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The overdiagnosis of ADHD

In Bobbys second grade classroom, his teacher threw up her hands and said, That is it! On that very morning, Bobby leaped out of his seat seven times to go sharpen his pencil, each time accidentally colliding into other students desks and chairs, sending papers and books plunging to the floor. Bobby screamed out comments to every slightly comical part of the book that the teacher read. His teachers last straw was when, after repeatedly kicking the desk in front of him, it toppled to the floor, spewing all its contents to the ground.

This is a strong example of Attention Deficit / Hyperactivity Disorder (ADHD) in the 90s. However, most cases in which a doctor is brought in to rule if a child has ADHD are not like the previous example. A majority of these cases are with children in the gray area, not constantly showing the signs of ADHD, but showing signs only occasionally. This is where the over-diagnosis of children with ADHD comes into play, in that gray area. Attention Deficit/ Hyperactivity Disorder is a disorder composed of three major components: inattentiveness, impulsivity, and motor hyperactivity.

Symptoms of these components include excessive fidgeting with hands or feet, repeated difficulty remaining seated, following through on instructions, extreme difficulty in attempting to play quietly, and excessive interruption of conversations, just to list a few. A child with ADHD can bear one or all of these features, depending on the severity of the case. These children usually have functional impairments in a variety of places including the home, school, and in relationships with fellow peers.

These signs can come and go, being extremely prevalent one day and unnoticeable the next. ADHD is a very complicated disorder. Most people have the false perception that this disorder is like a chronic ear infection or diabetes, where prescriptions of penicillin or continual injections of insulin will cure the ailment. Well, ADHD is different and is surprisingly unclear. There is no clear consensus on what the cause or causes of this disease are. There have been countless theories however, and all have been disproved through studies.

There is no urine test, blood test, PET scan, or physical test or examination that can tell if someone does or doesnt have ADHD. This translates into mass confusion when parents, teachers, and even doctors are called upon to diagnose a child with this disorder or not. Psychiatrists around the world say that, about half the children who show up in their offices as ADHD referrals are actually suffering from a variety of other ailments, including learning disabilities, depression or anxiety-disorders that look like ADHD, but do not need Ritalin.

Some seem to be just regular kids. (Newsweek, pg. 52) It is estimated that ADHD effects two million children in the United States, this translates into three to five percent of all school-age children. Even more frightening, is that in some areas up to twenty percent of children have ADHD. However, these diagnoses are inconsistent. One reason for this enormous number of cases is due to the fact that there is not proper testing for ADHD before the diagnosis is completed. One familys situation was published in an October 1998 issue of Time.

The parents took their daughter, Erin to a psychiatrist just before her fifth birthday. The doctor saw the concerned parents for 45 minutes. During this time the doctor read the teachers report on Erin. Then he saw Erin for 14 minutes. After that short time span, he came to his conclusion, and said, Your daughter has ADHD, and heres a prescription of Ritalin. (pg. 6) The parents were astounded to here those words come out of his mouth, to prescribe a powerful drug like Ritalin after only a 15 minute meeting with their child to evaluate her condition.

In a recent report in the Archives of Pediatric and Adolescent Medicine almost half the pediatricians surveyed said they send ADHD children home in an hour. (pg. ?) Many of these doctors have those children walking back out of that door so quick with their new label of ADHD, that they do not even have time to contact the teachers, look at their educational records, or have the child meet with a psychiatrist, which is all very essential. Doctors are not taking the proper time to analyze a serious problem like ADHD. One of the reasons that doctors rapidly diagnose ADHD is due to the persistence of parents.

Doctors find themselves feuding with apprehensive parents that are worried that their child is ruining his/her future because of a bit of hyperactivity, or jitteriness that is apparent in the classroom or at home. They demand drugs from their doctors, and if they refused to fulfill their demand, they will find a physician that is more understanding of their views. Parents are getting to the point were they feel they need to mold their children into a little angel. They will go to any extreme, even drugs. to accomplish this.

