My last blog warned that Attention Deficit Disorder has become an overused fad diagnosis, with resulting excessive prescription of stimulant drugs. In the past 15 years, rates of ADD have tripled and stimulant use has doubled. For kids with severe and clearcut ADD, the medicine is often essential and enormously helpful. But loose diagnosis and aggressive drug company marketing result in frequent mislabeling and a quick trigger to starting medication when it may not really be needed.
Martin Whitely offers a proven public health cure for this false "epidemic" of diagnosis and treatment, one that has already worked wonders in his native state of Western Australia. Mr. Whitely is currently a member of Parliament, was previously a teacher, and has always been a crusader for safe and effective mental health services. He describes the taming of ADD in Perth -- the world's first hotspot to see a massive downturn in child prescribing rates.
Mr. Whitely writes:
"When I was elected to the Western Australian Parliament in 2001, my state's ADD per-capita prescribing rate was approximately 3.5 times the Australian national rate and exceeded the U.S. rate."
"The numerous committees that had previously reviewed diagnostic and prescribing practices had been heavily influenced by 'ADD experts' -- usually themselves frequent prescribers who had commercial ties to the pharmaceutical industry. Not surprisingly, these reviews consistently found no basis for concerns about possible harms and even concluded that ADD was under-diagnosed and the drugs used to treat it were under-prescribed. Their recommendations usually encouraged the further prescription of ADD drugs (without a scientific basis other than the consensus of the experts on the review committee) and predictably were followed by further increases in ADD prescribing rates.""The most obvious problem (and opportunity for intervention) was the fact that frequent prescribers were largely exempt from accountability requirements. I advocated for much tighter, case by case, quality control administered by clinicians known to prescribe far less frequently. The resulting more rigorous and independently administered accountability resulted in a dramatic and sustained (60-70 percent) fall in child ADD prescribing numbers since 2003. Western Australia's child ADD per-capita prescribing rate is now marginally below the national average and is decreasing relative to other Australian states."
"Loose ADD diagnosis and the overprescribing of stimulants had also led to a big drug abuse problem. In 2005, 5.5 percent of Western Australian high school students had abused a diverted prescription stimulant within the last year. An amazing 45 percent of high school students who had ever taken dexamphetamine or Ritalin were not prescribed the drugs by a doctor and 27 percent of those who had been prescribed these drugs either gave away or sold them."
"Over the same period that child prescribing rates fell 60-70 percent, the number of teenagers abusing amphetamine dropped 51 percent. Far from supporting the commonly-made assertion that medicating for ADD prevents illicit drug abuse (by reducing self-medicating among untreated ADD sufferers), Western Australia's experience confirms the common-sense proposition that over-prescribing amphetamines legally facilitates their illegal abuse."
"Unfortunately old habits die hard among the ADD generation that was overmedicated in the 1990s. Western Australia's prescribing rate for adults is the highest in Australia -- far too many of our young adults still abuse prescription ADD amphetamines, particularly when binge drinking."
"The good news is that at least for the next generation of Western Australian children, the cycle of diagnosis, prescription and ongoing abuse has, to a significant degree, been broken. Our experience shows that rigorous and independent controls over prescribing can end the pattern of 'regulatory capture' by vested interests and thereby slash both the number of children legally on ADD drugs and the rates of illegal amphetamine abuse.
For more details see www.speedupsitstill.com."
Well done to Mr. Whitely and to Western Australia. I hope this example can be generalized wherever ADD diagnosis and treatment have gotten out of control. Fads in psychiatric diagnosis have been common throughout history. They usually begin suddenly, spread quickly to epidemic proportions, and then disappear in a fairly sudden death.
There are two potential tools that would allow us to tame the current ADD fad: 1) narrowed and more carefully applied diagnostic criteria, and 2) rigorous quality controls over stimulant prescription. DSM-5 will lead us in just the wrong direction on the first; Mr. Whitely shows us the way on the second.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.
Allen Frances: Predicting Psychosis Risk Is Pretty Risky
While I was a teacher, I did see a few students who clearly had ADD/ADHD and many more who simply had poor impulse control.
