gone

My thoughts? I've asked my DH to send it to his mum, who he finally told about the ADHD and medication after nine months of gratin her terrible negative reaction (which he was right about). That's our journey.

If it was (mild) Asthma and you'd tried OT and physio and diet and swimming (and, and, and), and it still wasn't enough for them to participate fully in life, do you send your kid out into the world and say "Well it's not bad enough to kill her and medication is evil, so she can just stay like this and manage..."

And before anyone says "but Asthma could still kill, even though for that person it's usually mild", ADHD sufferers are at risk of very serious consequences too (death by motor vehicle comes most immediately to mind).

I agree completely. While I don't think medication is the be all/end all solution, I can never understand the "absolutely not" view. If a child has diabetes, would you deny them insulin? If they needed an antibiotic for strep throat, would you just say "oh, it'll go away". Yet for some reason mental health issues seem to be an entirely different ball of wax for some people. My dd will tell anyone that asks that her medication makes her feel better, and will remind me when it's time for a dose. Of course I wish she didn't need it, but I would never deny her the chance to feel better about herself and her functioning by not letting her have it.

The problem is when your child is misdiagnosed as having a condition that they don't actually have and then they are given medications (or therapies or other "services") which cause them harm.

I am against meds. Always said I wouldn't medicate my kids unless they became violent. And then ... DS3.2 had to be on Zantac pretty much the first 12 months of his life due to severe silent reflux and DS4.9 won't sleep at night without a heavy dose of Melatonin and sometimes needs hydroxyzine to knock him out for the night (strong antihistamine used for allergies as well as anti anxiety medication) and as of last week he's on regular allergy meds twice a day (found out he's not only severely allergic to certain foods but also has a very strong allergy to trees, grass, molds, dust mites, cats, dogs, you name it he's go it). And we thought we were done. Than last week he started developing asthma (thanks to the crazy delayed spring season when now EVERYTHING is blooming) and on Saturday I watched him go in some sort of asthma attack / anaphylactic shock (not sure which one yet, but for sure caused by the tree pollen concentration) so now we are looking into more meds. As much as I hate it, I'd rather have my son on regular medication that "may" change his mood than watch him stop breathing like he did on Saturday ever again. So, I'm against medication yet ready to medicate my child I guess it comes down to the lesser of two evils?

THIS.

YES.


The difference between a diagnosis of diabetes/asthma/etc. is that there is a measurable impairment relative to a normative control.
There is absolutely nothing subjective about impaired breathing or blood glucose metabolism. You can monitor it and plot it, and then measure it again after interventions.

No human subjectivity comes into play at all. Now-- before anyone assumes that I think that allopathic = nonsubjective and that psychiatric = subjective, that's not the case.

I loathe studies that use "exercise tolerance" or "pain perception" as indicators for efficacy. They are notorious for producing artifacts that can't be reproduced.

But I agree with the complaints re: the DSM V, and there is a good reason. There is a huge difference between telling someone "I think that you're flirting with diabetes-- get out and get moving, drop some weight," and offering a person insulin because you think that they "might try it to see if they benefit" from it because they meet 3 of 7 items on a checklist.

Better diagnostic tools = better prescribing practices.

I agree that misdiagnosis is a definite problem in identifying things like ADHD in children. Unfortunately until science comes up with a way to definitively, objectively test for mental illnesses, we're stuck with what we have. When my daughter was diagnosed (AS, GAD) there were no doubts in my mind the diagnoses were right on. If there was doubt, I would have pursued it further. (Been there, done that, bought the shirt when she was younger and went from pneumonia to cystic fibrosis, enough said.)

I do think however, there can be measurable impairment with psychological issues, the only problem is, therapy or medication is needed to see the improvement. Until we tried the other avenues and went to medication, there was little visible improvement. When she started the meds, improvement was almost immediate. Relatives, friends, teachers, all commented within a week that they could see a major difference in her anxiety and irritation levels. I wish there HAD been a way to tell without the meds, but unfortunately none of us have a crystal ball.

http://m.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd

I am against spanking and CIO, but I agree with the rest of the article.

