The Debate on ADHD

adhdLately, there has been a great debate about the diagnosis of ADHD, brought on by Alan Shwartz’s article, “Drowned in a Stream of Prescriptions,” published in the New York Times.

In the article, Shwartz speaks about Richard, a 24-year-old college graduate who was prescribed Adderall, an amphetamine-based medicine for ADHD—a disorder that he did not have.[1] Richard was becoming extremely addicted to the medicine, worrying his mother.1 Soon after, Richard became violently delusional and spent a week in a psychiatric hospital, where he received a prescription for 90 more days of Adderall.1 Two weeks after they ran out, Richard hanged himself in his bedroom closet.1

Schwartz states that “The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medicine for ADHD.”1

As the medicine provides “tunnel-like focus” for those who do not have the disorder, many fake symptoms of ADHD to obtain steady prescriptions for the highly addictive medicine.1

Schwartz writes, “Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication—even increasing dosages—despite evidence of his growing addiction and psychiatric breakdown.”1

While it may be easy to obtain a diagnosis and the prescription medicines needed to treat it, some actually do suffer the disorder and benefit from the treatment.[2] Still, over-diagnosis is a huge problem and the long-term impact of treatment has not been studied as well as it could be.2 However, that leaves many in the middle: the ones who struggle with focus and activity to the point where problems persist but are not the kids who others easily recognize as bouncing off the walls.2

David Rettew, M.D. states, “The essence of the problem is that attention span and activity level are complex dimensional constructs with no clear boundary between normal and abnormal either on the surface level or even possibly when it comes to the underlying neurobiological processes in the brain.”2

However, a lack of these clear boundaries does not make ADHD “not real.”2 If that logic is applied to other disorders, such as chronic pain, autism, and hypertension, these, too, should be called into question.2 Speaking of the human brain, it is a complex organ which scientists and researchers do not yet fully understand.2 However, there has been great progress made to understand the causes of ADHD.2 In fact, genetic factors play a large role, and behaviors reflect the significant changes in brain structure and function.2 Writing off this significant amount of research data that comes from scientific studies is impossible.2

Schwartz speaks of the influence of the pharmaceutical industry and how it makes researchers “corrupt mouthpieces” of the drug companies, with psychiatrists being naïve, thinking that their marketing effects everyone except them.2 However, as trained professionals, evidence-based research ranks higher than marketing campaigns.2

Rettew states that although ADHD is subtle or difficult to measure, it does not make it unreal.2 No one wants to see children suffering needlessly, or being plastered with medicines they do not need.2 This debate goes to show that further research needs to be done regarding diagnostic measures and pharmacological treatments—for both those who have it and those who do not.2

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