Re: A Few Simple Truths About ADHD

From: Steve Harris sbharris_at_ROMAN9.netcom.com (sbharris_at_ix.netcom.com)
Date: 07/28/04 

Date: 28 Jul 2004 15:20:22 -0700

"Jeff" <kidsdoc2000@hotmail.com> wrote in message news:<ccvc76$lks@library1.airnews.net>...

>>Give me the medical test that proves that an adult who is
experiencing hallucinations, hearing voices and has no clue about
reality has schizophrenia. There is none.<<

COMMENT:

Sure enough, you have a point. Alas, hearing voices nobody else can
hear is not just one end of a normal human bell curve. ADHD is not
like schizophrenia. It's more like shortness or puny muscles in
children. Being really short or really puny and weak with slow onset
of puberty can cause all kinds of problems for children at school—-
particularly boys. And these problems can be dealt with
pharmacologically by giving growth hormone or anabolic steroids. So
what?

All this gets back to what we MEAN when we label something a
"disease." FYI, anabolic steroids really do help in muscle wasting
diseases. And also in puny kids. And growth hormone helps not only
short kids who are deficient in growth hormone, but also short kids
who are not. And it's being used in this fashion, too, as you may
know. They have sometimes had to invent disease-like names (familial
stature disorder, constitutional growth delay, blah) to justify
hormonal treatment on an essentially cosmetic basis. But they do it.
They didn't consider it before 1985, when all growth hormone was being
extracted from the pituitaries of cadaver brains, like some bad
science fiction movie. But now that we make it with genetic
engineering and the safety is up and price down, suddenly we're
branching out on what we use it for.

Is drug treatment of cosmetic problems "justified"? Well, why not?
Wouldn't boys and men all like to be faster, stronger, maybe taller,
with perfect noses and teeth and bigger muscles where we want them?
Sure. Does all of this need a disease diagnosis for fixing? Must we
have a medical disease name for "nose too big" or "breasts too small"?
I say no. I say it's all hypocrisy when we're merely modifying an end
of a bell curve. Or shifting an entire curve over (as we do with tooth
cosmesis and color). Let's just be honest about it, okay?

FYI, there isn't a single feature of AHDH which isn't a general
description of young mammals and the way they behave in general, as
opposed to fully mature ones. If you've ever even trained *dogs*, you
know that full-grown but adolescent animals have trouble with focus
and attention and sitting still. So also children. And some grow out
of it sooner than others. Some never grow out of it, both in dogs and
humans. That's today's newsflash for those of you who've never tried
to teach anything to a young mammal.

Do amphetamines cause unfocused children and adults to be able to
concentrate? Sure. Adrenalin and fear, OTOH, are great at improving
focus and attention. Nothing concentrates the mind like danger and or
pain. That happens in everybody, and that's what "speed" does, too.
Before there was such a thing as ADHD, there were merely "unruly
children," and these were treated by making them exercise and
threatening them with getting hit with a switch (an excellent inducer
of sympathetic hormones). Now these time honored treatments are
politically incorrect, and drugging is more correct. But do we really
need the labels? Why not just give the drugs to all who want them, or
all whose performance is improved by them, without having their health
destroyed or lives disrupted by them?

Is the academic performance of ADHD kids improved *more* by
amphetamines than that of normal kids? I know of no study which shows
this. If it were true the response to the drug itself could be used
for diagnosis, or used as a diagnostic criterion. It is conspicously
not. There is at least one study showing that amphetamines improves
academic performance in "normal" kids. But then we knew that. Speed
has been used (we say "abused" if the disease label has not been
applied by an authority) by students for decades. And these drugs work
for people whose jobs require great concentration for extended
periods. They are given out by the military to normal pilots for
combat and even combat training (they are called "go pills"). When
these drugs are used by truckers for the same purpose, however, we put
them in jail. That's what "authority" can do for you: make the same
action into a crime if you don't have permission, vs. a perfectly
reasonable action if you do. It is the same with school children and
Adderal.

>>Give me the medical test that proves that an adult who is totally
clueless about the world, has no short term memory, and has been
diagnoses with Alzhiemer's actually has Alzhiemer's. Brain biopsy.<<

COMMENT:

Actually a PET scan will diagnose Alzheimer's quite well. Would that
this were true for AHDH.

>Just because there is no gold-standard diagnositic test doesn't mean
that the problems are biological.<<

COMMENT:

True, but there are many biological differences which we don't label
as diseases. Having small breasts or short stature is certainly
biological.