Anybody who thinks a serious argument about anything can be built on the basis of that book by Pamela Druckerman shouldn't be allowed to write in a serious publication (oh, wait, Psychology Today?).

There are too kids with ADD in France.

http://www.midilibre.fr/2013/02/21/enfants-hyperactifs-la-maman-et-la-psy-decodent,648554.php

http://www.topsante.com/sante-au-qu...i-la-prescription-de-Ritaline-fait-debat

And yes, the French approach to psychiatric treatment can be a little different. Not always in a good way.

http://www.nytimes.com/2012/01/20/h...utism-strongly-criticized-in-france.html

Because if all psychological difficulties in children can be tracked back to bad parenting... well...

That depends on your definition of "bad" parenting.

I remember trying to pin ADHD as a "North American affliction" and after doing some research (read: google ) was disheartened to see that it really does exist in most countries.

(I guess I thought that if I could isolate it to North America that would have meant that it was more environmental than biological and therefor easy to change).

I did read somewhere that it's more prevalent on the east coast, but that could just be a reflection of population? Not sure.

Very clearly anything that leads to issues (attention disorders, anxiety, autism, schizophrenia...) in children.

Bad parent doesn't equal abusive parent, necessarily.

It's not like I don't believe it exists AT ALL, just not in the numbers that some countries claim.

I feel like there is a rotation in pop media with this same headline.

American parents are horrible compared to (insert French, Asian or Scandinavian) parents.

I'd characterize it more as a cycle of gross overgeneralization, evidence to the contrary, new gross overgeneralization, rinse, repeat. Parenting just happens to be one of the topics.

I think ADHD is overdiagnosed, mismanaged and mistreated, but I hate that freaking Psychology Today article. What a bunch of ignorant, parent-blaming claptrap. ADHD is real, even if some doctors diagnose it at the drop of a hat, even if there are real and serious problems with how it's currently being treated, and even if the educational system has some very real culpability in its overdiagnosis. I shudder when I think of parents of kids who have ADHD reading that piece. France is all kinds of messed up in terms of how it deals with neurodiversity. Let's not take it as a model.

BTW, Psychology Today is now like Forbes in that anybody seems to be able to write any wacktastic piece and publish it under their banner. The Internet really is starting to suck more and more. Nobody can tell anymore what's actual journalism and what isn't.

ITA. The author is also apparently shilling for her drug-free pseudo-therapy program. She's not a scientist, she's a salesperson. Why anyone should take her opinion as valid is beyond me.

DeeDee

That's actually one of the reasons why I like Psychology Today.

It's particularly speculative.

If you're going there for answers, though, you're going to the wrong place.

The Internet is mostly just people talking to each other.

It's not a source of Truth or Fact.

"Yeah, only a stupid idiot would believe that article".

This article didn't influence my opinion- the many people in my life who were wrongly diagnosed with ADD did. Plus, commonsense.

I suppose I should have said "Internet journalism." With "journalism" in very heavy air quotes. The problem is that people see Psychology Today, a known publication, and think they are getting something that has actually been fact-checked and edited for like, 5 seconds. Also, the proliferation of pay-for-publication fake-o Internet scientific journals is making this all even muddier. And nobody, but nobody ever actually goes to the source and reads the cited articles (most of which are behind a paywall anyway, unless they're the aforementioned fake-o type). My Facebook feed is full of people posting nutball junk about GMOs and vaccination from sites like naturalnews.com. These friends of mine have degrees and ought to know better, but the sites fake themselves up to look marginally science-y if you aren't really paying attention. This isn't even taking into account the fact that many real scientific articles are questionable.

I don't get it. If the child is smart and advanced according to the author, isn't it expected that she's not going to pay attention in the boring and slow paced class environment?

Here are some of the strikes I see against ADHD medication when not absolutely indicated:

-Something like a 50% higher ADHD diagnoses for children in the youngest quartile of their grade.

-A thinner frontal cortex in kids with ADHD compares disturbingly with the thinner frontal cortex of many highly gifted children, and perhaps often with the same symptoms. However the trajectory of the HG+ child is to rapidly gain cortical thickness until it is well above average in thickness around age 11 (if memory serves) then it thins back down some.

