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The great ADHD myth
Last updated at 00:07am on 10.03.07
Have hyperactive kids been misdiagnosed with ADD?
The psychiatrist who identified attention deficit disorder - the condition blamed for the bad behaviour of hundreds of thousands of children - has admitted that many may not really be ill.
Dr Robert Spitzer said that up to 30 per cent of youngsters classified as suffering from disruptive and hyperactive conditions could have been misdiagnosed.
They may simply be showing perfectly normal signs of being happy or sad, he said.
'Many of these conditions might be normal reactions which are not really disorders,' he continued.
Dr Spitzer developed the bible of mental disorder classification in the 1970s and 1980s, which identified dozens of new conditions including ADD and obsessive-compulsive disorder.
Since then hundreds of thousands of children have been diagnosed with ADD, a behavioural disorder linked to poor attention span, and ADHD, which adds an element of hyperactivity.
The disorders describe disruptive and restless behaviour that results in children having difficulty focusing their attention on specific tasks. ADHD is most commonly noticed at the age of five, and as many as one in 30 British children is said to have it.
It is often treated with drugs, with Ritalin being the most commonly prescribed.
Some scientists say ADHD is a genetic disorder that does not disappear with adulthood.
But sceptics believe the diagnosis is a 'biobabble' label, which has evolved from a soundbite culture that is too prepared to medicalise anti-social human traits.
Dr Spitzer, professor of psychiatry at Columbia University in New York, now says the classification led to many people being diagnosed as medically disordered when their mood swings and behaviour were simply normal feelings of happiness and sadness.
In a BBC2 documentary series The Trap, which begins on Sunday, he says that between 20 and 30 per cent of mental disorder diagnoses may be incorrect.
His admission comes as figures show that the amount spent by the Health Service on drugs to treat ADHD and similar disorders in children trebled to £12 million in just five years, from 1999-2003.
Almost 400,000 British children aged between five and 19 are believed to be on the drugs - despite doctors' fears about side-effects.
That is the equivalent of every child in Britain each taking more than four doses of the drugs every year.
NHS guidelines recommend drug treatment for the most severely affected, although there have been reports of cardiovascular disorders, hallucinations and even suicidal thoughts.
There have been at least nine deaths reported to the UK's Medicinesand Healthcare products Regulatory Agency since Ritalin became available in the early 1990s.
But Dr Spitzer, who chaired the taskforce that compiled the international Diagnostic and Statistical Manual of Mental Disorders, said he is less concerned by wrong diagnoses and possible side-effects from drugs, than failing to prescribe them where needed.
'By and large the treatments for these disorders don't have serious side effects,' he told the Times Educational Supplement.
'I mean, some do, but they're not that serious, whereas the failure to treat can often be very hard on the child and on the family.'
He acknowledged that some parents put pressure on doctors to diagnose ADHD and obsessive-compulsive disorder, and prescribe drugs.
'We don't know to what extent that's been happening inappropriately,' he added.
Ian Graham, headmaster of Slindon College, an independent boys' boarding school near Arundel, West Sussex, has 20 out of 100 pupils diagnosed with attention deficit disorder and a few more with related diagnoses such as oppositional-defiant disorder.
About 17 of the boys are prescribed drugs including Ritalin, while the remainder have their condition controlled through diets that exclude chocolate, sweets or gluten.
The school also employs therapy techniques, and the old-fashioned tactic of getting pupils to run off their energy in outdoor activities.
Mr Graham said: 'I've never met a parent who is happy with the medication. They would all prefer not to use them, but to a man and woman, they all say they can't believe the change in their sons' ability to concentrate in lessons.'
Reader views (16)
A parliamentary hearing on ADHD in Sydney, Australia (12 May 2009) noted a large number of "ADHD" kids have serious or complex conditions as the root cause of symptoms.