>>There is much evidence that shows that the brains of people with
ADHD are different that the brains of people without ADHD.<<

COMMENT:
Actually there is much evidence, but most of it is conflicting. I can
name half a dozen things, from size differences to receptor densities,
which have shown up in studies of kids diagnosed with ADHD vs.
controls. But there is not one which every investigator has found who
looked for it. If there was, we could diagnose this problem with a
brain scan or imaging modality. We can't.

>>Bullshit. You tell me that a child who never sits down, can't
concentrate, and can't get anything accomplished, despite normal
intelligence is normal.<<

COMMENT:
These children don't have normal intelligence, by definition. They
don't do as well on intelligence tests, because they can't. Deficits
in problem solving ability and short term memory are very common in
ADHD, just as you'd expect. The name for this syndrome used to be
"minimal brain dysfunction", and not for nothing. But it was never
very well-defined. Bill Cosby has a famous skit about how ALL children
have minimal brain dysfunction (he actually says brain damage), and of
course he's right. That's why we don't let children have certain adult
choices and privileges.

>>Actually, the evidence that peole with ADHD do have a chemical
imbalance is
overwhelming.<<

COMMENT:
Actually, it isn't. What chemical would this be? Ritalin? Evidently
it's not simply dopamine, or else these kids would all be treated with
L-DOPA (Sinemet, which they use for Parkinson's disease). DOPA was
tried for a while in the early 80's for kids with attention problems,
but it never produced results impressive enough to win out in
treatment.

>>I doubt many medical professions have the time to explain the way
the brain
works to each patient.<<

Nonsense. "Medical professionals" have very little idea about what is
happening in the brain of the "hyperactive" child. Or the normal one,
for that matter. We have guesses only. Fidgeting looks like too much
dopamine (akathesia), not too little. Learning deficits could be too
little dopamine, or anything else in the entire reward system.
Amphetamines increase dopamine, but they also work like
norepinephrine.

>The lie that Ritalin is a mild
> stimulant is even more difficult to maintain since a recently
> concluded study at the Brookhaven National Laboratory (BNL), and
> published in the Journal of the American Medical Association, not only
> confirmed the similarities of cocaine and Ritalin, but found that
> Ritalin is more potent than cocaine in its effect on the dopamine
> system in the brain. Referring to Ritalin as "kiddy cocaine" is not a
> joke.

>>Nor is it accurate. Whlile the two drugs do work on similar
receptors, they
have very different effects, becuase the way they are taken is very
different and the time course of their actions are very different.<<

COMMENT:

Well, all drugs are different. But the fact that amphetamines are used
for this problem rather than dopamine agonists (including dopamine
itself) means that this hypothesis just isn't up to snuff.

>>Actually, to imply that ADHD is not a real condition is a lie. Or
ignorance.<<

COMMENT:
Actually, the whole argument about whether or not medical conditions
are "real" or not, is pretty funny. But in any case, I've been over
this issue. ADHD is as real as puny muscles in kids who want to be
sports heros. Whether or not anabolic steroids are the answer for some
or all of these children, is the question before us.

> The truth is that protecting your children
> from toxic drugs is being completely responsible. It is those who
> advocate these drugs for children who are abdicating responsibility
> and avoiding the challenge of truly meeting the needs of our children.

>>Wrong. It is enabling the child to concentate and achieve on his or
her own.

COMMENT

Even anabolic steroids don't work, if you don't exercise. So I could
say the same about them.

>And part of the responsibility is to identify inaccurate sources of
information. This article is a very inaccurate source of information.<
Jeff
<<

COMMENT:

Actually, Psy has a point. The debate about treatment of hyperactive
kids and adults, and our use of amphetamines in our society, is shot
full of hypocrisy.

Now, even a stopped clock is right twice a day. The fact that some of
the objection to drug treatment of AHDH comes from Scientologists
doesn't make it automatically wrong. One must examine each claim, one
by one.

And do realize what I'm saying. I don't automatically object to use of
amphetamines by human beings who want to improve their lives thereby.
And perhaps for some people, this process even should include some
supervision— particularly if the person shows signs of not being able
to dose himself appropriately (see, for example, the case with
alcohol). But none of this is a reason to be arguing about whether or
not a "disease" really does or doesn't exist. And none of this is a
reason to bring in doctors for every case. Nor to bring in the law for
cases where there is no evidence of the public being threatened.

Use of an amphetamine merely modifies your body temporarily, rather
like a cup of coffee but more so. If we treated it like we treat
alcohol-use or tattooing or ear piercing, we'd be way ahead. Instead,
we've managed to mess it all up by trying to medicalize it and
criminalize it. Since we barely know what we're doing, bringing in
doctors and the cops, judges and jails, courts and lawyers, only
serves to make things more thuggish, more expensive, and less clear.
How about we all chill a bit and try some common sense?

SBH

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