- Position statement on ADHD
- ADHD Workshop Information
- Articles for downloading -
- Bibliography for Alternative views on ADHD
any children have real problems paying attention. Some may even suffer long term secondary effects (poor grades, poor self-esteem, poor long term social adjustment, etc.), from their apparent difficulties paying attention. These are serious problems which need serious solutions to help get these children back on track being successful. I do not mean to diminish in any way the seriousness of the issues, and the pain, frustration, time and energy that teachers and parents spend in dealing with, coping with, educating and raising these children. However, I wish to question, challenge and debate the currently held popular notion that these children have some type of genetically caused biochemical imbalance which needs to be medicated.
For over twenty years using the discipline approach described on this web site, I have been able to help students, parents, teachers and school systems resolve most of these difficulties without having to use medication. The volumes of books and materials written on ADHD, can be overwhelming and confusing to professionals in the field let alone parents. In my opinion, after spending years researching this topic, most of the pro ADHD material can be summarized within the following main points. Each one of these points could be elaborated on and documented extensively in its own right. However, for the purpose of this position statement, they will be listed with a few brief comments. For more in depth information on these points: download the web site ADHD articles, see my videos on ADHD with the accompanying materials; or refer to Dr. Peter Breggin's web site on ADHD (www.breggin.com.) {At times I will make a comment within a quote. When I do, it will be indicated by ( )*. Also at times I will underline a word or two to highlight a point or question the wording of the statement.}
- There is no medical evidence to prove there is a biochemical imbalance or genetic cause for this disorder.
There is roughly 50 years of research, 10,000 studies, millions of dollars spent and there is still no substantiated scientific evidence for any medical cause for ADHD. Every year the pro ADHD group will flaunt one or two new studies as proof that ADHD has some type of physiological, neurological, biochemical or genetic cause. However, after scientific review and replication of results are tried, none of these theories to date have shown any evidence for a medical causation. To drive this point home--no matter how compelling, scientific or sophisticated the newest medical causes sound, ask any Doctor or leading expert in the field, "If you had 100 children with ADHD and 100 who did not, and I gave you any medical, biochemical, genetic, PET scan, MRI or new theory of the day information you wanted, could you tell me, just from that information, which ones have ADHD and which do not?" The answer will be NO! There is no medical test for ADHD. There are no physical markers for ADHD. There is no medical evidence for ADHD. - There is no agreed upon definition for this "supposed" disorder.
The experts are still debating and arguing over the behaviors and definition of ADHD. They are still trying to define "often fidgets with hands or feet or squirms in seat." Read this quote and tell me what you think. "One of the problems facing researchers attempting to localize or identify the neurological basis of ADHD (wasn't this proved previously?)* is the inability to map behavioral descriptors (such as "often fidgets")* onto relevant neurologic components." (Exceptional Children, Vol. 60, No. 2, pp. 118-124.) Since they have no definition or behavioral descriptors, how can this be correlated with or mapped to any neurological components? No definition-no correlations-no neurological base. - There are no medical, educational or psychological tests or assessment instruments to reliably and validly diagnose this supposed medical condition.
"The differential validity of the current diagnostic construct of ADHD remains to be evaluated empirically. ... To reduce the number of false positives, professionals are now calling for a best estimate approach to diagnosis in child psychopathology. ...Currently, there is no consensus as to which best estimate procedure to use..." (School Psychology Review - Vol. 20, No. 2, 1991.) Nothing has changed in the last nine years. There is still no valid diagnosis for this supposed condition and how could there be when they have no agreed upon definition; no agree upon behavioral descriptors; and no agreed upon age group norms for such vague terms as "often fidgets in seat." - Parent and teacher assessments are subjective and are about the obvious--the student does not pay attention and he is a problem. Why waste time and money doing an assessment just so publishers and authors can get rich?