-Stunted or delayed average growth for ADHD kids on medication (~1" shorter after three years)

-The strongest outcomes pair cognitive therapies with medication. Taking a kid who has only had medication intervention off of the medication leaves them back at the starting line with no coping skills.

-Often brains grow resistant to psychotropic medications such as reducing the number of receptors for the given medication. Or a brain will cut back on producing its natural alternative. Or when the medication is a receptor blocker, the brain may ramp up production of the chemical for that receptor.

Bingo.

What's worse? Apparently some of those regulatory changes induced by psychotropics within the stimulant classes most commonly used to trial ADD/ADHD treatment cause permanent regulatory changes in receptors and transporters. They are profoundly addictive. Profoundly. In a small, but very real and very reproducible percentage of those who take them, they induce psychosis. Really. Rates vary by individual substance, but are well over 1%. It's not always reversible, incidentally.

The thing is, also, that stimulant meds increase focus for anyone taking them. This is why there is abuse on a positively horrifying scale in collegiate settings with these drugs. There is not really a 'paradoxical' effect that can be used to determine which people are actually in NEED of medication.

It's just like clinical depression-- everyone KNOWS it when they see it. It's just that there isn't a clear diagnostic picture which isn't ambiguous, and the line where medication becomes "the" treatment of choice also isn't clear.

If ADD/ADHD isn't fundamentally an asynchronous development problem for the vast majority of children, then why do so many of them "outgrow" the problem? (And they do, if left unmedicated-- far fewer than half of the children with ADHD retain symptoms into adulthood.)

I strongly suspect that there are multiple populations being lumped together into one classification based on behavioral constructs that probably don't reflect the same underlying mechanistic causes. Some of those people are probably just asynchronous in development, and we're only starting to tease apart who is MOST likely to be misdiagnosed.

Wouldn't it be awesome to get back to a place where people who truly NEED medication can get it without it being assumed that they are selling it for recreational use?

And the behavioral/cognitive therapy that works is hard to obtain for many (most) people. This is a serious failing of the medical establishment. I will not editorialize further, but ugh.

Important to note that behavioral/cognitive therapy alone doesn't necessarily work that well for most children with ADHD. In many cases, the child cannot really access the therapy without medication, which is why the combination is often the strongest choice for moderately to severely affected children (for people who actually have ADHD, not talking about misdiagnoses here).

The choice to medicate is not IME usually taken lightly; nobody's a huge fan of giving medications to kids in principle. In our community, I see it operating as a last-ditch thing that people try after having tried a number of other ways to make life workable for their children, and I see that it is typically associated with unjustly shaming the parents first for having an uncontrollable or out-to-lunch kid, and then for drugging the kid.

Unmedicated ADHD is associated with some other really undesirable things in young adults, like alcohol and drug abuse; if you let a person's frustration level climb sky-high over years by letting them feel like a failure for how their brain works, lots of really bad things can happen. This ought to be factored into decisions. I think families mostly try to do right by their kids; I do not think most families are trying to drug their children into submission and so on.

I would like so much of this public shouting and judgment to stop: the shaming, the overdiagnosis, the pressure to medicate or not medicate. I suppose that's unrealistic of me.

DeeDee

I think what I'd like is also unrealistic-- because it involves changing our expectations and dialing things back to a point where kids were allowed to be... well, children.

I think (and have had a lot of primary educators confirm) that the expectations placed on kids now in K-5 are way different than they were forty years ago. We expect children this age to be "self-regulating" and "self-directed" in ways that probably aren't really developmentally appropriate for about half of them.

DeeDee, I'm with you on this.

I'm a "non-medicator" (I could have written HowlerKarma's posts in this thread, I agree with them so strongly) BUT I feel like I'M judged for "not helping" DS for denying him meds.

The "why/why not" is a futile argument because each child is unique, and each decision made by parents is appropriate for their child ONLY. It is for this reason that I make an honest effort in supporting the people I know who medicate their kids. They know where I stand. My decision not to medicate my DS is not appropriate for my friend's 10 year old, or my other friend's 12 year old, etc etc.

