Raised on Ritalin • Process Blog

Is there ADHD in other countries?

Fri, 17 May 2013 10:35:55 -0400

Yes. While it is much more prevalent in the US (you might even call us the ‘home’ of ADHD) it is found and studied worldwide. But treatment approaches, and the concept of it, differ greatly. Some of that is cultural, including how we raise children and what we think about ‘childhood.’ Here are two opposing perspectives on ADHD in France (though the ‘response’ article is rather weak). The basic idea is, yes, there is ADHD in France, but the approach to diagnosing it and treating it are much different than in the US.

WHY FRENCH KIDS DON’T HAVE ADHD.

“In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France? French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes.”

FRENCH KIDS DO HAVE ADHD.

“the concept of ADHD… as a serious disorder is still not fully accepted in France. However, ADHD impacts the functioning of 3.5% of the population of France (Lecendreux, et al. 2011). In addition, ADHD is just as prevalent in other countries as it is in the U.S. (Faraone, et al. 2003). For those children who are not able to receive excellent parenting and high structure, ADHD behaviors can be extremely impairing.”

Other countries definitely provide more structure for their children, compared to the US and more hyper-Westernized nations. But we also know, from past experience, rigid structure can come at a price. Is there a good balance, especially for ADHD kids who benefit from the right amount of structure?

Difference is Not Disease: Scientific Integrity, Human Diversity, and the Potentially Bleak Future of Psychiatry - Mad In America

Tue, 14 May 2013 21:32:14 -0400

Difference is Not Disease: Scientific Integrity, Human Diversity, and the Potentially Bleak Future of Psychiatry - Mad In America:

There has been a lot of talk lately about neuroscience and the future of the medical model of “mental illness.” It was made clear, in NIMH director Thomas Inselâs statement, that the DSM is a system of identification and classification of what are deemed disorders within our human experience. This isnât exactly news to the vast majority of people who have spent even a little bit of time thinking about whether or not psychiatric diagnosis makes sense.

I like this sentiment from this link:

“Perhaps it would be more useful for us to focus on what seems to help, rather than trying to identify some elusive shared trait among those who struggle for some reason or another with their human experience. By establishing evidence of the efficacy of alternatives, the “problem” may become less important than the possible (or obvious) solutions. It doesn’t take a Ph.D to know that when we are empowered, accepted and loved for who we are we tend to feel better and enjoy our lives more.”

But I also wonder at… the naivete of the comment? We should definitely focus on what seems to help. For a long time that’s all that was done. Give Ritalin to kids and most of them settle down. A little. Sometimes. But knowing, if we ever can, the underlying etiologies, can help us figure out what works better, and WHY.

It might take a long time…

Psychiatry divided as mental health ‘bible’ denounced

Sat, 04 May 2013 21:38:00 -0400

From NewScientist

The world’s biggest mental health research institute is abandoning the new version of psychiatry’s “bible” – the Diagnostic and Statistical Manual of Mental Disorders, questioning its validity and stating that “patients with mental disorders deserve better”. This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5.

On 29 April, Thomas Insel, director of the US National Institute of Mental Health (NIMH), advocated a major shift away from categorising diseases such as bipolar disorder and schizophrenia according to a person’s symptoms. Instead, Insel wants mental disorders to be diagnosed more objectively using genetics, brain scans that show abnormal patterns of activity and cognitive testing.

This would mean abandoning the manual published by the American Psychiatric Association that has been the mainstay of psychiatric research for 60 years.

The DSM has been embroiled in controversy for a number of years. Critics have said that it has outlasted its usefulness, has turned complaints that are not truly illnesses into medical conditions, and has been unduly influenced by pharmaceutical companies looking for new markets for their drugs.

There have also been complaints that widened definitions of several disorder have led to over-diagnosis of conditions such as bipolar disorder and attention deficit hyperactivity disorder.

Now, Insel has said in a blog post published by the NIMH that he wants a complete shift to diagnoses based on science not symptoms.

“Unlike our definitions of ischaemic heart disease, lymphoma or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure,” Insel says. “In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain, or the quality of fever.”

Insel says that elsewhere in medicine this type of symptom-based diagnosis been abandoned over the past half-century as scientists have learned that symptoms alone seldom indicate the best choice of treatment.

To accelerate the shift to biologically based diagnosis, Insel favours an approach embodied by a programme launched 18 months ago at the NIMH called the Research Domain Criteria project.

The approach is based on the idea that mental disorders are biological problems involving brain circuits that dictate specific patterns of cognition, emotion and behaviour. Concentrating on treating these problems, rather than symptoms is hoped to provide a better outlook for patients.

“We cannot succeed if we use DSM categories as the gold standard,” says Insel. “That is why NIMH will be reorienting its research away from DSMcategories,” says Insel.

Insel is aware that what he is suggesting will take time – probably at least a decade, but sees it as the first step towards delivering the “precision medicine” that he says has transformed cancer diagnosis and treatment.