As Lawrence Diller states in Running on Ritalin, In order for them to succeed, we make them take performance enhancers. (Diller pg. 96) What he is saying is that parents want their children to succeed so much that they are making them take performance enhancers, like Ritalin. What once was looked at as normal, children interested in different things and having different skills and talents, is now analyzed as a disease that needs to be fixed with powerful drugs. After these faulty diagnoses take place, most of the time doctors prescribe stimulant drugs, such as Ritalin, Dexedrine, Adderil, and Cylert.

Above all, Ritalin is the most popular stimulant to be prescribed and has a series of adverse side effects. Ritalin is actually the manufacturers name for the generic chemical methyphenidate, a derivative of amphetamine. Ritalin is similar to the street drug of speed. A child on Ritalin can exhibit several of the following short term side effects: loss of appetite and resulting weight loss, insomnia, headaches, stomach aches, drowsiness, potential liver damage, facial tics, and a sense of sadness, just to mention a few. Also, several authorities report that there can be devastating long term side effects.

Probably the most disturbing fact is that this is a drug that comes from the amphetamine group and can possess strong addictions. This very drug with its addictive qualities, is prescribed to children as young as four years old. Ritalin is used mainly in treating children, whose brains and personalities are still being formed and who do not make the decision themselves about talking the drug. This drug greatly enhances the chance of a person, especially a child, of having long term drug and alcohol abuse. In Lawrence Dillers book Running on Ritalin, he talks about a number of animal and human studies that took place from the 1930s on.

In these studies subjects that were given the opportunity to self-administer Ritalin would choice to continually repeat the amphetamine experience. Laboratory rats will self-administer intravenous Ritalin literally to death, repeatedly choosing the drug over food, and there by starving (Diller pg 23). These desires would increase over time over time, indicating a built up tolerance for the drug. This was followed by a similar pattern emerging outside of the lab by the late 1960s, finally revealing the darker side of stimulant drugs like Ritalin.

The surprising fact is that this drug, with its harmful side effects, is dealt to some children that, for the most part, are not even positively identified with ADHD. Doctors must set strict guidelines and start using structured parent questionnaires, rating scales, or teacher and school input to correctly diagnose kids, so they receive the proper medication and treatment. This will eliminate the harm done to the wrongly diagnosed children that are currently ingesting powerful drugs like Ritalin.

Doctors have to find a new way to deal with this overwhelming increase in ADHD more effectively, instead of continually administering Ritalin. There has been a new finding that is less harmful in helping children with ADHD. This new tool is EEG (electroencephalogram, or brain wave) biofeedback. The way they use this towards treating ADHD patients is quite simple. Technicians distinguish between training at higher frequencies (15-18 Hz, which is referred to as beta) and at lower frequencies (12-15 Hz, or SMR training) with the overall beta range of frequencies.

Thes have vastly dirrerent effects. In beta training we appear t obe dealing with conditions of underarousal, either in duded by trauma of some kind, or fo genetic origin. In SMR hypervigilance, of heightened stress susceptibility. The EEG in ADHD children tends to be of larger amplitude than that of other children. In particular, the DDG is higher at the lower frequencies. This condition is more appropriate to a sleep or day-dreaming state than an alert and focused state. IN these chidren, the EEG shows that cortical electrical activity is disregulated.

The greates point of difference between a typical ADHD EEG and a normal adult EEG is in the low-frequency component. The low frequency activity gradually diminishes as the child ages, and as the brain learns to stabilize and reulate the cortex. Hence, the EEG of an ADHD child looks like that of a younger child. Unfortunately, it may not mature in the normal fashion by itself. The symptoms may arise, then, from a condition of a disregulated EEG, in combination with whatever the childs particular weaknesses are, given his genetic makeup and any trauma he may have suffered.

The disregulated EEG shows up over a broad are of the cortex. The specific weaknesses related to localized areas of the cortex. So then in EEG training for ADHD, they present information to the child about what is happening at that moment in his cortex. They are seeing their own brain waves misbehave, and they try to get them under control. Gradually, the patient is able to do so. Once the childs brain has learned to regulate itself better, it continues to use that skill, just as other childrens brains do naturally. When this happens, there are numerous improvements.