"ADHD" children disproportionately suffer from food sensiitivies and gastro intestinal leakages (the latter often an effect of some medicines and today's children are much more medicated). Loss of digestion can break the nutritional buffer against heavy metal contamination. A biomedical approach is often applicable to such complexities. Parents at the hearing complained bitterly at the lack of public funding for it, despite often excellent results through doctors or naturopaths.
Psychiatric drugs are publicly funded but add a layer of complication. Ironically, they deplete nutrients and cause gastro intestinal leakage in children. The inquiry confirmed what the largest treatment study for ADHD (The Multi Modal Treatment Study For Children With ADHD released in January 2007) has - namely, psychiatric stimulants have no long term effect other than side effects!
In Australia, the Therapeutic Goods Administration has noted children young as 5 have had strokes, heart attacks, hallucinations and convulsions due to ADHD drugs. Some die. The drugs are not the answer.
In Sydney, Australia, children are diagnosed and drugged as ADHD up to 10 times more in the poorest areas than wealthier ones. ADHD is a syndrome and oppression, not a concrete medical condition.
- Linda Vij, Sydney, Australia
As a well known member of The British Psychological Society and Author of many Educational Assessment books I should warn all parents to check that any assessments carried out are only by members of the above organization.There are a lot of charlatans involved in carrying out child assessments and it is very much a case of 'caveat emptor' I am afraid.
- Dr Martin A. Phillips Phd, paphos cyprus
Brian -you are so very, very wrong. I find it scary that you are involved in human rights when you clearly fail to educate yourself on a subject before you write.
Please, do some reading, check your information. Talk to people with ADHD.
- Sarah, london
My son has been diagnosed with ADHD for 8 months now and is on medication, it took 5 years to diagnose we would love our child to be condition free and drug free but life would be non existent for all of us. Atleast we all get a little relief now my son has a condition and it does exist you don t know until you experience this problem.
- Tracey Price, Staffs, England
I am not surprised by Dr. Spitzer's comments that: 'Many of these conditions [AD/HD type behaviours]might be normal reactions which are not really disorders'. It is unfortunate that it has taken us so long to recognize that differences in learning styles are simply normal variations in human development. Too long have we clung to the notion that these differences are disorders.
AD/HD characteristics are delightful in children who are not in traditional school settings. The problem therefore does not reside within the child, but rather with the educational system. Perhaps money invested in drug therapy would be better spent on developing programs that meet the learning styles of these children.
- Brenda, Canada
Concerning so-called ADHD, there is a fundamental flaw, which lies in the inability to produce any test to confirm the presence of such a ‘disorder.’ That doesn’t mean children don’t experience problems, and it doesn’t mean parents don’t have days when they pull their hair out. What it does mean is that a psychiatrist cannot produce any tangible evidence to support his or her claim of a ‘chemical imbalance,’ ‘neurobiological disease,’ or ‘brain-based disease,’ or any other esoteric term they decide to use.
Metaphorically speaking, children are being psychologically kitted out with the ‘Emperor’s new suit,’ a designer label, worn by the boisterous, argumentative, defiant, inattentive, disruptive, forgetful child or adolescent. But how much longer can this pretence be kept up? With these latest reports, we can see the ‘fabric’ of the label is starting to wear thin.
I urge the public not to be taken in by the unscientific and ill-founded psychiatric labelling that has become accepted as scientific fact when, in reality, it is nothing more than opinion.
- Brian Daniels, Citizens Commission On Human Rights (Uk), East Grinstead, UK
Well done CCHR - it seems you've been right about the misdiagnosis of ADHD all along!
- John Wood, East Grinstead, West Sussex
I can't help but wonder whether I would have been diagnosed with ADHD if it had been invented when I was a kid - my mother always said about me: "quicksilver in your bottom, and ants in your pants" - I was everywhere - and I still am - at times I feel many of these symptoms - but I wouldn't be without them...
