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Hail the Tripod

Brave New World

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http://www.bbc.co.uk/news/health-23674235

There has been a 50% rise in the use of drugs for attention deficit hyperactivity disorder in six years.

Prescriptions for methylphenidate drugs, including Ritalin, rose from 420,000 in 2007 to 657,000 last year, the Care Quality Commission said.

Medicating children to make them compliant with your needs seems so wrong. I cannot ever imagine a situation where I would allow my kids to be drugged like this.

Reminds me of this:

8018411882_96ceeb3911_z.jpg

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Brave New World indeed. Create a new 'disorder' - a 'disorder' that is not so far removed from 'normal' behaviour (kids being 'naughty' or 'fidgety') and which some drug company just so happens to have a drug for (that also fills a social need for quick easy 'solutions') and bingo - all your kids are now medicated for their own good and a better society!

Thing is, there is no real test for ADHD, it's just opinion at the end of the day. Same for 'depression', which is why we have a massive problem with overprescription of SSRIs, many times for people who probably just need someone to talk to about their problems (or CBT for those with real psychological barriers that they need to overcome). GPs are a menace with prescribing hard drugs for things they don't really understand. And they're encouraged to do it. Shocking.

(apologies for the amount of inverted commas, but so much of the medical rationale is pure BS, imo)

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Thing is, there is no real test for ADHD, it's just opinion at the end of the day.

Having had our youngest diagnosed with ADHD, I'd have to disagree with that. There are fairly specific symptoms; and unlike (for example) SSRIs, the medications actually have a demonstrated track record of working. Plus they don't generally work with non-ADHD kids.

There is a fairly large amount of research in differences in brain function between ADHD and Neurotypical people as well.

I have variants on the symptoms myself - it's a genetic condition. There are aspects that are useful, not least hyperfocussing which is probably why I can write release-quality computer code at about 100x the industry average rate..

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Having had our youngest diagnosed with ADHD, I'd have to disagree with that. There are fairly specific symptoms; and unlike (for example) SSRIs, the medications actually have a demonstrated track record of working. Plus they don't generally work with non-ADHD kids.

There is a fairly large amount of research in differences in brain function between ADHD and Neurotypical people as well.

I have variants on the symptoms myself - it's a genetic condition. There are aspects that are useful, not least hyperfocussing which is probably why I can write release-quality computer code at about 100x the industry average rate..

A genetic condition the incidence of which has increased by 50% in the last 5 years???

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A genetic condition the incidence of which has increased by 50% in the last 5 years???

*Detected* incidence has increased. Some of that might be over-detection or under-detection in the past.

It's like autism. Diagnoses have increased rapidly in recent decades but could equally be down to recognition of the condition as autism rather than something else.

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A genetic condition the incidence of which has increased by 50% in the last 5 years???

Or for which we have better diagnostic criteria. Or is being over diagnosed and over treated. I'd also add that ADHD in Adults may well be contributing.

There has been a lot of research on behavioral vs chemical interventions, and the conclusions are basically that behavioral interventions are not very effective without the drugs; this combined with the fact that doctors are generally reluctant to prescribe to young children could be another reason.

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Having had our youngest diagnosed with ADHD, I'd have to disagree with that.

Fair enough. I should have really given the caveat that some people will inevitably benefit from these drugs, same way as I know people who feel they have benefitted from SSRIs. But what percentage is that, out of the total prescribed population? It is the way that these drugs are prescribed incautiously that I take issue with, rather than their effectiveness per se. Benzodiazepines are very effective as sleeping pills, but their widespread prescription led to all manner of problems. Same with many other drugs. GPs don't have the time, or even the expertise very often (imo, of course), to manage these drugs effectively, and better alternatives are often dismissed because they are more costly (which although perhaps an inescapable reality, doesn't mean that drugs are necessarily the best option).

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*Detected* incidence has increased. Some of that might be over-detection or under-detection in the past.

Or it may just be a spectrum of behaviours that do not suit our modern childcare arrangements and are now categorised as a disease, which is treatable with medication to make them more pliable. This medication is not without some quite serious side-effects. It is unclear what proportion of children are being medicated at any given time from that article but it is clearly growing at a phenomenal rate.

What proporttion of British children need to be medicated for a rather vague psychological disorder? I can accept an argument that in some rare instances this could be helpful as part of a therapy, but we're talking hundreds of thousands here. Plus it's concentrated in socio-economically disadvantaged areas: http://adc.bmj.com/content/97/Suppl_1/A62.1.abstract

Socioeconomic deprivation appears to be significantly associated with the prevalence of ADHD in children and adolescents living in the North West of England, as demonstrated by very high coefficients of correlation

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Fair enough. I should have really given the caveat that some people will inevitably benefit from these drugs, same way as I know people who feel they have benefitted from SSRIs. But what percentage is that, out of the total prescribed population? It is the way that these drugs are prescribed incautiously that I take issue with, rather than their effectiveness per se. Benzodiazepines are very effective as sleeping pills, but their widespread prescription led to all manner of problems. Same with many other drugs. GPs don't have the time, or even the expertise very often (imo, of course), to manage these drugs effectively, and better alternatives are often dismissed because they are more costly (which although perhaps an inescapable reality, doesn't mean that drugs are necessarily the best option).