“It’s potentially game-changing, but needs to be based on underlying science that is reliable,” says Simon Wessely of the Institute of Psychiatry at King’s College London. “It’s for the future, rather than for now, but anything that improves understanding of the etiology and genetics of disease is going to be better [than symptom-based diagnosis].”

Michael Owen of the University of Cardiff, who was on the psychosis working group for DSM-5, agrees. “Research needs to break out of the straitjacket of current diagnosis categories,” he says. But like Wessely, he says it is too early to throw away the existing categories.

“These are incredibly complicated disorders,” says Owen. “To understand the neuroscience in sufficient depth and detail to build a diagnosis process will take a long time, but in the meantime, clinicians still have to do their work.”

David Clark of the University of Oxford says he’s delighted that NIMH is funding science-based diagnosis across current disease categories. “However, patient benefit is probably some way off, and will need to be proved,” he says.

The controversy is likely to erupt more publically in the coming month when the American Psychiatric Association holds its annual meeting in San Francisco, where DSM-5 will be officially launched, and in June in London when the Institute of Psychiatry holds a two-day meeting on the DSM.

It will be very interesting to see what this leads to. Hard core psyche critics are already saying “see, we told you so, no biological basis,” but they’re throwing the baby out with the bath water. Switching over to purely biological testing/or basis won’t work either. Especially given it will take years, probably decades, to have anything that is functional in a clinical setting.

It's Different for Girls with ADHD

Wed, 03 Apr 2013 21:18:26 -0400

It's Different for Girls with ADHD:

“Yet also harmful are the consequences of ADHD untreated, an all-to-common story for women like me, who not only develop symptoms later in life, but also have symptoms—disorganization and forgetfulness, for instance—that look different than those typically expressed in males.”

The New York Times Opens a Can of Worms on the Increased Use of Stimulants for ADHD

Mon, 01 Apr 2013 23:25:08 -0400

The New York Times Opens a Can of Worms on the Increased Use of Stimulants for ADHD:

“In today’s NYTs there is an excellent article by Alan Schwartz and Sara Cohen on the rapid rise of the ADHD Diagnos. The series of articles by Schwartz is especially refreshing given that for decades the Timesreporters, for the most part, have ignored the critics. The Times quotes several promoters of the ADHD diagnosis who now have second thoughts. It is a tad humorous that the Times chooses to publish the confessions of those who promoted the diagnosis, rather than mention the critics who were apparently correct all along.”

Debate Over Drugs For ADHD Reignites

Mon, 25 Mar 2013 14:08:38 -0400

Debate Over Drugs For ADHD Reignites:

“…the most obvious interpretation of the data is that the medications are useful in the short term but ineffective over longer periods but added that his colleagues had repeatedly sought to explain away evidence that challenged the long-term usefulness of medication. When their explanations failed to hold up, they reached for new ones…”

Neurologists Warn Against ADHD Drugs To Help Kids Study

Thu, 14 Mar 2013 14:28:19 -0400

Neurologists Warn Against ADHD Drugs To Help Kids Study:

“Quite a few of those pills don’t end up being used to treat ADHD, though. They’re used as “smart drugs” or “study drugs” by students who find the pills give them a mental edge. The American Academy of Neurology now says: Stop that.”

I agree people shouldn’t be taking meds that haven’t been prescribed to them. But the irony of people speaking out like this is they can’t do it without laying bare the side effects of the drugs which apply to ALL users.

“But they can cause a wide range of side effects including insomnia, aggression, mood and behavior changes, twitching, and shaking.”

Inconsistent cultures produce more kids with behavioral problems?

Thu, 28 Feb 2013 22:49:56 -0500

Taking notes on research I came across this interesting, though unstudied theory. In a 1982 paper by researchers Ross and Ross they posit:

“Consistent cultures will have fewer children diagnosed with hyperactivity as they minimize individual differences among kids and provide clear and consistent expectations and consequences for behavior that conforms to the expected norms. Inconsistent cultures, by contrast, will have more kids diagnosed with hyperactivity as they maximize or stress individual differences and provide ambiguous expectations and consequences to kids regarding appropriate conduct.”

There’s definitely a correlation between what has been perceived as lower rates of ADD/ADHD in ‘traditional’ countries (even in Europe) compared to the US. But that gap is definitely closing.

ADHD, Autism, and Others Have Common Genetic Link

Wed, 27 Feb 2013 22:41:55 -0500

ADHD, Autism, and Others Have Common Genetic Link:

“Autism, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, and schizophrenia share common genetic underpinnings — despite differences in symptoms and course of disease, researchers discovered.

In particular, single nucleotide polymorphisms (SNPs) in two genes involved in calcium-channel activity appear to play a role in all five, Jordan Smoller, MD, ScD, of Massachusetts General Hospital in Boston, and colleagues reported online in The Lancet.”

The Jekyll and Hyde happy pill: It's brought relief to millions but is linked to suicide, low libido and birth defects, and we still don't know how Prozac works.

