD 'Epidemic' "by Allen Frances MD -Keith Conners whose checklist has identified millions for ADHD medication has advice for parents to prevent over-diagnosis - Courtesy of The Huffington Post - October 2014

How Parents Can Protect Kids From the ADHD 'Epidemic' by Allen Frances

Keith Conners can be considered the father of ADHD. He did the early studies, helped work out the definition, developed the most widely used diagnostic tools, and did research that led to treatment guidelines. He knows as much about ADHD as anyone on the planet.
In a recent New York Times article, Keith was interviewed about his deep misgivings that ADHD is now being wildly over-diagnosed and inappropriately treated with excessive medication.
This false epidemic of ADHD was triggered by three events that occurred almost simultaneously about 15 years ago:
·         Drug companies used their political muscle to gain the unprecedented right to advertize directly to consumers -- and then used misleading marketing to convince parents and teachers that ADHD was everywhere
·         They brought to market new and expensive drugs for ADHD
·         A multi-center NIMH study gave the impression that drugs were much more effective than therapy and drugs for ADHD (a finding that didn't hold up on follow up)
Drug companies were given the means, the motive, and the message to disease-monger ADHD and blow it up out of all proportion. They succeeded beyond all expectations in achieving a triumph of clever advertising over common sense. Rates of ADHD have tripled and drug company revenues have multiplied by a factor of twenty -- now approaching an astounding ten billion dollars per year.
Fortunately, the press and the public are beginning to catch on. And luckily, we have the master to provide advice to parents on how to protect their kids from all this unneeded medication. Keith writes:
Parents and teachers are understandably confused about the latest flaps around the diagnosis and prevalence ofADHD. On one hand, they hear that more than 10% of all kids (and almost 20% of teenage boys) have ADHD. On the other, skeptics say it does not exist at all or is simply the naughtiness of ordinary childhood.
Both extremes are wrong. The high numbers do not reflect clinically meaningful ADHD. But the idea that ADHD should never be diagnosed and treated misses the clinical reality that some kids have an early onset of severely impairing symptoms that do require diagnosis and do respond well to treatment.

The ridiculous epidemic-like level is most surely a mistaken exaggeration caused by careless neglect of differential diagnosis. Doctors are prescribing stimulant drugs for a hodgepodge of childhood disorders and for basically normal kids who happen to be on the active and distractable side of the spectrum.
What is the true rate? You can't find it using the usual broad brush phone survey methods used in large scale national studies -- these capture many false positive cases' and provide no more than a screening upper limit.

An accurate assessment of ADHD requires comprehensive and repeated interviews of the kid and parents; gathering information from teachers; a differential diagnosis that also considers comorbid conditions; and an evaluation of whether the symptoms and behaviors are severe and persistent enough to be considered clinically significant; and much more.
The results of a study done with this rigor were startling. The true prevalence of ADHD appears to be between 2-3%, and most of the cases being treated with stimulant drugs failed to meet DSM diagnostic criteria. Stimulant drugs were both over-prescribed (given to children not meeting DSM criteria) and under-prescribed (not given to children who met rigorous DSM criteria). Many of the children who were treated as if they had ADHD instead met criteria for Oppositional Defiant Disorder, a condition well-treated by behavioral and parent training methods -- not stimulant drugs.
What therefore, should the public conclude about the "diagnosis" of ADHD?

First, there is no doubt that 2% or 3% of children and adolescents suffer from a serious and treatable disorder, for whom medication or CBT or both is required to avoid the serious lifetime impairments.

Second, no child should be diagnosed with ADHD without a thorough clinical assessment that includes self-report by the child or adolescent, a family psychiatric history, and developmental history of the child. Reports from teachers are essential and represent one of the most neglected sources of information in ordinary pediatric practice. Treatment almost always requires working together on school-related problems.

Third, it is apparent that the DSM's are part of the diagnostic problem, providing definitions that are too loose and insufficient guidance to the practitioner on how to make a proper diagnosis.

Finally, the public should be skeptical both of the diagnostic enthusiasts who see ADHD everywhere and the diagnostic nihilists who see it nowhere.

What should parents do when they suspect their child may need treatment?

First, remember that most medication is prescribed by pediatricians, and these days many do not specialize in developmental behavior problems. Those who do have a specialty are more likely to have the time and experience to recognize and treat real ADHD. They will give advice on other therapies in addition to medication.

Even some specialists (like child psychiatrists or child psychologists) lack the background or training for ADHD or may have biases that fail to account for the particular needs of the child. So don't hesitate to check credentials, and look for those who have a record of extensive care of ADHD. Ask what tests or procedures are being used to identify ADHD, and do not accept cursory, brief examinations that do not involve a complete picture of family environment, school, and development from an early age.

