Thursday, 27 June 2013

ADHD Overdiagnosis and Overmedication- The Risks and Pitfalls

The CDC’s report  (2011-2012 National Survey of Children’s Health) has raised some worrying aspects about the problem of overdiagnosis of ADHD and also as a consequence, overmedication. Over 76,000 parents were interviewed by phone.

The New York Times did not wait for the CDC to sum up its findings but went ahead and published all this data. The figure of 11% ( I in 5) of school children being diagnosed with ADHD represents a sharp rise over the last forty years or so.  These concerns have been raised before. Some famous examples are Hillary Clinton’s press conference in 2000. 

But are these gloomy predictions really true?  Perhaps ADHD really is increasing and there is a need for more and more medication. That is worrying.

It could be that there is growing awareness of the problem or as the New York Times states, there is far too much mislabelling of our children who may not have ADHD at all.  There are so many childhood conditions that mimic ADHD that this really should be taken into consideration more often.

The publication of the DSM V edition has broadened the areas of definition of ADHD which may mean that more and more children are going to fall into the net. There are fears that this redefining of the criteria and the extension of the age limits may actually lead to even more over diagnosis of ADHD.

There is also the question as to whether ADHD is being under reported in the case of inattentive children (especially girls) who tend to go unnoticed.

To sum up. The main concerns are:-
1.      There is far too much willingness to seek an ADHD diagnosis because parents and teachers want children to behave better
2.      They also want children to do better academically and they are not concerned about the ethics of giving medication as a study aid!
3.      Meds are shared among class mates and are taken by those students who are perfectly normal
4.      The health risks associated with such  misuse and abuse of the meds are considerable.
5.      Normal childhood behavior such as being fidgety and restless is part of childhood but is now being regarded as pathological. (This is the view of Dr. Jerome Groopman of the Harvard Medical School). He is the author of the book. ‘How Doctors Think’.

Finally, we should be wary of getting a fast diagnosis for our child who may have ADHD. There may simply be parenting issues. According to Dr. James Swanson, professor of psychiatry at Florida International University, the possibility that one in five high school kids has ADHD is grossly exaggerated. The real problem is with the misuse of the ADHD meds and he believes that these meds are given freely to schoolmates and he says that this could be as high as 30%.

Friday, 21 June 2013

Who Decides If You Are Normal? Vital Questions To Be Asked

The publication of the latest DSM manual (Edition V) has caused a storm of controversy. Just in case you do not know, this is the so called bible which is used by psychiatrists and medical staff to diagnose a whole range of mental illnesses and disorders.

The problem is that the net is being cast wider and wider to include every temporary, permanent disorder or mental stability problem. That can include bouts of depression, excitability, distraction, obsessions and of course the great favourite ADHD. It is no longer acceptable to be fidgety, excited, impulsive or even distracted in society. How boring!

According to the DSM V, I am mentally ill!  Let me explain. I have various addictions. For example, I check my email obsessively.  This is no simple obessesive disorder and DSM VI may well include it as a mental disorder. That will mean 90% of the western population and they will all be drugged. That is very disturbing.

Look at how they are defining temper tantrums. They say that of the frequency and the severity are X times, then the child (or adult) may be suffering from DMDD. Now that stands for disruptive mood dysregulation disorder.   These temper tantrums are of course abnormal but who is going to define what is normal and what is not?

Let us take another example. Eating. Now according to the DSM V says that if you have eaten far too much, like say, twelve times in the last 90 days, then I am afraid you have an eating disorder!

Do you tend to hoard things like I do? Well, join the club. You, my dear reader ,and I have a hoarding disorder which is described as  ‘persistent difficulty discarding or parting with possessions regardless of actual value’.  The next time your nearest and dearest claims that an object ‘might come in useful one day’ ring your psychiatrist for an appointment!

Let us be serious for a moment.  Red flags have been raised and one distinguished British body,  the Division of Clinical Psychology (DCP) which represent 10,000 psychiatrists have called for an end to over diagnosis and especially want the words ‘illness’ and ‘disorders’ removed from the language of diagnosis. That would be a great first step.

Are we becoming a society of normal, boring, entirely predictable people who will behave according to the rule book, every single time? Who decides what is normal?  Why is every mental condition treated with psychotic drugs when there could be other solutions in cases where the severity of the condition really does call for treatment.

I am not saying that mental illness should be ignored. It just needs to be diagnosed and treated in a radically different way.

Now, I have decided not to check my email after writing this post. I will mow the lawn instead. Maybe I will be able to overcome my internet addiction without having to take a mind numbing drug. Hope so!  And what are YOU going to do after reading this post?