Pediatrician T. Berry Brazelton is breath-ing new life into the popular perception of Attention Deficit/Hyperactivity Disorder (ADHD) as a “disease”—a chemical imbalance that requires a stabilizing, “counter-balancing” agent such as Ritalin, Adderall, Concerta, or another name-brand amphetamine to correct a defective brain. An example can be found in his recent syndicated column: “Managing ADHD Once It’s Diagnosed” (March 9).
On the positive side, Dr. Brazelton does acknowledge that “[o]verdiagnosis is a major problem with ADHD” and that “many children so labeled are merely anxious, resulting in overactivity and short attention spans.”
His argument breaks down, however, when he discusses children who are “over-focused.” Brazelton claims that the severity of the disorder boils down to the “quality of [a child’s] attention” coupled with his “ability to control” it. The classic scenario of ADHD is nonstop activity, combined with the inability to sustain attention on any particular project (ADD). To categorize its precise opposite—intense concentration (i.e., “overfocusing”)—as the same illness is nonsense.
All medical researchers and practicing physicians (psychiatrists included) study the normal, disease-free status of human beings along with the abnormal, which they label “disease” or “illness.” They are responsible for distinguishing one from the other. When no abnormality/disease is present, there is nothing to make normal; therefore, there is no need for medical treatment.
A growing chorus of professionals are challenging the conventional wisdom on ADHD. There is still no proof that ADHD is a disease and, thus, no objective means of diagnosing it. We are left with only a hodge-podge of subjective phenomena. And a great deal of that—particularly as it relates to concentration and focus—amounts to perfectly normal behavior.
Many of those described by mental-health workers as “hypersensitive” and “obsessive,” for example, not only are not mentally ill but possess incredible genius. It is their very hypersensitivity and obsessive dedication that allow them to create what others do not, even if others happen to have the raw talent to do so.
One third to one half of patients seeking help for psychological/psychiatric symptoms simply have no abnormality. The lure of pills and/or talk therapy for unhappiness, personal failings (real or imagined), emotional hang-ups, and just plain quirkiness is understandable, and the pharmaceutical industry, along with many ethically challenged clinicians, has capitalized on it. Scrupulous professionals know, however, that making diseases out of such conditions as too much or too little concentration, aversion to crowds, or frequent shopping sprees is overkill, if not downright bogus medicine.
Psychiatry and neurology were formally separated in 1948: Psychiatry was to deal with emotional and behavioral problems of physically/medically normal individuals; neurology, with physical/medical abnormalities of the nervous system. The latter can be verified with medical tests; the former cannot.
With the advent of psychotropic (mind-altering) drugs in the 1950’s and 60’s, a psycho-pharmaceutical industry was born. It has since morphed into a kind of legal drug cartel whose sales pitch is the correction of “chemical imbalances.” The American Psychiatric Association’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), grew from 112 mental “diseases” in 1952 to 374 in 1994. Virtually none of the new categories are scientifically verifiable. For example, in a 1970 congressional hearing, psychiatrists insisted that “hyperkinesis” (a.k.a. ADHD) was a disease, and ADHD became the field’s prototypical “biologically based” mental illness. Psychiatrist John Peters, of the University of Arkansas, insisted that “it has to do with some dysfunction of the brain.” The FDA’s Ronald Lipman echoed Peters’ determination: “hyperkinesis is a medical syndrome.”
Chairman Cornelius Gallagher tried to inject some common sense, asking: “Who makes a decision . . . as to whether a child has hyperkinesis, or is just a bored, bright, creative, pain-in-the-neck kid?”
Nevertheless, ADHD was institutionalized as a disease in the mid-1980’s. Now, inexplicably, we have an epidemic of some half a million “sufferers.”
In 1990, Alan Zametkin of the National Institute of Mental Health (NIMH), using PET (Positron Emission Tomography) scans, reported that the brains of individuals diagnosed with ADD used eight percent less glucose than those of “normal” people. The diagnoses, however, were based on parent-teacher interviews. No one could duplicate Zametkin’s findings. That did not stop pharmaceutical giant Ciba/Novartis or the high-profile mental-health activist organization Children and Adults with Hyperactivity Attention-Deficit Disorder (CHADD) or the psychiatric community in general from chanting “disease!” at every opportunity.