- Kjell Tring, Bergen, Norway
That means that by Dr Spitzer's own estimate hundreds of children have been fraudulently labelled and drugged. As for the good doctor's cavalier assertion that the side-effects of these drugs are not serious he must be dreaming. Here in Australia we have hundreds of officially reported cases (to the TGA) of very serious adverse reactions to these powerful and addictive drugs - they include heart conditions, psychotic episodes and death.
- Mario Cardile, Sydney, Australia
"...it is a much greater problem to not diagnose people with ADD than it is to misdiagnose people with ADD."?
And in more 'other words': It is better to be on Ritalin than not.
What a load! Mass hysterectomies were also once thought to be 'better than not'. (That's where the word 'hysteria' comes from.)
- Beajerry, Colorado, US
Anna,
What point are you trying to make?
- Shnarf, Raleigh, USA
Why did it take most of this article to get to the real point: "But Dr Spitzer, who chaired the taskforce that compiled the international Diagnostic and Statistical Manual of Mental Disorders, said he is less concerned by wrong diagnoses and possible side-effects from drugs, than failing to prescribe them where needed. "
In other words, it is a much greater problem to not diagnose people with ADD than it is to misdiagnose people with ADD.
ADD is a genetic, hereditary disorder, that is also characterised by high creativity, high intelligence and a very different type of mindset (Billy Connolly is a good example). ALL children who have ADD become ADD adults. ADD adults are perfectly capable of making their own decisions about whether they function better on medication or not, and in many cases, they do function better on medication; that is why they take it.
- Anna Rosevear, London
I wonder what sort of establishment Mr Ian Graham is running at Slindon College to have 20% labelled 'ADHD" as well as others with 'oppositional defiance disorder' - code for they don't do what they're told, like the docile students they are expected to be. These numbers are surreal and outrageous. In light of the fact that there is absolutely no proof of any long-term academic benefit derived from stimulant drugs I would urge Mr Graham to think ahead to the time when he, like Mr Spitzer, will have to admit things are not what they were portrayed to be. Wouldn't it be better to seriously consider safer alternatives?
- Mario Cardile, Sydney, Australia
What a good idea! Kids misbehaving? Forget about leading my example or correct discipline - just drug them into obedience. Chemical straightjackets are the way to go so all we "adults" can watch the football in peace. It's just a pity that so many of the children get worse or even die - but we don't want to talk about that - the footy's back on.
- Peter Jb Davies, Hawthorn, Australia
This article appears very slanted IN FAVOR of drugging the kids.
20 - 30% are misdiagnosed.
Cardiovascular disorders, hallucinations and even suicidal thoughts are not enough to stop it. Nor or 9 deaths.
NO ONE KNOWS the long-term effects. AT ALL.
- Justa Thought, USA
Kids being misdiagnosed and wrongly medicated? No kidding! I find it suspicious that kids' overall attitudes and behaviors are growing worse, not better, as ADHD has become more "identified". (I know a girl who is "ADHD," on Ritalin, and is one of the most obnoxious, lazy, and disruptive kids anywhere. So much for fixing the problem with drugs.)
I know people love to claim that these bad attitudes arise from hormonal imbalances or some nonsense, but how many kids on Ritalin were tested for said imbalances? Or are their doctors just guessing? Bad medicine...
Well, let me tell you something. As a former "ADHD" labeled child - not officially, because my parents would NOT consent to my being drugged or counseled and therefore "disabled" for life - I learned to control myself WITHOUT the chemical crutch. The root of MY problem was that I was smart and the school didn't care to keep me interested; they'd just rather pump me full of pills. After all, everyone knows that a child who hates doing excessive and pointless homework is obviously not right mentally!
So instead of doing the usual round of shirking responsibility, I went to university at 15. Oddly enough, the challenge made all the difference; suddenly, I had somewhere to apply all that energy and attention!
I think the misdiagnosis level is much higher than 30%. With how lame the public education systems are these days, I'll wager it's more like 98%.
- Mrs. Pilgrim, East Texas
