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.
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?
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S'IL VOUS PLAÎT AJOUTER COMMENTAIRES SO je peux améliorer l'information que je partage sur ce sujet très important.