The ADHD/ADD Phenomenon: Another Perspective

by Rebecca Chesner

I read with much interest the article by “Turtle” about his struggles growing up with academic and social difficulties. I felt empathy and compassion for what he must have gone through as a student. His recent revelation that he has ADD and his taking Ritalin appears to have worked for him. However, as a school psychologist, I feel it is important to share another perspective, no matter how controversial, about the phenomenon of ADHD and medication, and the impact they are having on our children.

I respect the fact that the author of this article made the decision to see a psychiatrist, get a diagnosis, and go on medication. However, we must remember that the person making this decision is an independent, thinking adult. Unfortunately, many children, the most vulnerable and powerless members of our society, are being labeled and essentially forced to go on medication. In fact, the diagnosis of ADHD has skyrocketed over 500 percent in the past decade, with an estimated four to eight million children, as young as three years of age, being put on drugs. (ADD, Attention Deficit Disorder, without the hyperactivity component, has recently been reclassified as one of the variant forms of ADHD, Attention Deficit Hyperactivity Disorder.)

Of particular concern was the fact that nowhere in this article did this author mention anything about his family background or, for that matter, what kind of school he was in. Perhaps he was the victim of parental discord in the home. Perhaps, his parents were too busy to spend sufficient time with him. (There is a saying that ADD stands for Attention Dad Deficit.) Perhaps, the curriculum was too difficult for him. Perhaps the class size was too large and he needed to be placed in a smaller class. Perhaps, he should not have attended college but should have gone to a vocational school instead. Perhaps his teachers were not meeting his needs and he needed a different kind of setting in order to succeed.

I have seen the scenario many times, even in my own children, that when students have a particularly nurturing, supportive, and creative teacher, they do very well in school. Other years have suddenly produced “ADHD/ADD” symptoms, because the children are totally bored and unhappy with their teacher, who may be lacking the necessary skills to control and captivate the class or bond with the students. (There are many creative teacher workshops that teachers can take advantage of to improve their skills in these areas.) In addition, sometimes a teacher and a student are just not compatible.

Of course, there are students whose behaviors are more difficult to manage than others. Nevertheless, we must ask ourselves if this justifies the current massive rush to diagnose and medicate millions of youth during the past decade. In fact, the U.S. uses nearly 90 percent of the world’s methylphenidate (the ingredient used to make Ritalin).

While the medical/biological model of psychiatry appears to place the blame for this disorder on the child’s brain, I must tell you that in most cases that I have seen, there is almost always an environmental component that is causing the child’s symptoms. This may also be expressed in the relationship between the child and his parents. Unfortunately, the cultural breakdown of the family – including divorce; limited time spent with one’s children due to employment and job constraints; lack of consistent parental discipline; overexposure to television, MTV, video games, etc.; lack of proper nutrition, sleep, and exercise – are all factors that have contributed to the skyrocketing rise of AHDH/ADD symptoms in children today.

Likewise, it would appear to make sense that in well-adjusted families, where both parents provide unconditional love, consistent rational discipline, and a total commitment to meeting the child’s emotional and physical needs, these symptoms are most likely to be much lower or non-existent. This statement is not meant to ignore the fact that some children are more challenging to raise than others, not is it meant to cause parents to go on a destructive guilt trip; rather, it is a chance for parents to empower themselves and take responsibility to find out how they can best enhance the family unit and at the same time do what is best for their child.

Unfortunately, many mental health specialists have talked teachers and parents out of the timeless truths of parental and community responsibility for their children’s quality of life. They have instead created diagnostic categories of children, who are then seen as incorrigible – that is, untouchable – by ordinary means. This is good for the business of doctoring and the business of selling drugs. It may also make life easier for some parents and teachers. However, it is very bad for children. While drugs may temporarily constrain the behaviors, they create dependency and do not teach children the skills needed to solve their inappropriate behaviors. Thus, the child learns he cannot function unless he has his “magic pill.”

The well-respected psychiatrist Dr. Peter Breggin, in his book Talking Back To Ritalin, (a must read for anyone considering putting their child on this drug), indicates that Ritalin is a highly addictive drug. In fact, the U.S. Drug Enforcement Administration classifies methylphenidate (Ritalin) as a schedule II substance along with cocaine and morphine. Furthermore, the DEA and the International Narcotics Control Board have both issued warnings about the danger of widespread stimulant prescriptions in North America.

In addition, stimulant drugs can produce a wide variety of other adverse effects. By causing loss of appetite and by disrupting growth hormone, they suppress the growth of the body, including brain size and development. They can also cause severe biochemical imbalances in the developing brain that can become permanent and even cause psychosis. Furthermore, stimulants can cause tics and other abnormal movements, which sometimes become irreversible. Other effects can include drug-induced depression, lethargy, or robotic behaviors. Finally, research has indicated that, while these drugs may temporarily make the child more docile and obedient, thus making him more willing to comply with rote, boring tasks, they have no positive effect on a child’s overall academic performance and achievement.