There are so many things that factor into this decision that really shouldn't such as the media, peer pressure, guilt, stigma, overworked doctors who rush, school based teams with insufficient child specific information, etc.

My bottom line is that instinct is what guides me, for my DS8 only. I would never question the instinct of another parent who was guided down a different path, for their child.

Yes, I'll take that, too, while we are being unrealistic.

DeeDee

Zen Scanner, I agree with your post and your reading of the literature.

I still hate the piece about why French kids don't get ADHD because their parents feed them dinner on a schedule and spank them. Lordy.


I will say that I see medication being pushed as a first-line choice by doctors. This is consistent with the research, which shows that it's what dosctors say to do, regardless of the evidence that this isn't what should be tried first. I don't think PARENTS want to do it as a first-line defense, but doctors are often very, very insistent that it's necessary.

Oh, yes. To me, it isn't an MD versus psychologist issue, because both can be guilty of the same thing, which is, namely, failure to perform due diligence. My outrage at this sort of behavior stems from the fact that we both basically do the same thing for a living: troubleshoot complex systems. This is, incidentally, why I enjoy excellent health care personally... doctors and I share the same perspective and approach to the problem at hand.

If I did my job the way so many doctors do, the consequences would be the loss of a few billion dollars. No biggie. For them the stakes are much higher, and to see them failing so hard, so regularly, makes my blood boil. The problem is this: there are many doctors who are prescribing these meds based on a full evaluation and data-driven, evidence-based needs. And there are far more doctors who say, "I dunno... let's give this a try."

And... there are a great many parents who consent to medications as a last resort, and/or based on good information. There are a great many more parents who consent because an authority said so, and they don't know any better (critical thinking being a vanishing skill). There's also a significant subset of parents who view their child as a "thing", and anything unusual is a problem that must be diagnosed and treated... as opposed to, say, that the "problem" is that the kid is, in fact, a kid.

So yeah... lots of reasons to sympathize with the parents who are dealing with these things, and also reasons to be suspicious, too. This is why I tend to avoid the 2e section of this forum, because I'll likely read things that set off alarm bells on some of these behaviors, but honestly I'm in no position to judge based on a few paragraphs in a forum, and I don't want to offend.

It is clearly a great way to prevent ADHD, of course (which is why there isn't much of it in France to start with), but beware, if you are too structured, then your child develops autism. Because cold mothering.

Or so say the French psychoanalysts, who also happen to be running most of the French psychiatry system.

(and yes, it is always the mother)

This is actually a great sniff test for "research" validity. If that "Bringing up bebe" is mentioned in an article talking about anything except the trend of making a quick buck by playing on the anxieties of the modern American parent, you know it is going to be crap.

+1 on everything else on current trends, over-diagnosis, and medication/no medication.

p.s. One prop to the French study (in regards to scheduling) is the floating question of sleep related issues vs. ADHD. Another gifted challenge here is the increase in allergies amongst gifted and the relation of allergies to sleep apnea.

Forgot I had read this post a while ago:
http://well.blogs.nytimes.com/2012/04/16/attention-problems-may-be-sleep-related/

Thanks HK, appreciate the psychosis connection and support from your work in this arena. Anecdotally, it's easy to see as psychotic is an appropriate adjective before I get my first cup of coffee in the morning.

and props to mumofthree, the op article definitely fails a sniff test of authentic experience. Particularly that she just floated gifted through as if it was just another false diagnosis.

As I stated before, I am completely against spanking.

The majority of Americans spank, so I definitely don't think that is what is helping France's kids- that would be purely coincidental. However, food habits and sleeping habits make sense to play a part in a growing brain.

There IS a food/ADHD connection, backed by research. It's not as simple as "take out gluten," or something like that, but evidence suggests that many of these kids have food allergies or sensitivities and that figuring this out can help. Snacking, though? SNACKING causes ADHD? Snacking causes obesity, sure.

The sleep connection is certainly something to be concerned about. Do French kids get a lot of sleep? I don't know. I'm inclined to doubt it--Europeans tend to put their children to bed late, according to my European friends.