Actually we had to see specialists, not GPs. They don't just hand them out..

I've had to look at this due to the effects.. personally, I'd be extremely reluctant to touch SSRIs, but things like Ritalin at least have the advantage of having short term effects, as in the effects last for perhaps 4-6 hours. Unlike SSRIs where the effects can take weeks either way.

There is a stigma in the whole issue, because there is a lot of lazy stereotyping around ADHD.

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Actually we had to see specialists, not GPs. They don't just hand them out..

I'll happily defer to your experience on this. My limited knowledge of ADHD and Ritalin stems from a research of relevant literature from about 2005/6, and much of it was from an American context. I think they probably are more pill happy there than here, and the 'specialists' in particular. But my point still stands: just because we can prescribe something that 'improves' the behaviour of children perceived to have ADD/ADHD, that doesn't mean it is unquestionably the right course of action. The point Hail The Tripod makes about these kids not fitting in easily with our modern childcare system is a serious point - I recall one peer reviewed paper I read had studied the prevalence of Ritalin use in the US in terms of pressures from teachers and other parents to 'control' hyperactive children or exclude them from class. Enter the magical pharma 'solution'...

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Just to add that I also recall the the pharmacology of Ritalin is very similar to cocaine (or is it speed?), and this seems to be born out by the fact that there seems to be a black market for it amongst young people. I'd be worried about giving it to my children for that reason alone.

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I'll happily defer to your experience on this. My limited knowledge of ADHD and Ritalin stems from a research of relevant literature from about 2005/6, and much of it was from an American context. I think they probably are more pill happy there than here, and the 'specialists' in particular. But my point still stands: just because we can prescribe something that 'improves' the behaviour of children perceived to have ADD/ADHD, that doesn't mean it is unquestionably the right course of action. The point Hail The Tripod makes about these kids not fitting in easily with our modern childcare system is a serious point - I recall one peer reviewed paper I read had studied the prevalence of Ritalin use in the US in terms of pressures from teachers and other parents to 'control' hyperactive children or exclude them from class. Enter the magical pharma 'solution'...

Well, given the prevalence, there's probably been some historic genetic selection for it. Someone has to be at the front of the charge into battle.. Impulsive, physically active, poor awareness of risk..

I can certainly agree that there is overprescription in the US, they have much greater commercial incentives. Although, of course, which proportion of the population is most likely to feel sufficiently restless and risk-taking to emigrate to a new continent? Yes, that sector with various levels of ADHD.. and there is a genetic component there as well. So you could speculate that the higher incidence in the US is real and based on a self-selecting population. That would be speculation, though.

It is more of a problem with our education system. Moreso with the huge emphasis on early literacy and numeracy nowadays - I couldn't believe it when my oldest first came home with homework, aged 6. I do think some of the upswing is just trying to teach kids 'academic' stuff well before they are ready.

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Well, given the prevalence, there's probably been some historic genetic selection for it. Someone has to be at the front of the charge into battle.. Impulsive, physically active, poor awareness of risk..

That's a fascinating notion! But it echos my concerns that we're choosing to medicate for psychological traits that are well within the 'normal' spectrum of what it is to be human. Not everyone is naturally attentive in school, and then it becomes a philosophical question of whether we all should be.

I certainly remember those kids who were constantly jiggling their legs and staring out of the window, eager for the bell to sound so that they could run around the playground. But at the end of the day, that's some kids for you. My rhetorical question is whether we all now live in a Brave New World where such normal human traits are to be 'treated', and who exactly is this good for? Is it purely in the interests of the child in question, or is it to make teaching/parenting/socialising easier and more convenient.

This is in no way to be taken as a judgemental attitude towards any parent who consents to their child being prescribed these drugs - like I say, I do understand that they can probably seem to be wonderfully beneficial in some children.

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*Detected* incidence has increased. Some of that might be over-detection or under-detection in the past.

It's like autism. Diagnoses have increased rapidly in recent decades but could equally be down to recognition of the condition as autism rather than something else.

Yeah, I suspect ADHD used to be diagnosed as "needs a good hiding".

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That's a fascinating notion! But it echos my concerns that we're choosing to medicate for psychological traits that are well within the 'normal' spectrum of what it is to be human. Not everyone is naturally attentive in school, and then it becomes a philosophical question of whether we all should be.

I certainly remember those kids who were constantly jiggling their legs and staring out of the window, eager for the bell to sound so that they could run around the playground. But at the end of the day, that's some kids for you. My rhetorical question is whether we all now live in a Brave New World where such normal human traits are to be 'treated', and who exactly is this good for? Is it purely in the interests of the child in question, or is it to make teaching/parenting/socialising easier and more convenient.

This is in no way to be taken as a judgemental attitude towards any parent who consents to their child being prescribed these drugs - like I say, I do understand that they can probably seem to be wonderfully beneficial in some children.