Even when children do not become addicted to stimulants, they sometimes give them away or sell them to friends who abuse them. In fact, Ritalin is the number one teen street drug today. Teens grind it down and snort it like cocaine. What kind of message are we sending to our children by telling them to say “no to drugs” while “legally” drugging millions of children a year with Ritalin! Interestingly, CHADD the largest support group for families of children with ADHD, receives hundreds of thousands of dollars in funding from the drug company that manufactures Ritalin. (Does anybody see an ethical conflict here? I certainly do!)

In his books, Dr. Breggin reveals that, though biochemical psychiatry advocates have attempted to show that brain scans of ADHD children are somehow different from those of others, there are no consistent differences between their brain scans and “normal” brain scans. Currently, scientific conclusions confirmed by both the November 1998 NIH Consensus Conference and the 2000 American Academy of Pediatrics official guidelines reveal that there is no evidence for brain scan abnormalities or any brain abnormalities in children labeled ADHD. In fact, science does not possess the technology at present to measure biochemical imbalances in the living brain.

Breggin indicates that the “biochemical imbalances” speculation is actually a drug company-sponsored marketing campaign to sell drugs. His thorough and meticulous research reveals how the drug companies have often gotten their psychiatric drugs approved on the basis of very marginal and questionable evidence for their effectiveness. These same drug companies give millions of dollars to the American Psychiatric Association to promote these drugs.

Withdrawal from these drugs must be carefully monitored as well, since withdrawal symptoms can cause emotional suffering, including depression and exhaustion. Withdrawal symptoms can sometimes make children seem psychiatrically disturbed and lead, mistakenly, to increased doses of medication or the prescription of new unnecessary and harmful drugs.

Currently, there is a series of class action lawsuits that have been filed against Novartis, the manufacturer of Ritalin, accusing the giant pharmaceutical company of fraud in overpromoting its stimulant drug Ritalin, as well as the ADHD diagnosis. The suits also charge the American Psychiatric Association and the parent’s group CHADD of conspiring with the drug company to promote sales of the drug.

Fortunately, people are beginning to question the alarming trend to rush to medicate so many of our country’s children. In fact, a recent study in the Journal of the American Medical Association questions the safety of these drugs to alter young children’s behaviors. And, in November of 1999, the Colorado State Board of Education passed a resolution recognizing that many discipline problems are just that, rather than biological disorders requiring psychotropic remedies. The board voted to encourage school staff to use “proven academic and/or classroom management solutions to resolve behavior, attention, and learning difficulties.” The board also voted “to encourage greater communication and education among parents, educators, and medical professionals about the effects of psychotropic drugs on student achievement and our ability to provide a safe and civil learning environment.”

I would like to conclude by stating that I realize this topic is a deeply controversial and sensitive one, especially to parents in this situation. Ultimately, each family must make its own decisions about what they are most comfortable with. My intention is not to be judgmental, G-d forbid, but to help parents be informed. Parenting is one of the most difficult jobs in the world, even in the best of situations. This is compounded by the daily stressors of our culture, a culture, I might add, that promotes quick fixes to solving problems of all sorts.

Unfortunately, the pressure to drug children is so strong today that it can be intimidating for both mental health practitioners and parents of these youth, who struggle to know what to do. The most important thing to do, before committing to any course of action, is to educate yourself. There are several wonderful books out by Dr. Breggin that address these issues. There is also a relatively new book by Dr. David Stein called Unraveling the ADD/ADHD Fiasco: Successful Parenting Without Drugs. In this book, Dr. Stein promotes the Caregivers Skills Program to help cure children of their ADHD characteristics without the use of drugs. Parenting groups such as the Family Enrichment Leadership Training Program (F.E.L.T.) sponsored by Torah Umesorah are also very valuable.

Finally, there is a wonderful organization called the International Center for the Study of Psychiatry and Psychology. ICSPP was founded in 1971 by Dr. Peter Breggin. It is a reform-oriented international center for professionals who are concerned with ethical and scientific issues in human research and services. It is the only professional organization that has taken a firm public and professional stand against the massive psychiatric drugging of America’s children. Because of its many successful efforts on behalf of truthfulness and justice in the psycho-social and biomedical sciences, ICSPP has been called the “conscience of psychiatry.”

The organization offers a general membership and hosts international conferences that are open to the public and to professionals. The next conference will be held in New York on October 8, 9, and 10. (This year the holiday of Simchat Torah is celebrated on Thursday and Friday, October 7 and 8, followed by Shabbat. However, it is still possible to attend the Sunday conference.) For more information, please go to www.icspp.org or www.breggin.com.