Since there are no valid medical or psychological tests for this supposed condition, the diagnosis is basically the subjective opinion of parents and teachers. "In the absence of clear neurological evidence (I thought this was already proven)* for diagnosis, clinicians will continue to make diagnoses based on behavioral observations." (Exceptional Children, Vol. 60, No. 2, pp. 118-124.) The question to ask is: will they make the diagnosis on "behavioral observations" of what - such powerful indicators of a disease like "often fidgets"? Behavioral observations tell you the obvious. For example: Professional observer - Q: Is the student out of his seat? A: Yes. Teacher - Q: Is the student out of his seat? A: Yes. Parent - Q: Is the student out of his seat? A: Yes. You could also make these observations more scientific and controlled. You could count the number of times the student is out of his seat in a minute, an hour, a day. You could do all kinds of pseudoscientific manipulations of the obvious, but the point is even though these observers agree on the "behavioral observations," you cannot make a quantum leap to a medical cause for ADHD. When reviewing the research literature on parent and teacher evaluations of children, rarely do the evaluations from teachers and parents even come close to agreement. "However, different types of informants (e.g., parent and teacher) can be expected to demonstrate an agreement level no better than approximately 0.30. How then should information from different sources be weighed in making best estimate diagnoses? (This really means you have Mom, Dad, two to three teachers, the school psychologist or counselor fill out their subjective opinion on any assessment instrument and they will not agree.)* Discordance does not necessarily imply that one informant is right and the other is wrong. Instead, it may reflect differences in the child's behavior due to particular settings; that is it may reflect some degree of situational specificity." (School Psychology Review - Vol. 20, No. 2, 1991.) Does this last statement sound like professional double talk to anyone else but me? - Medication responses are not an indication of this supposed disorder but we are medicating (or drugging) our children extensively.
If anyone is given medication, there is usually a normal range of responses and reactions to that medication. It does not mean there is a biochemical imbalance in the brain. It means the brain responds to that drug. If given LSD, cocaine or alcohol the body will respond to it. All children, regardless if they have been diagnosed as ADHD or not, basically respond to Ritalin in similar ways. It does not mean they have a biochemical imbalance. If you want children to stop inappropriate behavior there are many drugs which when given to them will, for the short term, stop their inappropriate behavior. However, drugging them does not teach them the skills they need to control themselves. In the long term usually the medication dose must be increased or changed to maintain the initial results. Today if Helen Keller came to see a psychiatrist, her autobiography would never be written. She would have been drugged to stop her extreme acting out and violent behavior. Everyone would probably say the drugs "worked." Why? Because she would sit quietly and not cause her care giver any trouble. Unfortunately 15 years later, when she is taken off the drugs, she would not have the emotional and social skills or the education and personality to be able to read or communicate with others. She would not have had the phenomenal life she had nor touched so many people in such profound ways. - Labeling children with ADHD will put millions of children on a highly addictive Class II drug that has not shown any positive long term beneficial educational, social or behavioral effects.
Ritalin is in the same classification as cocaine and amphetamines and has the potential to be highly addictive. Currently in the United States Ritalin use is five times greater than the combined total use of the rest of the world. There are no longitudinal studies that indicate any social, behavioral or academic long term benefits for the medication. However we continue to medicate children in the US at an increasing rate. "Of greatest concern is the lack of data supporting the long-term efficacy of stimulant medication treatment. In fact, most studies conducted to date have not found significant differences between groups of children with ADHD who have or have not been treated with stimulants." (Barkley & DuPaul, School Psychology Review, Vol. 20, No. 2, 1991.) Of greater concern to me is the possibility of and the mounting evidence for long term negative effects of stimulant treatment. "This prospective longitudinal study of ADHD and age-mate control subjects, ... has provided evidence that childhood use of CNS (central nervous system) treatment is significantly and pervasively implicated in the uptake of regular smoking, in daily smoking in adulthood, in cocaine dependence, and in lifetime use of cocaine and stimulants." (Lambert, Dr. Nadine, NIH Consensus Development Conference on Diagnosis and Treatment of ADHD, 1998.) - Many of the "innovative" educational interventions that some of the "experts" give us to help children with ADHD, are in my opinion, weak, inane, miss the point or are so obvious or general that every educator should be using the concepts, principles, or strategy with every child.
Read these and tell me how innovative you think they are? "Reviewers suggest that especially with rote learning tasks, educators should explore the effectiveness of adding color to instructional materials and increasing their novelty. In planning instruction, educators should also explore the effects of varying rates of presentation and levels of detail on the comprehension of students with ADD. They should also explore ways for students to actively respond during academic tasks and to engage in alternative motor activities. Additionally researchers should study the role that computers and other technologies can play in the education of students with ADD." (Fiore, Executive Summaries) "... The development of an appropriate match between teacher expectations and student performance seemed to be important elements of promising practices." (Burcham & Carlson, Executive Summaries) (How true! How very novel!) * - It will cost tax payers billions of dollars and they will receive nothing in return for the money spent other than to have children labeled.
