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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by johnLA on March 13, 2014, at 19:55:08
In reply to Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm..., posted by Ronnjee on March 12, 2014, at 15:24:11
i'll jump in...
i think the 'truth' lies in the middle.
i taught high school (grades 9 thru 12) for close to 30 years.
this is just my experience.
my 1st ten years was at a 'inner-city' school here in los angeles. not many kids on meds at all. many came from very difficult circumstances. this was the 80's/early 90's. wrong colors in your neighborhood and you could be in big trouble.
many of the kids at this inner-city school struggled academically, emotionally, etc. but, either due to lack of knowledge, funding, culture, etc. for whatever reason, the community that these kids came from, one just did not see the amount of medication i was going to see at my next school. we did lose several students due to gang related tragedies. if i remember correctly; 6 students.
my next school that i was at for almost 20 years was a very different; a very upper class community. the amount of kids on psych drugs was unbelievable. i am not saying this in a critical way. it was just so different than my previous school. i think there are many reasons why this was the case. one of the main reasons i think is the parents had the means to have their kid 'evaluated' by a psychiatrist. the parents would often search for answers as to why their child was not 'succeeding' academically, socially, etc. my gut feeling was many of these kids were needlessly drugged. no problem with what colors you wore at this school. but, we lost about 10 kids to suicide. that never happened at my first school. sad.
the parents at the second school (not all) had a very hard time accepting that there kid was just 'average.' anxiety, depression, adhd, and much more seemed sometimes to be the 'reason' the kid wasn't succeeding.
these are powerful medications. dangerous too. mix that in with a kid who's brain is still developing and there is a good chance of disaster.
again, i am in the middle here on this. but, what are we doing to these kids for down the road?
much harder being a kid today. throwing drugs at them in many cases i feel makes it even harder...
Posted by johnLA on March 13, 2014, at 20:00:49
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm..., posted by SLS on March 13, 2014, at 10:54:06
>Crappy doctors will misdiagnose and mistreat ADHD. Good doctors won't. That's the deal. ADHD exists. It can be academically and vocationally debilitating. Stimulants are effective in treating it, even in adults. Some children's future depends on the proper identification and treatment of ADHD.
- Scott<possibly scott.
i would say maybe the bigger problem is school's have not changed enough.
how can a kid concentrate when they are bored to death?
i really believe that some of the kids dx'd w/adhd (and who are not) would do wonderfully in a different type of educational setting.
i do agree with you that adhd does exist.
Posted by SLS on March 13, 2014, at 22:59:01
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » SLS, posted by johnLA on March 13, 2014, at 20:00:49
Hi.
I can't speak to how screening and treatment are implemented in schools. However, I don't see that the incidence of pediatric ADHD should be much higher than 5%. Len Adler puts it between 6% - 9%. That seems awfully high to me, but he's one of the experts.
What would you say is the incidence of a ADHD diagnosis in children of the more affluent schools?
- Scott
Posted by phidippus on March 13, 2014, at 23:01:55
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm..., posted by Ronnjee on March 13, 2014, at 15:11:52
>it's considered a reasonable expectation for all kids to sit still for 6 hours, 5 days a week.
I don't think its an expectation at all.
>too many things have been pathologised
Or maybe just enough things have been pathologised.
>many people are treated unnecessarily and/or improperly
You'd have to show me some hard numbers to back that statement up.
>the diagnosis is rare
Maybe it is and we haven't identified as many patients as we should have.
Eric
Posted by johnLA on March 14, 2014, at 9:48:10
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by SLS on March 13, 2014, at 22:59:01
>Hi.
I can't speak to how screening and treatment are implemented in schools. However, I don't see that the incidence of pediatric ADHD should be much higher than 5%. Len Adler puts it between 6% - 9%. That seems awfully high to me, but he's one of the experts.
What would you say is the incidence of a ADHD diagnosis in children of the more affluent schools?
