In the Western world, for example in the United Kingdom and in the Netherlands, governments are extremely concerned about the increased prescription of drugs like Ritalin and Concerta for children and teenagers. But also adults with ADHD-like symptoms have become an important and lucrative market for the pharmaceutical industry.
First some facts about Attention Deficit Hyperactivity Disorder (ADHD):
– ADHD is NOT an illness.
– You are NOT born with it.
– Medication is very often NOT the appropriate way of dealing with ADHD symptoms.
The classic mistake (also made by quite a few prominent psychiatrists) is to think that ADHD is the cause of hyperactivity, impulsiveness and concentration problems. It’s very tempting and understandable to accept the pseudo-explanation of psychiatry. Because nobody is to blame and there is this simple story that the behavior of the child is caused by something in the brain. In reality ADHD is a name that has been given for certain behavior.
ADHD is not some neurobiological brain abnormality which explains certain behavior. No, ADHD IS that behavior. And that behavior has not one unequivocal cause; there are always several (environmental) factors which influence each other. But most important, the diagnosis ADHD can only be made if, besides looking at ADHD-behavior in its proper context, there are serious problems with social functioning and/or functioning at school or at work.
With family, twin and adoption studies it’s almost impossible to separate the effect of hereditary factors from environmental factors. Is the child of a restless mother restless because of the reaction and copying of the mother’s behavior or because of the genes that it has from the mother? Besides this, studies show that there are for example no simple or combination of known genes responsible for any psychiatric disorder. After 50 years of intense and extremely costly (trillions of dollars) genetic research for psychiatric disorders, experts are very pessimistic about ever finding these genes.
Perhaps there is some complex interaction with genetics, but the influence of the environment (for example the family dynamics you grew up with, or other experiences) is paramount.
ADHD is not a medical but a BEHAVIORAL problem and psychologists are better equipped to deal with that than medical doctors. Many psychiatrists want to do what they are trained for: to treat serious complex problems as best as they can, but most ADHD behavior doesn’t fall within that category. The best way of dealing with ADHD behavior is a treatment that starts with advice and training and when nothing else works then medication can be considered. Needles to say, that when an extremely demanding child does need medication (for a short time) it should be given straight away.
ADHD is a label for behavior that can be caused by numerous factors. Tensions between the parents, the noisy class at school has too many children, the teacher can’t handle the class because of stress, a sibling is in a difficult phase and demands much attention from the parents, the child goes to bed at an inappropriate time, etc. etc. Medication can only suppress unwanted ADHD behavior for a maximum of two years and has a number of serious disadvantages (see my previous articles about ADHD). Sometimes in difficult cases medication is appropriate.
In many cases parental advice, teacher training and psychological support suffices. It’s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behavior should be noted and rewarded.
Many studies conclude that the outcomes of research that has been financed by the pharmaceutical industry are much more positive about the studied pill or illness than non-financed studies. Numerous ADHD-researchers (like the American psychiatrist Joseph Biederman and the epidemiologist Ronald Kessler) have strong financial ties with the pharmaceutical industry which makes their findings at the least suspect. Kessler’s World Mental Health Survey Initiative (WMH), part of the World Health Organization, extremely overestimates the prevalence of ADHD with adults.
These ‘findings’ are particularly important for Big Pharma because existing ADHD licenses are usually limited to the age category six till 18 years. This WMH study has many serious shortcomings. To name one, the interviews were done by laymen who had only received a short interview training (no medical doctors as is required in the DSM) and who were not equipped to assess a difficult ADHD diagnosis. Another WMH study that concluded that ADHD with children is a good predictor for ADHD in adulthood, has broken practically every rule for conducting proper research and is best disregarded.
It’s disturbing that figures from these WMH studies are used in policy making papers concerning ADHD.
Eighty to 90 percent of the adults, who meet the criteria of ADHD, simultaneously meet the criteria of other disorders like depression, bipolar disorder, anxiety and obsessive-compulsive disorders, addiction to alcohol and drugs, and personality disorders.
This huge overlap shows in the first place the pointlessness of the concept ADHD for adults. Many people who are suffering from problems, have difficulties with concentration and are restless and irritable, something that is hardly surprising. There is no foundation for the claim that ADHD is the cause of the other disorders. Secondly, this high percentage of other disorders shows that this is a group of vulnerable people, who often have battled their whole lives with issues. There is no independent research that shows that lifelong existing problems will disappear or diminish with ADHD medication.
Furthermore, a meta-analysis (Koesters et al, 2009) concluded that the effects of methylphenidate (the most used ADHD medication) with adults are only short term and at best mediocre. Adult people with problems are talked into a diagnosis plus medication while most of them are not helped with these at all.