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ATTENTION DEFICIT DISORDER: DOES IT EXIST? The 1994 Textbook of Psychiatry, published by the American Many parents around the country have discovered that Ritalin- Psychiatric Press, contains this review by Popper and Steingard. taking has become a condition for their children continuing in The pronouncement makes a number of things clear. "Stimulants school. There are even reports by parents of threats from social [such as Ritalin] do not produce lasting improvements in aggres- agencies: “If you don't allow us to prescribe Ritalin for your sivity, conduct disorder, criminality, education achievement, job ADD child, we may decide that you are an unfit parent. We may functioning, marital relationships or long-term adjustment." decide to take your child away." Parents should also wake up to the fact that, in the aftermath of This mind-boggling state of affairs is fuelled by teachers, prin- the Littleton, Colorado, tragedy, pundits and doctors are urging cipals and school counsellors, who do not have medical training. more extensive "mental health" services for children. Fine, except Yet the very definition of the "illnesses" for which Ritalin whether you have noticed it or not, for the most part this no longer would be prescribed is in doubt, especially at the highest levels of | means therapy with a caring professional. It means drugs. It the medical profession. This doubt, however, has not filtered means the drugs I am discussing in this inquiry. down to most public schools. In December 1996, the US Drug Enforcement Administration Commenting on Dr Lawrence Diller's book, Running on (DEA) held a conference on ADHD and Ritalin. Surprisingly, it Ritalin, Dr William Carey, Director of Behavioral Pediatrics at issued a sensible statement about drugs being a bad substitute for the Children's Hospital of Philadelphia, has written: "Dr Diller the presence of caring parents: "...the use of stimulants [such as has correctly described...the disturbing trend of blaming children's Ritalin] for the short-term improvement of behavior and under- social, behavioral an lemic performance problems entirely on achievement may be thwarting efforts to address the children's an unproven brain deficit..." real issues, both on an individual and societal level. The lack of On November 16-18, 1998, the US National Institute of Mental long-term positive results with the use of stimulants and the Health held the prestigious NIH Consensus Development specter of previous and potential stimulant abuse epidemics give Conference on Diagnosis and Treatment of Attention Deficit cause to worry about the future. The dramatic increase in the use Hyperactivity Disorder. The conference was explicitly aimed at of methylphenidate [Ritalin] in the 1990s should be viewed as a ending all debate about the diagnoses of marker or warning to society about the prob- ADD and ADHD, and about the prescription lems children are having and how we view of Ritalin. It was hoped that at the highest and address them." levels of medical research and bureaucracy, ae nearly a dozen cases The Brookhaven National Laboratory has a clear position would be taken: this is what involving Prozac have studied Ritalin through PET brain scans. ADHD is, this is where it comes from, and Lab researchers have found that the drug these are the drugs it should be treated with. disappeared from the decreased the flow of blood to all parts of the That didn't happen, amazingly. Instead, the court record. brain by 20 to 30 per cent. That is, of course, official panel responsible for drawing con- a very negative finding. It is a signal of dan- clusions from the conference threw cold ger. But parents, teachers, counsellors, prin- water on the whole attempt to reach a com- ... lawsuits against the cipals, school psychologists know nothing fortable consensus. aa: about this. Nor do they know that cocaine Panel member Mark Vonnegut, a manufacturer, Eli Lilly, produces the same blood-flow effect. Mossachuset pcdiacin. oid: ml have apparently been mm, Jn bok, Tang Bak Rtn The panel essentially said it was not settled, without trial, In effects: "Stimulants such as Ritalin and Sis. In other words, ADD and ADHD such a quiet and final impute onthe brain-reduing overall might be nothing more than attempts to way, with such strict blood flow, disturbing glucose metabo- categorise certain children's behav- confidentiality, that it is lism and possibly causing permanent y almost as if they never happened. iours—with no organic cause, no clear- shrinkage or atrophy of the brain." cut biological basis, no provable reason for even using the ADD or ADHD labels. The panel found "no data to indicate that ADHD is due to a brain malfunction [which malfunction had UNSETTLED OUT OF COURT In the wake of the Littleton shooting, we find that "the American people" and lawyers, pundits and child psycholo- been the whole psychiatric assumption gists are pointing the finger at in the first place]". Hollywood, at video games like Doom, The panel also found that Ritalin has not been shown to have _at inattentive parents, and at the availability of guns. We have to long-term benefits. In fact, it stated that Ritalin has resulted in wonder why almost no one is calling out these drugs. Is it possi- "little improvement on academic achievement or social skills". ble that the work of PR people is shaping the national response? Panel chairman David Kupfer, Professor of Psychiatry at the An instructive article, "Protecting Prozac", by Michael Grinfeld University of Pittsburgh, said: "There is no current validated in the December 1998 California Lawyer, opens several doors. diagnostic test [for ADHD]." Grinfeld notes that "in the past year, nearly a dozen cases involv- Yet at every level of public education in America, there remains ing Prozac have disappeared from the court record". He is talking what can only be called a voracious desire to give children Ritalin about lawsuits against the manufacturer, Eli Lilly, and he is say- (or other similar drugs) for ADD or ADHD. ing that these cases have apparently been settled, without trial, in Nullifying the warnings, assurances and prescriptions that doc- such a quiet and final way, with such strict confidentiality, that it tors routinely give to parents of children who have been diag- is almost as if they never happened. nosed with ADD or ADHD should be a national goal. This smoothness, this invisibility, keeps the Press away and ... hearly a dozen cases involving Prozac have A Sena ene ee court record. ... lawsuits against the manufacturer, Eli Lilly, have apparently been settled, without trial, in such a quiet and final way, with such strict confidentiality, that it is almost as if they never happened. NEXUS - 31 ATTENTION DEFICIT DISORDER: DOES IT EXIST? disappeared from the AUGUST - SEPTEMBER 1999