- Scott<hi scott. :)
i am just one teacher. my experience may be quite skewed for a # of reasons. (if your interested let me know.)
before i answer, i contacted an old friend/colleague that was the department head for the special ed/learning "accommodated" kids. i was curious what he had to say.
just like depression there is a very wide spectrum these days on the type of kid kid that gets labeled under this umbrella. very different than when you and i went to school.there are kids that are severely mentally challenged; let's use a down's syndrome kid. special classes for them. i'm not including these kids in the discussion here.
then, there is a whole 'new' population of kids that fall under kids that have been dx'd w/some sort of 'learning disability.'terminology is interesting here. i have watched it change over the decades of my career.
this is the group i think you would be interested in; adhd, dyslexia, autism, depression, anxiety, bipolar, etc.
again, before i answer your specific question (suspense! ;)), it's also very interesting that adhd is dx'd almost 2x's as much on the east coast (high income) as it is on the west coast (high income). strange, no?
not too strange if you think about it. the city of berkley, CA tried to ban the use of ect several years ago. california has always been a more 'progressive' or 'natural' state in almost all ways. including education.
ok, now on to your specific question...
my colleague said at our school kids on psych drugs was between 15% to 20%. by far the most were on ritalin. his guess was half.that puts your answer at 7.5% to 10%. he also mentioned many kids were dx'd w/adhd and their parents chose to not 'drug' them. he said that if the parents and the kid put in the 'work' these kids were just as fine as the kids on meds.
he also mentioned that the #'s of kids on all sorts of meds is climbing. anxiety/depression seem to be the fastest possibly in his opinion.whew!
these #'s are what i would have said on my own. my classes had about 40 kids in them. i would say about 4 to 8 in each class were either on some psych med or 'labeled' with some learning mental processing deal.
back in the 70's at catholic school we would just get swats for acting out is sister mona's class. no meds then!
hope that answers some of your question.
Posted by johnLA on March 14, 2014, at 10:13:46
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » Ronnjee, posted by phidippus on March 13, 2014, at 23:01:55
>it's considered a reasonable expectation for all kids to sit still for 6 hours, 5 days a week.
I don't think its an expectation at all.
>too many things have been pathologised
Or maybe just enough things have been pathologised.
Eric<eric;
not sure what you are saying here? i'm curious. :)
i am somewhat 'neutral' on meds for kids. leaning towards not giving them meds for adhd, unless absolutely necessary.
i think i am with ronjee on his statement that kids are 'expected' to go to school 5 days a week for 6 hours a day.
this schedule is over 200 years old. based on farming/etc. some progressive schools are now changing that schedule. i think that is good in my opinion. for all kids.
i think if you gave more kids options in regards to schedules, class types, etc the #'s of kids would be reduced who are labeled adhd.
also, 'standards' in each state is a very interesting concept. very political and financially influenced. for example; the textbook industry is corrupt in my opinion. these publisher's are hitting golf balls w/state senators all the time. in a state like california if a publisher contracts with a school district for books it is a multi-million dollar bonanza. i can tell you many of these books absolutely suck. but, we are forced to use them. imagine how difficult reading these books are for a kid who is already bored to death?
luckily there are some really good teachers who make a class exciting and educational for many kids. unfortunately their are also teachers that should never have been in a classroom to begin with.
again; in my experience some kids are simply bored with what is going on at school. giving a drug so they can 'focus' on something that they have absolutely know interest in seems wrong to me.
as a nation we continue to lag behind other countries in many subject areas. lots of reasons for this. let me know if you want to know my opinions why. and, i don't think a drug will be making-up the difference anytime soon.
einstein was a mess in high school. he was so bored supposedly in his 9th grade math class that he got the boot. i wonder if they would have put him on meds...
Posted by phidippus on March 14, 2014, at 11:08:44
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » phidippus, posted by johnLA on March 14, 2014, at 10:13:46
> i am somewhat 'neutral' on meds for kids. leaning towards not giving them meds for adhd, unless absolutely necessary.
The fact remains is ADHD is real and the only real treatment for it is stimulant medication. I simply don't understand why there is such reluctance to use these medications.
> i think i am with ronjee on his statement that kids are 'expected' to go to school 5 days a week for 6 hours a day.
Trust me, children need the structure.
>the #'s of kids would be reduced who are labeled adhd.
Not 'labeled' ADHD, rather diagnosed with ADHD. A reduction in ADHD diagnosis will only come when psychologists make diagnostic criteria more stringent.
> again; in my experience some kids are simply bored with what is going on at school.
ADHD behaviors carry into the home as well
>giving a drug so they can 'focus' on something
When treating ADHD with stimulants, the drug does much more than increase focus.