Ones sleeping may improve, bedwetting may stop, headaches may disappear, less temper tantrums, reading level may increase, school behavior may become less disruptive, and his math and writing may also improve. Among the symptoms responding to the training, it is easiest to document progress with tests of cognitive function and of intelligence. In one thirteen year old boys case by the name of David tremendous results occurred. David was an eighth grade student who had reading and math shills one to two years below grade level. He was failing every subject and seemed distined to repeat the eigth grade.

His teachers described his as disruptive and oppostional in class and stated that he had difficulty paying attention during structured and unstructured activities. The school administrators contacted his grandparents and suggested that he was likely suffering form an Attention-Deficit Hyperactivity Disorder. They recommended that he be taken to his pediatrician and placed on Ritalin. At home his father virtually abandoned him from birth. His mother, overwhelmed by the task of raising him and his two sisters without spousal help, relapsed into drug and alcohol abuse.

She was frequently drunk and around David she was moody and volatile. He ran wild. He refused to obey her curfews, going to be late at night and failing to rise for school in the morning. Intermittently he wet the bed. He never helped the family with housekeeping or yard work chores. His mothers parents, sensing that she needed heip with David, and having been advised of his problems at school, intervened. Even though David attended a good school in an affluent district, his grandparents doubted the wisdom of placing David on drugs. They thought it would only compound his problems.

When they sought the advice of the family pediatrician, they asked for an alternative to Ritalin being concerned about Davids potential for developing a substance abuse problem like his mother. They referred to A Center for Educational and Personal Development (CEPD) where they could find a balanced, non-pharmacologic treatment approach which used as its cornerstone brainwave-based biofeedback, also called Neurofeedback. The director of the center, Barry Belt, a Licensed Psychologist and Certified Neurotherapist, found David so hyperactive that he could only sit still for a minute.

They measured Davids brain functioning, and found too much slow-wave activity and not enough fast wave activity. Simply put, his brain was daydreaming instead of paying attention far too much to allow him to learn effectively. David was put on a strict diet, entered an alternative school that fit his needs better, and was enrolled in counseling. However, most importantly, David began to use Neurofeedback which trained him to alter his brain functioning so the he would daydream less and pay attention more. They used special software and computer enhanced techniques which allow him to monitor his progress like it was a videogame.

After the third session of Neurofeedback David started to enjoy the sessions. By the tenth his mother mentioned that he was more attentive at home. After the fifteenth session he started to help the family with household chores. After the twentieth he stopped wetting his bed, and by the twenty-fifth his grades and behavior drastically improved. By the fortieth session his attention span had increased from less than a minute to over forty-five. After a six month time period his math and reading scores increased by one whole grade level. He was now on the honor roll, and his teachers described his behavior as excellent.

David looked forward to making it back to his original junior high school, at his respected grade level. He though of himself as responsive young man. David continued to experience greater success, but he also had his occasional setbacks. We know that most children that are diagnosed with ADHD do not have drug addictions running in their family. However, if this treatment can work for people like David, then it can most certainly be worth at least a try for other children with his same disorder, instead of repeatedly popping dangerous pills into their mouths, like Ritalin.

Attention Deficit / Hyperactivity Disorder is a condition that many of the children of the United States are continuously getting diagnosed with more and more. This prognosis comes in combination, for the most part, with Ritalin. There has been a 700 percent increase in prescribing this drug since 1990. This statistic would not be as frightening if there was a cause for this disease, so that there would be a proper way to diagnose, so over-diagnosis did not take place. What we are doing to our children is trying to put the pieces of their life together as we see fit, like a puzzle.

However, we stumble upon the situation where a piece does not fit were we want it to be. So, instead of taking our child for how they are, excepting their small differences and leaving the piece of lifes puzzle where it fits naturally, we try to smash the piece into place where it should be compared to all the other children. This is what happens when slightly different kids are diagnosed with ADHD and prescribed Ritalin. The kids are manipulated into something that they are not. Hopefully, with some time, there will be a medication found that can treat ADHD without masking the childs true feelings.

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