In a widely publicized 1994 article aimed originally at professional audiences in the field, “Driven to Distraction,” Edward M. Hallowell and John J. Ratey proclaimed: “[T]here is enough evidence that neurochemical systems are altered in people with ADD.”
Turning their attention to CT (computed tomography) scans for support, Hallowell and Ratey noted that, in 1986, H.A. Nasrallah, et al. had found brain atrophy (shrinkage) in 58 percent of young adults diagnosed with ADHD. However, they added a caveat that was subsequently forgotten by the pro-disease faction: “[S]ince all of the patients had been treated with psycho-stimulants, cortical atrophy may be a long-term adverse effect of this treatment.”
This caveat was largely ignored until a few renegades in the field recently took the trouble to point it out. From 1986 to 1998, nine MRI (Magnetic Resonance Imaging) brain scans were performed on psychostimulant-treated groups diagnosed with ADHD. The professional bigwigs concluded that, since all showed brain atrophy, the culprit must be ADHD. The possibility that the “treatment” itself was causing the atrophy was dismissed.
Had the behavioral-science community and NIMH been interested in the truth, researchers would have been eager to confirm those results by conducting MRI scans on untreated symptomatic individuals. Over the course of those 12 years of brain-scan research, however, the medical community failed to commission a single such study.
By the time the Consensus Conference convened on November 18, 1998, the ADHD “epidemic” had swelled to between four and five million cases. Dr. Fred A. Baughman, a pediatric neurologist, attended the conference as an invited participant. At one point in the proceedings, NIMH’s Dr. James Swanson and F. Xavier Castellanos announced that there is “converging evidence that . . . ADHD . . . is characterized by reduced size in specific neuroanatomical regions of the frontal lobes and basal ganglia.” They did not mention that all of the ADHD subjects tested had been treated with stimulants.
So Dr. Baughman brought up the subject himself: “Dr. Swanson, why didn’t you mention that virtually all of the ADHD subjects . . . have been on chronic stimulant therapy, and that this is the likely cause of their brain atrophy?”
Dr. Swanson replied: “I understand that this is a critical issue and in fact I am planning a study to investigate that. I haven’t done it yet.”
The University of Pennsylvania’s William B. Carey later testified: “What is now most often described as ADHD in the United States appears to be a set of normal behavioral variations. . . . This discrepancy leaves the validity of the construct [ADHD] in doubt.” Vindicating Dr. Baughman’s professional heresy, the Consensus Conference Panel concluded: “[W]e do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction.”
Four MRI studies have since been published. Though all of them utilized stimulant-treated subjects, the researchers found that treatment using Ritalin and other amphetamines is causing brain atrophy and not that ADHD is a disease. If this stands, we could see class-action lawsuits in this country that make the tobacco settlement look like a parking fine.
Only a paper by F. Xavier Castellanos, published last year in the Journal of the American Medical Association, claimed to have proof that ADHD, not amphetamine “treatment,” is the cause of brain atrophy. Castellanos cited “the first neuro-imaging study to our knowledge to include a substantial number . . . of previously unmedicated children and adolescents with ADHD.”
While the study in question did include 49 ADHD-labeled nonmedicated subjects, it also included 103 amphetamine-medicated subjects. Furthermore, the 49 nonmedicated subjects (mean age, 8.3 years) were not compared to a matched control group. Instead, the control group was a full 2.6 years older than the nonmedicated group—which means, on average, larger, less vulnerable brains. This alone should have invalidated the study.
This sleight-of-hand is never exposed in the popular press, so parents and teachers never see it. How is the average parent to make an informed decision concerning an ADHD diagnosis and the medication of his child?
In an April 15, 1998, letter to then-Attorney General Janet Reno, Dr. Baughman wrote that
the single, biggest health care fraud in U.S. history [is] the misrepresentation of attention deficit hyperactivity disorder . . . as an actual disease, and the drugging of millions of entirely normal American children.
Psychiatric research has yet to prove him wrong.