Eric
Posted by Ronnjee on March 14, 2014, at 12:29:26
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by phidippus on March 14, 2014, at 11:08:44
When my son was in high school, upon a recommendation from some school person, he went to a psych practitioner, who diagnosed him as ADHD (BF surprise!). He was always restless in school, which I understood from my own less-than-fun experiences. I wasn't real keen on giving him medication, even though at the time, I was still taking psych meds. His mother, however wanted to go along with it. He took Adderal for a few weeks, reported it made him feel like crap, and discontinued it. Here we have a very bright (130 IQ) kid, who simply finds his classes boring. Restlessness would be a pretty logical result. He finished high school just fine, went through some typical "finding himself" years. He is now 32, very well-adjusted and happy, married, has a job he actually likes. So, in this particular case the ADHD diagnosis was of absolutely no use to anybody, and meds only made matters worse.
An aside: When my son was in early puberty, his pediatrician wanted us to put him on some sort of hormones. The reason - because he was short! She said that the hormones would slow down his maturation, allowing him to grow more. His mother was actually going to allow this! There was NFW I going to let doctors mess around with his system, especially for such an idiotic reason, especially on a perfectly healthy kid. Did they really think they knew better than Mother Nature???!!! Yep, he's short, like his dad, who also entered puberty early. He's also just fine, as I described above, better than me, for sure. There are reasons why I am very cautious about medical interference. This is just the tip of the iceberg.
Posted by johnLA on March 14, 2014, at 12:49:59
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by phidippus on March 14, 2014, at 11:08:44
> i think i am with ronjee on his statement that kids are 'expected' to go to school 5 days a week for 6 hours a day.
Trust me, children need the structure.
Eric<
you make very good points which i agree with.
as i said, i believe that adhd exists. what i am not too sure about is that medication is the best approach.
and, i completely agree that kids need structure. but, that structure does not have to be a 200+ year-old schedule based on dated agricultural influences.
just one example;.
eric; there are current schools now starting at 9am or later, instead of the traditional 8am. some even at 10am. of course they finish later. studies are showing that kids do much better academically, socially, etc when starting school later. many european and asian countries start school later. just one example of using a behavioral approach before a medication approach. these countries also have a lower rate of adhd AND score higher on the same type of standardized testing. of coursei know there are several other factors involved in this. a schedule is not a cure-all. just a simple one-off example. still, we have a very narrow view on many things here in the states. i guess growing-up in greece has given me a bit of another side perspective. (there the students have a 2+ hour lunch break where they go home and eat,nap and go back late afternoon.)
i even taught a twice-a-week night class. it was a very popular class at school. there was a lottery to get in. seniors only. i really think one of the reasons was for some kids it was easier to concentrate at that time. calm, quiet, uncrowded campus. these are some ways to help anyone, adhd or not, to concentrate easier.
i could give you more of my ideas since i feel very passionate about education and young people. but, i don't want to bore you. ;)
this is a complex issue. pretty much just like meds for other psychiatric conditions. we could 'discuss' this at great length. i feel there are no absolutes on this issue regarding treating adhd.
i will just finish with one of my original statements; medication is not the only way to treat adhd. especially when it involves children. i think medication is just 1 tool in the box. also, it wouldn't be my first choice. but, that is only my opinion and experience.
Posted by johnLA on March 14, 2014, at 13:30:07
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by phidippus on March 14, 2014, at 11:08:44
Posted by SLS on March 14, 2014, at 15:14:52
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm..., posted by johnLA on March 14, 2014, at 12:49:59
> as i said, i believe that adhd exists. what i am not too sure about is that medication is the best approach.
What would make you sure?
:-)
- Scott
Posted by Ronnjee on March 14, 2014, at 15:19:21
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by SLS on March 14, 2014, at 15:14:52
Is not being sure a bad thing?
Posted by johnLA on March 14, 2014, at 15:58:29
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by SLS on March 14, 2014, at 15:14:52
>What would make you sure?
:-)
- Scott<nice. :)
would have loved to have had you in class scott! eric too. you could sit wherever you'd like. eric i'm thinking would be right next to my desk. lol
one of the reasons i really loved teaching was how much i learned from the kids...
ironically i am not 'sure' what you are asking me here? no pun intended.
i mentioned earlier in the thread that there are no 'absolutes' when treating adhd in my experience. many factors come into play. just like other mental conditions. it's complicated.
so, what are you asking me exactly?
Posted by phidippus on March 14, 2014, at 18:14:09
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm..., posted by Ronnjee on March 14, 2014, at 12:29:26
>he went to a psych practitioner
He should have seen a psychiatrist, first and foremost.