At 23, he says he can now read a book in a week - something that was impossible for him throughout adolescence. When he was 19, he began cutting out sugars and starches, which helped a great deal. He has now advanced to very low-carb/paleo lifestyle and this is what has been the most successful. He says he feels the best he has ever in his life. I hope other young people will give it a try and have their lives turn around like son's did.
it is a great shame that you align yourself with Martin Whitely.
Whitely has a limited education, and has some worrisome associations.
Actually, there IS an epidemic of ADHD, and is is easily observable to those of us who have memories long enough to remember back to the 1970's.
The epidemic though, is not because of a change in genetics. It is because of a change in social conditions. The Reagan/Thatcher' Hawke/ Howard economic rules are poisoning our society and are causing great distress and dysfunction.
We have a situation where the conditions for positive child rearing no longer exist.
Yes, there is an epidemic. For those of us (myself included) affected by this epidemic, stimulants are a helpful medication.
What is needed though is a change in social conditions. Shorter working hours, restoration of the extended family, restoration of community life, more time playing and exercising for kids, and less time learning the complete garbage thrust at us through our school curricula.
You have a good reputation though- and you lower yourself through association with the member for Bassendean.
I do not know the history of the member for Bassendean, but I do intimately know the damage done by the over diagnosis and over medication of "ADD." My own son was diagnosed and medicated for several years. You yourself hit the nail on its proverbial head when you linked it to a change in social conditions. This change is not alterable by stimulants or any other medication, but only by radically changing the way we live. Each one of us has choices to make. Another half an hour with the telly, or a run with the dog? A new video game for Junior, or a daily trip to the park? McDonald's for supper, or making a sit down meal from actual food ingredients? Your brain is not broken. A pill will not fix it. The fact that it makes life more bearable reminds me of my alcoholic grandmother who swore that gin was the only medicine that cured her stomach ache. Did it make it feel better? Probably. Did it make the underlying condition worse? Yes. If as much attention was paid to actually getting children (and adults) outside, exercising, eating properly, and having satisfying relationships with other humans, as is paid to the purported "epidemic" of ADD and the subsequent drugging of an entire generation, there would BE no epidemic. The only answer is to change our lives and our priorities, and to work for change in the larger society. This is a good start.
I was diagnosed with ADHD at age 47.
The condition had been an issue all my life- and the treatment was remarkably powerful.
I progressed beyond medication once I got a grip on things though.
Now I use exercise, posture management, trauma release exercise, and careful attention to diet and exercise.
Without the medication I would not have had enough mental stability to start meditation!
I am still unravelling the damage to my marriage caused by my previously uncontrollable ADHD behaviours and the outworkings of related pain and trauma. That trauma was a direct result of "failure to diagnose" and failure on the part of the professionals involved to keep themselves up to date with the science.
In Australia the diagnosis and the treatment are radically neglected, and the attitude of the medical profession to the profusion of good science is overtly negligent.
I am a doctor myself, and I urge every patient with a missed diagnosis of ADHD to firstly report the offending doctor to their professional registration body, and secondly ( if feasible without undue cost or stress) to look at a formal negligence action.
The science here is clear cut and very well backed up.
I am 100% with you in advocating social change- and the first social change I would push for is shorter working hours and higher pay.
why do people dope their kids up all the time? i can't count how many kids i've watched grow up on those meds that don't need them. many of them now take pills to get high. i'm sure it's because of such long term pill use. many of them have had adverse reactions to the meds and became violent when in school. one boy got put into a mental hospital only to find out he didn't have add/adhd at all and the meds were actually making him more hyper.
it's very scary, the power that drug companies have over us all. they have a pill for everything and advertise on tv. how on earth is it ok to advertise with cute lil commercials for medications? it doesn't seem right to me.
at my local pharmacy, they throw out all advertising that the drug companies put around the pharmacy area. the pharmacist said you wouldn't believe the people who come in, asking for the meds being advertised, like they're buying a loaf of bread or something.
meds should be given out of necessity NOT out of convenience.