Although medication can sometimes provide dramatic initial relief from a serious situation, additional help with school, peer, and home problems is almost always needed.

ADHD can be a frequently changing, up-and-down experience for a child and family. Make sure that your doctor or therapist follows the situation regularly, and adjusts the treatment as needed in order to maintain gains or deal with new problems as they arise. This applies to both medication dosage and behavioral or cognitive treatments.

Parents need to understand that severe, chronic ADHD can be a mind-numbing experience that can wear any family out- never accept a neighbor's view that you are the cause of the problem. To avoid burnout, get all the help and support and once in a while try to take a vacation away from the stress of raising a lovable but difficult ADHD child.

If you are wondering whether your child has ADHD, The National Resource Center has trained staff to answer your questions at 1-800-233-4050. For help in your area contact the National Dissemination Center for Children with Disabilities by logging on to http://www.nichcy.org/ or 1-800-695-0285 . These sources can also put you in touch with CHADD, a national organization of parents of ADHD which is likely to have meetings in your area and will supply all of the literature you need to understand the facts about ADHD.

If your child is already being treated with medication, but still has significant handicaps in dealing with peers, with school adjustment and learning, or dealing with problems within the family, it may be time to seek out additional help. Ask yourself these questions:

Is the medication being checked and adjusted frequently for necessity and adverse reactions? Have you received help on specific methods for homework and in-class school behavior? Does your child receive help in social skills and peer behavior? Does your physician seek out reports from school teachers as well as from you?

If any of these answers are "no," then you should discuss these issues with your physician, and if not satisfied with the answers, consider getting second or third opinions.

Finally, as your child moves towards adolescence or young adulthood, many additional issues will be have to be faced, so adjustments in a treatment plan will surely be needed. As many as half of children with ADHD continue with significant problems in learning, work, or social problems as they move to young adulthood and need continued treatment. But adolescents and young adults are also the group where over-medicating is most common. Careful re-evaluation for your child may be required. New forms of help in school or college or the workplace, as well as alertness to possible over-medication will be mandatory. Be mindful that drug companies are now directing their misleading, high pressure sales pitch to the adult ADHD market."

Wow, what great advice. Thanks so much, Keith. Just a couple of closing thoughts. Parents need to be super informed and should feel free to ask lots of questions and expect clear answers.
Treatment shouldn't be started casually or stopped casually. Get lots of advice both ways.
And wouldn't it be nice if we stopped wasting billions of dollars on unnecessary drugs and instead paid for smaller class sizes and more gym teachers?

Monday 6 October 2014

SAVING NORMAL - 12 Ways Parents Can Protect Their Kids From Too Many Pills - by Allen Frances MD and Dave Traxson - COURTESY OF HUFFINGTON POST OCT 2014

 “There can be no keener revelation of a society's soul than the way in which it treats its children.”

Click on hyperlink for full article:

12 Ways Parents Can Protect Their Kids From Too Many Pills

Beware of pill pushing by drug companies and doctors.
Published on October 2, 2014 by Allen J. Frances, M.D. in Saving Normal

We are turning our kids into pill poppers. The rate of ADHD has tripled in just 20 years - it is now diagnosed in 11 percent of all children aged four to 17 and is medicated in six percent of them. And the percentages get really crazy for teenage boys- 20 pecent are diagnosed and 10 percent are medicated.

There is also compelling evidence that most of this "ADHD" comes from careless diagnosis. How else to explain that a child's date of birth is the best predictor of whether he gets the label- the youngest kid in the class is almost twice as likely as the oldest to be diagnosed with ADHD. Misplaced diagnostic exuberance has turned age-appropriate immaturity into a psychiatric disease and treats it with a pill, rather than just letting the kid grow up.

The drug companies are delighted. Their annual revenue from ADHD drugs has exploded- it is now 50 times greater than 20 years ago, up to almost $10 billion a year. Wouldn't most of this money be better spent not on pills but rather to reduce class sizes and provide more gym periods so that fidgety kids could blow off steam?
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It gets worse. Prescribed stimulants are now a favorite drug of abuse in colleges and high schools. Visits to emergency rooms because of overdoses have quadrupled in the last few years as ADHD pills provide easy access to legal speed.
And it gets scary ridiculous- 10,000 toddlers under age three are receiving ADHD drugs. How can this possibly make any sense?

