How should one look upon concentration Deficit Hyperactivity Disorder (Adhd) and what is the productive way to aid those who are given this diagnosis? There has been vital debate as to either or not Adhd is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an test by Hartmann in 1993 felt that Adhd is unquestionably normal variant of human behavior that doesn't fit into cultural norms.
In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the Tova (test of variables of attention), a test where the client must use a computer and hit a target at assorted points. This test is designed to part the person's response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the prognosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of Adhd, he states, medications alone do not provide sufficient or full treatment in this disorder.
Nervous System Facts
Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for Adhd is that about 1% of these children will establish tics and or Tourette's Syndrome. Hedaya asks the question,"One might wonder-, why use methylphenidate at all?" Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects contain nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of Adhd lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of Adhd are lessened.
However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same succeed in both those diagnosed as Adhd and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children's Hospital of Philadelphia commented at the National Institutes of reasoning condition Consensus argument in 1998 that the behaviors exhibited by those determined Adhd were normal behavioral variations. A Multimodal treatment Study was conducted by the National Institutes of reasoning condition in 1999 in regards to Adhd. Psychiatrist Peter Breggin and the members of the International center for the Study of Psychiatry and psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the prognosis conducted of behaviors in the classroom of those children studied showed no vital differences between those children receiving stimulant medications versus those who only were utilizing a behavioral supervision agenda (Mta Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no operate group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication supervision group, they numbered only 144 of which Breggin finds to be enormously small.
Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a vital factor by the investigators. Breggin also believes that the study was flawed in that drug treatment prolonged for 14 months whereas behavioral supervision was utilized for a much shorter duration. Breggin argues that the behavioral supervision strategies, which involved generally a token cheaper system, were ineffective as well and did not take into notice house dynamics but regardless, the study still showed that there was no discrepancy between the populations treated with drugs versus those undergoing behavioral supervision solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents.
The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of scholastic carrying out or communal skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have approximately same adverse reactions and have the possible for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often come to be robotic and lethargic and that permanent neurological tics can result.
In his textbook, concentration Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of Adhd, notes that there is itsybitsy improvement in scholastic carrying out with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can work on growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a prognosis of Adhd.
Dr. Sidney Walker, Iii, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large amount of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children unquestionably come to be psychotic - the fact that many hyperactive children respond to Ritalin by becoming calmer doesn't mean that the drug is treating a disease. Most citizen respond to cocaine by becoming more alert and focused, but that doesn't mean they are suffering from a disease treated by cocaine. It is sharp to note Walker's analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, Emp (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous supervision produces a high similar to that of cocaine. Walker (1998, pg. 14-15) that in expanding to emotional struggles of children foremost to Adhd-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette's syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be determined Adhdehowever Walker feels that these issues are most often overlooked and the man is determined to be Adhd.
F. Xavier Castellanos states at the 1998 Consensus argument that those children with Adhd had smaller brain size than those of children who were determined to be normal. However, Castellanos reported as well that 93% of those children determined Adhd in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with Adhd since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse succeed of this treatment. doctor Warren Weinberg and colleagues stated, a large amount of biologic studies have been undertaken to chronicle Adhd as a disease entity, but results have been inconsistent and not reproducible because the symptoms of Adhd are merely the symptoms of a variety of disorders. The Food and Drug supervision has noted (Walker, 1998, pg. 27) that ee respond that as of yet no positive pathophysiology (for Adhd) has been delineated.
There has been concern as well about the addictive component of psychostimulants. The Drug compulsion supervision (1995c) reports that it was found that methylphenidate's pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse possible as these agenda Ii stimulants.
Breggin states that psychiatrist Arthur Green in the farranging Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be related to abuse and/or neglect. Abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with itsybitsy concentration span and hyperactivity. (Breggin, 1991, pg. 274)
Being that Adhd is a subjective prognosis and that stimulant treatment has been shown to have risk as detailed above, what is the productive alternative to aiding those who have been diagnosed Adhd and what unquestionably is underlying the difficulties that these individuals may be manifesting? Psychologist and trainer Michael Valentine (1988) suggests that it is vital to love your children, care about them, do as much as possible to have them grow and develop, teach them communal skills, and teach them how to identify and express their feelings and to come to be uniquely human; but at the same time, care about them and love them sufficient to give them guidance, structure, limits, and operate as they need it.
Valentine advocates a psychosocial approach to aiding children and adolescents who would be determined to be Adhd. Psychiatrist Peter Breggin also advocates this approach and feels that it is vital for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is vital to scrutinize the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of Adhd itself). It is vital to scrutinize the sense of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an standard educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them.
Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, Epediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don't like it as having concentration deficit disorder or concentration deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it's good to use drugs than to try to apply their reputation and clout in the society to the real problem: improving our school s so that students find them enjoyable sufficient to pay concentration and learn in an environment where drugs are not needed. This misguided psychiatric attempt has created an epidemic of drug treated reasoning illnessEin the schools.
Breggin continues that it is also vital to scrutinize the environment the child lives in and the stressors colse to them. It is vital to build relationship and collaboratively establish structure and limits with the child or immature (Breggin, 1998, pg. 318) Breggin feels it is vital to train parents in relationship construction with their children and in working through situations of conflict. He states, parent supervision training has consistently proven flourishing in improving parent self-esteem, in reducing parent stress, and in ameliorating Adhd-like symptoms, especially negative attitudes toward parental authority and aggression.
Dr. David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as Adhd who Stein prefers to call extremely misbehaving children. In this program, known as the Caregiver's Skills program, Stein states it is vital to treat your child as normal and not diseased. He states that the children should not be taking any medications, as they are risky for the child's condition and merely blunt behaviors. Stein argues, if the behaviors don't occur, we can't help (them) learn new habits.
The agenda encourages communal reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The agenda encourages development of target behaviors and consistent encouragement and communal reinforcement as well as consistent consequences for misbehavior. The agenda encourages the self-assessment and appraisal of the child of their own behaviors.
References:
Barkley, Russell, Taking payment of Adhd, Boys Town, Ne, Boys Town Press, 1995)
Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, Ma, 2000)
Breggin, Peter R., Talking Back to Ritalin,Common Courage Press, Monroe, Me, 1998)
Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)
DuPaul, Barkley, and Connor, Stimulants (article appearing in text concentration Deficit Hyperactivity Disorder, 1998).
Glasser, William, Psychiatry Can Be dangerous to Your reasoning Health, Harper Collins, New York, 2003)
Hedaya, Robert J., insight Biological Psychiatry, W.W. Norton, New York, 1996)
Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)
National Institutes of reasoning condition Consensus argument Statement, 1998
Stein, David, Unraveling the Adhd Fiasco, Andrews McMeel, Kansas City, 2001)
Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)
Weinberg, Warren et al., concentration Deficit Hyperactivity Disorder: A Disease or a symptom Complex, Journal of Pediatrics, 130, 665-6
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