In 1994 alone children's disability programs cost $3.6 billion. Now add in all the costs for doctors visits which have no real purpose except to prescribe medications; psychologists assessments which show or tell you little more than the obvious; the cost of medications which have shown no long term benefit except allow the pharmaceutical companies to get rich; all the legal and due process cases in the school systems; all the out of district placements of some ADHD children, some of which are over $100,000 per year per student; and all the wasted professional time doing IEP's for the obvious. These additional billions of dollars could have been used for direct services for children to help resolve some of these difficulties instead of just diagnosing and labeling them. - We will end up labeling millions of children who will eventually learn to believe they are biochemically, genetically flawed individuals who can't control themselves. The implication for the second and third generation of these "genetically flawed individuals" will then have even more profound ramifications for future educational systems and society.
Today more and more students at younger ages are coming to school with their IEP's telling teachers and administrators they can't control themselves because they have ADHD. Many educators are already experiencing students who tell them they don't have to behave today because they have forgotten their medication. When these out of control impulsive children have children (probably at a young age), how will these children be raised? Naturally when this second or third generation of children then act out impulsively, a medical model oriented researcher will draw the conclusion--like they already have--this disease runs in the family and it is "genetic!" - There is a big risk that this labeling and medicating of children will eventually become a social control issue for lower SES and minority students.
Many out of control inner city schools have children who are much more active, aggressive and impulsive than most children currently diagnosed or labeled as ADHD. Staffs trained in this discipline approach have had success in turning these schools around for the most part without having to medicate these children. The majority of lower social economic inner city students typically are minorities and they are at risk of becoming a psychiatric disorder or disease that might need to be socially and politically controlled by drugging them. This is already a reality in some psychiatric hospitals and prison systems and is close to becoming a reality in schools. To get a sense of the direction the "medical model genetic causation orientation" is moving toward, please read "The Violence Initiative" on Dr. Peter Breggin's web site or read his book, War Against Children of Color - (See Bibliography on ADHD) - There are political and economic realities behind this battle to have this label become a handicapping condition other than pure science.
There is no medical evidence for this condition. There is no valid assessment for this condition. Then why are millions of dollars being spent to promote this disease model and to lobby congress to have ADHD become a handicap condition under IDEA? How can a parent organization, which began in 1988-89 have, within one year, enough funds and power to launch a major national campaign to try to have ADHD declared a handicap. The pharmaceutical companies have spent a lot of money underwriting and promoting this organization and this disease model. In the past the pharmaceutical companies and well paid national researchers in this field have used this organization to petition the DEA to change Ritalin from a Class II drug to a Class III drug so they can produce more Ritalin without government restrictions. Why didn't the experts and the pharmaceutical company petition the DEA? Of course it was probably because the parent organization knew more of the chemistry, the pharmacology and the addictive qualities and side effects of Ritalin than the scientific experts.
CONCLUSION
here is a lot of information and misinformation about this supposed disorder - ADHD. I feel sorry for parents and teachers trying to wade through the tons of information available and then trying to make informed appropriate decisions for their children and students. My experience has been that profound changes can be made in children's behavior without having to drug them. There are always a few exceptions, but the key word is a "few," not the millions of children who are being drugged daily in the US.
A state behavioral consultant colleague of mine asked a psychiatrist after his presentation on ADHD, "What information the psychiatrist needed to know about the child, parents and school; and what changes, strategies and interventions needed to be tried and for how long in terms of parenting, school and home discipline, curriculum, instruction, reading and motivation before he decided the child was biochemically flawed and needed to be medicated?" The psychiatrist was so angry and offended he said this presentation was over and walked out. This example is a reflection of the kind of difficulty parents, educators, and psychologists will have in getting the medical experts to even consider other explanations for children's inappropriate behavior other than something being physically wrong with the child. Someday I hope the medical profession will stop being offended so they can answer the questions of both professionals and parents in a straight forward, concrete and honest manner.
It is my hope and wish that both parents and schools will be a little cautious, a little conservative and try many other interventions besides the currently prescribed pro-ADHD interventions before they decide to jump on the medical model's bandwagon as the solution to children's problems.
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