Eric
Posted by phidippus on March 14, 2014, at 18:23:51
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » SLS, posted by johnLA on March 14, 2014, at 15:58:29
Don't treat me like a kid!
I'll school you any day.
Eric
Posted by phidippus on March 14, 2014, at 18:30:05
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm..., posted by johnLA on March 14, 2014, at 12:49:59
>i am not too sure about is that medication is the best approach
Do you think medication isn't the best approach for treating Bipolar Disorder? ADHD is a mental disorder just like BPD and schizophrenia and requires treatment with medication.
Eric
ps. You'll have no disagreement from me on when school should start.
Posted by Ronnjee on March 14, 2014, at 18:33:39
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » Ronnjee, posted by phidippus on March 14, 2014, at 18:14:09
> >he went to a psych practitioner
>
> He should have seen a psychiatrist, first and foremost.
>
> EricI genericized it because I don't remember what the person's credentials said. But it doesn't matter, as everything worked out OK, despite the bad advice.
Posted by SLS on March 14, 2014, at 19:56:31
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » SLS, posted by johnLA on March 14, 2014, at 15:58:29
> > What would make you sure?
> nice. :)
>
> so, what are you asking me exactly?What type of evidence would you need to see in order to convince you that, for properly-diagnosed ADHD, pharmacotherapy is often necessary as a first-line treatment, even when used in combination with behavioral and psychosocial approaches?
ADHD might be more difficult to diagnose than Major Depressive Disorder. Anyone can get depressed, but not everyone has a depressive disorder. Likewise, a great many children can have behavioral and academic issues, but not all distractible children have ADHD.
Would it be at all helpful to see evidence that the brains of children with properly-diagnosed ADHD deviate from the norm as revealed in imaging studies?
What are your requirements of a source of information in order for you to consider it?
Here is a review I came across that was written by a study team in Italy. Unfortunately, they have fewer drugs available to them to treat ADHD compared to the USA.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016271/
- Scott
Posted by SLS on March 15, 2014, at 1:36:49
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » SLS, posted by johnLA on March 14, 2014, at 15:58:29
Here is an interesting study as cited by the authors of the article I provided a link for. If accurate, this would certainly reinforce your perspective on the use of medication versus psychosocial treatments. I would like to see more data to corroborate these findings, though. There is still so much to be learned about ADHD and the long-term effects of medication on the developing brain.
"Behavioural therapy and pharmacological treatment have both been shown to benefit ADHD patients. A longitudinal study of the efficacy of different treatments (an intensively monitored medication program, behavioural therapy, combination of medication and behavioural therapy or treatment as usual by community care) showed after 8-year follow-up that all four of the original treatment groups had a similar outcome: all showed improvement in comparison with pretreatment baseline scores, but none demonstrated superiority [58]."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016271/
- Scott
Posted by SLS on March 15, 2014, at 7:40:54
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » SLS, posted by johnLA on March 14, 2014, at 15:58:29
Here is the synopsis of the original study that I provided a link to:
Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA)
http://www.clinicaltrials.gov/ct2/show/NCT00000388?term=NCT00000388&rank=1
This study investigated how a 14 month intensive, controlled treatment would influence the course of a proband's life afterwards, regardless of future treatment decisions. This is not a true continuation study.
This is the same MTA study at the 3 year follow up. It verbalizes the concerns I had initially after reading the results at the 8 year follow up.
http://www.ncbi.nlm.nih.gov/pubmed/17667478
**** During the 14 months of active treatment, medication was superior to psychosocial treatments.
----------------------------------------------------------
CONCLUSIONS:
By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.
-----------------------------------------------------------
In summary, MTA study cited by the review article does not prove very much other than that medication works better than psychosocial treatments.
It still seems to me that in properly-diagnosed ADHD, especially when symptoms are disabling, medication should be included in a first-line treatment algorithm.