The Turtle Replies

I want to thank Mrs.Chesner for her insights.

She raises many important issues and questions in her article. There are many legitimate approaches to the problem, and my small article could not possibly do justice to them all. The reason for my article was to raise awareness of the problems and solutions from a personal viewpoint.

To explain myself further, I want to say, first, that the use of the term “neurobiological disorder” was deliberate. Before deciding to use Ritalin, I did research alternative treatments. I read Dr. Breggin’s discussion about ADD/ADHD, along with those of other researchers who disagreed with his conclusions. I made the decision to use Ritalin after researching all of the available options. In the article I also mentioned that I had tried traditional psychotherapy, without any significant progress. Ironically, the therapist insisted that I was clinically depressed and wanted me to start taking antidepressants.

In addition to the books listed in the footnotes to my article, I would like to draw readers’ attention to Dr. Daniel Amen’s recent book, Healing ADD. In Healing ADD, Dr. Amen devotes an entire section to brain scans, showing the differences between the ADD and non-ADD brain. He also co-authored the chapter on functional brain imaging in a comprehensive textbook of psychiatry. He also devotes an entire section to myths and facts about ADD. It is interesting to note that Ritalin has been used since 1902. In all the books I have read on the subject, Ritalin or other psycho-stimulants are presented as a second line of defense, after other methods have been ineffective. In fact Dr. Mate, in his book Scattered, advocates a far more holistic approach to treatment. However, all of these researchers conclude that ADD/ADHD is neurobiological in nature. There seem to be many respected researchers who disagree with Dr. Breggin’s conclusions.

With regard to some of the other questions Mrs. Chesner posed: The reason I did not mention my childhood was that it seemed irrelevant. My parents were neither neglectful nor abusive. Although there is no question that other external factors, such as prolonged watching of television, playing computer games, and lack of sleep, can mimic symptoms of ADD, and that changing those behavior patterns will cause the symptoms to cease to exist, I did not have those issues. My parents had very strict rules about television watching. I got a full eight hours of sleep a night, and computers were not even being marketed to the general publi il I was in my teens.

In terms of school, there was nothing remarkable about my classroom situations. In fact, partially due to my poor performance in school, I did attend a vocational school and worked at a trade for a couple of years. I don’t know who was more disappointed in my performance, me or my employers. In high school some of my worst grades were in vocational studies. To clarify my college experience: In any course for which I had a natural affinity, I was able to receive an A. In all other courses, I had to rely on my sporadic study habits and my ability to “wing it.” After the past three years of treatment, the possibility of going for a graduate degree remains a tantalizing prospect, knowing that many of the obstacles to concentration and self-discipline that I faced in the past have been removed.

The most important issue Mrs. Chesner has raised is the rise in diagnosis of ADD in young children and the ease with which medications are prescribed. It is equally important to understand that this is not simply a problem with the diagnosis of ADD; it exists in all areas of mental health. In addition, Dr. Amen points out that many other, potentially more debilitating, disorders can be misdiagnosed as ADD/ADHD. Just to mention a few, there are bipolar disorder, anxiety disorders, obsessive-compulsive disorder, Tourette’s syndrome, and thyroid dysfunction.

I can’t emphasize enough the idea that a proper diagnosis must be made by a professional with a level of expertise. In addition, even when Ritalin or another psycho-stimulant is recommended, it is only to be prescribed by a doctor on a once-a-month basis, after having re-evaluated the patient at each visit. It is essential, as well, that any medication prescribed be accompanied by talk therapy and/or coaching that specifically addresses the underlying issues.

In the September 1, 2004, issue of Hamodia magazine, page 27 of the educational supplement, there is a wonderful article which details the types of educational and psychological testing required before reaching a correct diagnosis.

Presuming that all the researchers who concluded that ADD/ADHD is a legitimate disorder are correct, we can do enormous harm by not treating it with sufficient respect. While Ritalin is indeed a medication that has to be prescribed and used with tremendous caution, those who oppose its use too often fail to take into account the risks of non-treatment. Much of my article was devoted to illustrating such problems as the loss of self-esteem, a feeling of despair because of numerous failures, and the inability to reach one’s full potential, which are so common among those with untreated ADD. One of the most harmful aspects of ADD is that socialization skills do not develop during the appropriate time in childhood because the mind is occupied elsewhere. Of course, medication can only treat the symptoms; it does not change the underlying biochemical makeup of the individual. But the problems arising from not treating ADD with enough respect do more harm than the underlying condition itself.

There are many ways to help someone cope effectively with his or her issues, however recognition of the underlying causes is the essential first step. That is why I advocate having a comprehensive examination that rules out other conditions. If the examination concludes that ADD is the culprit, then a comprehensive program can be designed which helps the individual (or parents) to properly address all the person’s problems.