Sat, 09 Feb 2013 12:55:44 -0500

The Jekyll and Hyde happy pill: It's brought relief to millions but is linked to suicide, low libido and birth defects, and we still don't know how Prozac works.

The Ten worst changes to DSM-V?

Fri, 14 Dec 2012 13:04:06 -0500

The Ten worst changes to DSM-V?:

“ When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only- so that DSM 5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation. “

From Allen Frances, head of the DSM-IV Task Force.

Some more recent, but still old, drug ads, including one of the...

Fri, 07 Dec 2012 10:01:24 -0500

Some more recent, but still old, drug ads, including one of the original Prozac ads. Also a couple iconic ADD/Ritalin ads.

Psychiatry Beyond the Current Paradigm

Thu, 06 Dec 2012 11:59:00 -0500

“Psychiatry is not neurology; it is not a medicine of the brain. Although mental health problems undoubtedly have a biological dimension, in their very nature they reach beyond the brain to involve social, cultural and psychological dimensions. These cannot always be grasped through the epistemology of biomedicine. The mental life of humans is discursive in nature.”

A really great article in the British Journal of Psychiatry summing up what needs to change in Psychiatry as more and more people realize the value of ‘non-technical’ aspects to treatment and ‘disease’ conception (sort of the brain vs. mind concept).

(also a video of a lecture from one of the article’s authors, Dr. Pat Bracken, on the subject of psychiatric reform.)

Old Ritalin ads. ‘“Acceptable” behavior at any...

Tue, 04 Dec 2012 16:31:33 -0500

Old Ritalin ads. ‘“Acceptable” behavior at any age’ says one. Another says, ‘You can bring patients “out of the corner.”’

Some of the old - really old - drug ads I’ve collected...

Tue, 04 Dec 2012 16:22:57 -0500

Some of the old - really old - drug ads I’ve collected over the last year, including one for cocaine toothache drops! More to come…

Raised on Ritalin update: I think I’m about halfway done...

Fri, 30 Nov 2012 13:15:50 -0500

Raised on Ritalin update: I think I’m about halfway done with a rough draft. I’ve spent the past few months writing and doing rough page layouts like these. I’m up to 151 pages.

The middle part of the book provides context to my personal story: the history of ADHD, some history of meds and psychiatry in general, and a look at current ADHD theories and meds.

Then it will segue back into my story and how learning all of this stuff reshaped my perception of my childhood, my past in general, my family, my relationships, my work, and so on.

And then the ever-important sound-bite-ready conclusion ;)

How Drug Company Money Is Undermining Science

Sun, 25 Nov 2012 11:50:18 -0500

How Drug Company Money Is Undermining Science:

“…the pharmaceutical industry has come up with many ways to funnel large sums of money… into the pockets of independent medical researchers who are doing work that bears, directly or indirectly, on the drugs these firms are making and marketing.”

Am I pro- or anti-medication?

Tue, 16 Oct 2012 09:42:02 -0400

Given all the articles and info I’ve posted that are critical of medications and the psychiatric field, I’ve had a couple of people ask me if I’m anti-medication. The simple answer is “no.”

Medications have a place in treatment, but only in the most serious or critical of cases. Especially with ADHD. I’ll attempt to articulate my extended feelings in my book, but it’s worth mentioning at this point that I’m not out to denounce medication or psychiatry completely.

I just want people to think critically and make informed decisions. I know it’s hard in this day when we are always so ‘busy’ but it’s worth it. It might seem like an easy choice to medicate your kid or yourself because it might solve your problem tomorrow or next week, but what about a year down the road? Five years? Or ten years?

Medications are not benign interventions. There is always a consequence, good or bad. And our knowledge of the brain and the mind is constantly growing. At the very least we know that for as much as we know, we still don’t know very much. History has taught us that it’s not usually as simple as we thought - especially with a system as complicated as the human brain/mind.

Attention Disorder or Not, Pills to Help in School

Mon, 15 Oct 2012 09:54:55 -0400

Attention Disorder or Not, Pills to Help in School:

Giving drugs to kids so they do better in school because it’s easier than the schools/teachers or the parents changing. I can’t believe this doctor admitted to behavior like this. Unfortunately it’s more common than not.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Freidman Criticizes the Overuse of the Atypical Antipsychotics

Thu, 04 Oct 2012 16:41:54 -0400

Dr. Freidman Criticizes the Overuse of the Atypical Antipsychotics:

Nice commentary on THIS recent article in the NY Times about the overuse of antipsychotics (including for ADHD).

“The problem with the overuse of the antipsychotics, as almost everybody acknowledges, is that the medical literature on these medications is little more than an infomercial. For anyone who wants to have their eyes opened just read the Rothman Report, which lays out how the medical literature was co-opted by the companies. The atypicals have been promoted for everything from borderline personality disorder to ADHD. In one study of children in Florida on Medicaid almost 40% of the children (age 0-18) taking an atypical were diagnosed with ADHD. Can the doctors in the trenches really be faulted for following the literature? Aren’t they supposed to do this?”