- Scott
Posted by johnLA on March 15, 2014, at 10:07:19
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by SLS on March 15, 2014, at 7:40:54
scott;
as i said would have really liked to have you as a student. eric too. (eric gets an A- just because.)
just had my coffee. i need to read thru what you submitted in your 'class' report again more carefully. lol
very good work as usual. taking my experience as a teacher and emotional feelings out of the equation, you gave me some very good data that i never knew about.
i'll get back to you on the 'sure' question you originally asked. thanks for giving me some homework.
an aside; have you ever given thought to tutoring teens? i have mentioned to you before that i think you have a lot to offer from an educational point of view. i know you love to research. you could roll that into some type of teaching/tutoring.
one of the coolest things, as i mentioned before, is how much YOU learn when you teach/tutor.
i think, correct me if i am wrong. that you really enjoy the 'hunt' of research. why not try that in a different area? you could really help some kids. i'm not sure how your condition would get in the way, but, just something to think about.
being a teacher is pretty cool. i think you have the gift to be one.
ok; thanks again for the research.
i'll try my best to combine what you provided with my experience and answer your question.
Posted by SLS on March 15, 2014, at 12:14:10
In reply to A+ for scott. A- for eric :) » SLS, posted by johnLA on March 15, 2014, at 10:07:19
Wow, John. You sure know how to bolster my self-esteem.
When I was 22, my plans were to (in chronological order):
1. Become an attorney
2. Enter politics
3. Be elected to higher office
4. Teach high school biologyI am not so much into the research per se as I am into doing whatever is necessary to continue learning (and arguing). Knowledge and understanding have always been my passion. It was cruel of God to smite me with the inability to read, learn, and remember. At the moment, I am about 35% improved over my untreated baseline depression. This allows me to read word-for-word more than a few sentences. Skimming is still necessary. I have to pound things into memory through repetition. I had been able to learn after a single exposure to information. This occurs with aging, of course. It is a matter of degree. I am grateful for my 35%. It allows me to survive and live independently. Surviving isn't enough, though. I want to come alive.
I am not so much afraid of dying as I am of never having lived.
Thank again for the A+
:-)
- Scott
Posted by Phil on March 15, 2014, at 15:26:57
In reply to Re: A+ for scott. A- for eric :) » johnLA, posted by SLS on March 15, 2014, at 12:14:10
i have a friend of a friend who most agree is the top paramedic in austin.
he also was the first kid in dallas ISD to be put on ritalin. does he still take it? yes.
Posted by SLS on March 15, 2014, at 16:43:02
In reply to Re: A+ for scott. A- for eric :), posted by Phil on March 15, 2014, at 15:26:57
> i have a friend of a friend who most agree is the top paramedic in austin.
>
> he also was the first kid in dallas ISD to be put on ritalin. does he still take it? yes.Someone very close to me demonstrated classic ADHD symptoms as a young child. His parents were against medication at first. I would be too. Unfortunately, his academic and social issues were too severe not to reconsider. Ritalin changed the course of his life. He did very well in school and made lots of friends. He turned out to be a very sweet and functional young man. At age 25, he still takes Ritalin, and is happy to do it. Of course, we don't know what, if any, adverse effects might emerge in the future. Most of medicine is that way.
- Scott
Posted by ed_uk2010 on March 20, 2014, at 5:59:51
In reply to Re: Doctor: 'ADHD Doesn't Exist, Drugs Do More Harm... » johnLA, posted by SLS on March 15, 2014, at 7:40:54
RE the whole 'Does ADHD exist?' debate. ADHD is a behavioural syndrome, it's not a specific disease entity. Like all psych diagnoses, the validity of grouping certain symptoms together into a disorder or syndrome will always be up for debate. The symptoms are real but the causes are variable and different pts experience different sets of symptoms.
I think the doc makes some good points about the importance of identifying all treatable causes of behavioural problems in children. As he says, Rxing stimulants is not an appropriate knee-jerk reaction to a child presenting with problem behaviour. Medical causes (eg. anaemia, hearing/visual impairment), sleep schedule and diet, psycho-social causes, family and school problems, other psychiatric disorders, and sometimes drug/alcohol use in teenagers all need to be assessed and dealt with before jumping to any conclusions.
The headline is an attention grabber and is highly typical of Daily Mail reporting. I think it's best to ignore it and make the best of the useful points he does make, whatever your opinion of the validity of the ADHD diagnosis. Medication may be useful in some cases but current prescribing rates in certain areas are alarming. It seems very odd to me that so many children apparently need stimulants. I suspect some of them actually do not. Medication is only going to help when prescribed appropriately to the right people, with careful monitoring of effectiveness and side effects, also taking into account the possible long-term effects of potent psychiatric medication on the developing brain. I think this is a particular concern when prescribing to young children on a long-term basis, and is an area which has not been sufficiently researched considering how frequently these drugs are prescribed.
This is the end of the thread.
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