It appears that every study is attempting to find the "magic bullet" by indicating that if all children were the same and raised the same...we could avoid ADHD (in this case) or a host of other issues... it is the same thing we rage against in education...standardization, one size fits all "common core". Every person is from a unique place...from DNA, to Nature, to Nurture, to choices.....

I can't type more now, ill come back later, when i have time to type and to think about how much to share, but really I could have written that article. The passages that don't make sense to moomin make perfect sense to me...

And I think some of it comes down to having a fairly decently bahaved, very gifted girl child. She does not look like most people's idea of ADHD (including not looking in attentive because in a group scenario she's gifted enough not to need to have heard the teacher and well enough behaved to have looked like she was listening). But medication is quite literally a magic pill for her, with difference obvious to everyone. She herself was absolutely clear from the first day that she felt better, liked feeling better, wanted it to last.

But the judgement we face from school, teachers, family is constant and very very hard.

I feel like I have too much to say in on post and too much of it would require personal information that I don't want to share to make sense.

Ultramarina - diet absolutely is a factor, but it's way more complex than "just go gluten free", as you say. My DD with ADHD has LESS food issues than her sisters, but is GF/CF and additive free and it did help. Sleep is critical.

Moomin - how many of those kids you see with ADHD and put onto meds are gifted girls (possibly highly gifted girls) with primarily in-attentive type? Even when they are combined type (which my DD actually is) it doesn't look like combined type in a boy. Because honestly all of those quotes make PERFECT sense to me and they make perfect sense TOGETHER. My DD didn't get the chance to be diagnosed as having a disorder of written expression or dysgraphia, but she was on the path, she would have been.

Someone else commented about how it's almost always outgrown. It's not, increasingly it's becoming clear just how much it is NOT outgrown. The hyperactivity might be, but the inattention and impulse control, which are the more damaging are often ongoing.

Note also that I am in Australia - where ADHD can only be diagnosed and medication prescribed by a specialist, not the family Dr. Certainly misdiagnosis still happens sometimes, just like with other diseases, but statistically we are under diagnosing and under treating compared to international predicted incidence rates.

I agree with all of this, and especially the bolded. (not that I have any personal experience with near death by motor vehicle. ahem.)

Yes, yes, yes.

A.men.

So well said.

I was that girl. And I can say that I felt *more* myself on medication. I'm sorry you are being judged.

Thank you for telling me that, it means a lot. She IS more herself, more productive, more creative, more engaged. Medication is not perfect, it has issues, but we've tried taking her off (because it's so freaking hard to have your little girl on medication) and she asked every day for her medicine and it was so obvious all the ways she was better off.

My DS10 would also say that his medication helps him be his best self. He would much rather live without the extreme anxiety and the countless very serious behavior mistakes that anxiety led him to make.

DeeDee

FWIW, my DD at 17 also finally felt great on the meds... until they quit working (after only 3 months).

Neurofeedback changed her life for the better, permanently, in every way. New research is coming out daily to support Neurofeedback and it has been endorsed by the American Association of Pediatrics as level one support putting it on par with Ritalin in effectiveness for treating ADHD. Additionally it has been approved by the FDA for stress (anxiety). I have seen the results first hand and I highly recommend that anyone who is concerned about their child but hesitant to medicate look into it as a first line of treatment.

Nik we have plans to try neurofeedback, but its not easily accessible for us.

MumOfThree Google "Zengar neuroptimal". On their website they list trainers by location and some trainers offer rental units so you can do it at your convenience at home for a fraction of the price (Neuroptimal is the only system that I personally know of that is fool proof enough that I would recommend the at home route and I did a lot of research). If you are ever in Texas, look me up and I'll let you try mine for free

I'm actually in Australia... With very few, very expensive options in my state and more than one person with major health issues in the family, so we currently have neither the financial or time resources. But it's on the list.

a bit late on the reply, but if you get to that part of your list, these guys are in Australia and their rates look pretty reasonable:

http://www.neurowise.com.au/

I don't know if they rent machines but that would be the way to go if time and travel are issues (and it could help with dealing other major health issues)