The kiddie pill pushing is not restricted to ADHD. Having saturated the adult market for antidepressants, the drug companies began recruiting kids. Children are ideal long term customers because they start early and may stay on pills for life. An amazing four percent of teenagers are already on antidepressants despite the fact that these meds are less effective and more risky in this age group.

Antipsychotics round out the marketing nightmare. They are prescribed loosely and without clear indication for all sorts of childhood behavioral problems- even though they can turn kids into zombies, promote massiveobesity, and raise the risk of diabetes and heart disease. Some kids are taking a whole cocktail combination of different pills with additive side effects and risks.

The drug companies successfully penetrated and then saturated the kiddie market by employing aggressive marketing to doctors and a massive direct advertising campaign to consumers (note that this shameful practice is permitted only in the US and New Zealand). They have sold the misleading message that psychiatric problems were under diagnosed in kids, easy to diagnose, caused by a chemical imbalance, and easily treated with a pill.

The marketing was mostly aimed at primary care doctors who now do the bulk of prescribing of psychiatric medicines. They usually write quick and unnecessary scrip after a very brief visit, seeing the child on his worst day. Kids change a lot from month to month without intervention and are the toughest patients to diagnose. Medication should be a last resort used only for the clearest, most impairing, and most persistent disorders. Instead the meds are often prescribed carelessly- almost like candy.

The pill pushing, disease mongering, fear inducing advertising has been aimed at parents, teachers, and the kids. It is everywhere on TV, the internet, and print and usually ends with "Ask your doctor!'' If you do, he is primed by drug salesmen to write a scrip or give you a free sample.
This is great for profits, terrible for kids. The long term benefits of inappropriately prescribed meds are questionable, the long term risks real. We are in effect doing an uncontrolled experiment bathing immature brains with powerful chemicals- without knowing what will be their ultimate impact.

Because parents are the best protection against this glut of kiddie medicating, I have asked Dave Traxson to offer his advice. Dave is a practising Educational Psychologist, a member of the Division of Educational Psychology Committee of the British Psychological Society, and a tireless campaigner against the over-prescription of psychotropic drugs for school aged children. Here are his tips for parent to safeguard their children from excessive diagnosis and medication treatment:

1) If the ADHD behavior is not severe and does not occur in all settings, then medication may well be inappropriate. Try ‘watchful waiting’ instead- i.e. see if improvements occur naturally or with changes in environment, exercise, expectations, diet, schedules, routines, and parenting. Counselling and relaxation training can really help and should be tried before medication.

2) Increasing physical activity can help fidgety kids. Enroll them in a team sport, swimming, yoga, martial arts, dance or tumbling - anything to let the kid blow off steam and acquirediscipline.

3) Realize that there is a wide range of normal when it comes to activity and focus. Not every difference is a sign of disease.

4) Kids also differ in the pace of their development. Immaturity is not a disease.

5) Many drug advisory bodies around the world say avoid medication if your child is under the age of five.

6) Children on psychotropic pills for longer than two years should have a ‘drug holiday' to see if they still need them.

7) If you are worried about the cumulative toxicity from a ’drug cocktail’ ask the advice of both your pharmacist and your physician. The more opinions the better.

8) If you or your child’s school have noticed adverse side effects, consult your physician and also inform yourself by internet search (e.g. enter ‘Factsheet – Ritalin side effects’). The factsheet gets you started and also provides good additional references.

9) If your child has high levels of anxiety, psycho-stimulants can raise agitation levels.

10) Do you regularly worry about the wisdom of your action to co-operate with your child’s medication for behavioral issues - then a good ‘rule of thumb’ is to discuss the situation with a range of people whose opinion you trust and then reflect on the courses of action available.

11) When your school is pressing for your child to be medicated, first, don’t be railroaded. They are worried most about quieting the class; you need to worry most about the welfare of your child.

12) When you make a well informed decision to withdraw your child from a medication due to concerns about side effects etc. always do it under medical supervision and based on information provided by reliable sources. Medicine should always be started carefully, but should also always be withdrawn carefully.

Thanks Dave for the great advice.

Parents need to know that psychiatric drugs are being way over-prescribed for kids and that common sense changes in life style and parenting are much better than a headlong rush to pills. There is, for example, no evidence that pills improve long term academic achievement and every reason to fear long term complications.

This is not to say pills are never needed. They can be helpful, sometimes essential, for clear cut and severe cases when all else has failed- as a last resort, not a careless panacea.

Nelson Mandela said: “There can be no keener revelation of a society's soul than the way in which it treats its children.”

We should be treating our kids with fewer drug company pushed pills and with more love, understanding, and exercise.