Exactly, there undoubtedly are extreme cases where ADHD becomes a true handicap and these medications may assist in coping while more comprehensive behavioural therapies are being worked on with the child. But when your looking at literally hundreds of thousands of predominantly poor kids it does start to look very much like it is ALSO being used to quickly and cheaply deal with just vanilla difficult kids.

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Exactly, there undoubtedly are extreme cases where ADHD becomes a true handicap and these medications may assist in coping while more comprehensive behavioural therapies are being worked on with the child. But when your looking at literally hundreds of thousands of predominantly poor kids it does start to look very much like it is ALSO being used to quickly and cheaply deal with just vanilla difficult kids.

The problem is that ADHD runs in families and tends to result in lower lifetime earnings. Which would mean a concentration in poorer kids to start with. Add this to the basic problem that poorer families are on average going to have less ability to cope with an ADHD child and you might have an answer.

If you have some evidence that ADHD medications are being routinely prescribed by GPs with minimal consultation (which is the complete opposite of my personal experience, but there you go) can you show us?

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The problem is that ADHD runs in families and tends to result in lower lifetime earnings. Which would mean a concentration in poorer kids to start with. Add this to the basic problem that poorer families are on average going to have less ability to cope with an ADHD child and you might have an answer.

It's a perfectly possible explanation. ADHD is a natural self-selector for americans and people living in deprived areas.

If you have some evidence that ADHD medications are being routinely prescribed by GPs with minimal consultation (which is the complete opposite of my personal experience, but there you go) can you show us?

No, obviously not. I do know a perfectly normal boy who was on Ritalin for a year and a half because he was diagnosed with ADHD (however that was in HongKong).

If the number of diagnoses shifts by 50% in 5 years, there are a number of explanations:

1. It was previously very underdiagnosed.

2. People with ADHD genes are breeding like crazy, relative to the rest of the populace.

3. Some environmental factors are causing it to manifest more.

4. The range of behaviours determined to conform to ADHD has widened.

5. The use of medication as opposed to other treatments has increased.

1 and 4 may just be the same thing expressed differently according to personal bias. I rather suspect all of these play a part although to what expent I have no clue.

Some articles are now suggesting the prevalence is 7% of the populace.

In a similar vein, depression medication has quadrupled in the last 20 years and continues to increase. "The Office for National Statistics analysis showed that doctors in England issued 39.1 million prescriptions for anti-depressant drugs such as Prozac in 2009"

Our population seems to either be increasingly mentally unwell, or increasingly resorting to drugs to cope with being mentally unwell in extraordinary numbers. Either way I find it extremely troubling.

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Yeah, I suspect ADHD used to be diagnosed as "needs a good hiding".

It likely was substantially misdiagnosed in this way. These people would have ended up in borstal, or eventually turned to criminality.

However, ADHD is unquestionably different to, and can be clearly distinguished from, bad behaviour. A lot of people are lazy and don't look for the difference, or they lack the understanding that there might be a difference. This is frequently the case even in people who should know better, such as teachers.

I studied under a prof of child psychiatry for a while, whose specialist expertise was in ADHD. He used to tell me all sorts of stories, about how teachers might have told parents not to bring their child back to school "until they were on Ritalin", when the diagnosis was something different (in one case, partial deafness, and the behaviour problem was solved by hearing aids).

One day, he had 2 appointments for ADHD assessments, and I accompanied him for these. The first was a 7 year old where there were some concerns over progress in school, and the parents had had conflicting opinions from various members of school staff. The second was a pair of 6 year old twins who had both been excluded from school. The first young lad, to my eye, seemed to behave quite well; a little erratic, but who isn't at that age. The twins, however, might as well have been possessed by demons; shouting, screaming, throwing toys everywhere, tipping up the furniture and generally refusing to do anything.

We had a gap for a conference between the various staff members who had performed the assessments, prior to bringing the families back in and telling them the results. The prof pointed out where I had gone wrong. The first lad had severe ADHD; he was only behaving because of the skill and constant attention of the nurse that was supervising his play. He couldn't finish even the most simple game, and would be distracted by anything and everything. He would do things when told, but wouldn't finish, except without huge amounts of prompting and chivvying. The twins, however, were just disobedient and "naughty". If you could find something that interested them, they would do it and they would finish it. However, they seemed to enjoy making a nuisance as it got attention from the parents and teachers.

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It likely was substantially misdiagnosed in this way. These people would have ended up in borstal, or eventually turned to criminality.

However, ADHD is unquestionably different to, and can be clearly distinguished from, bad behaviour. A lot of people are lazy and don't look for the difference, or they lack the understanding that there might be a difference. This is frequently the case even in people who should know better, such as teachers.

Sir Ken Robinson in his talk Changing Education Paradigms thinks that ADHD seems to be grossly over diagnosed. Although in his US centric discourse he may have uncovered an epidemiological cause worthy of further investigation.

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The problem is that ADHD runs in families and tends to result in lower lifetime earnings. Which would mean a concentration in poorer kids to start with. Add this to the basic problem that poorer families are on average going to have less ability to cope with an ADHD child and you might have an answer.

If you have some evidence that ADHD medications are being routinely prescribed by GPs with minimal consultation (which is the complete opposite of my personal experience, but there you go) can you show us?

Has anyone ever looked at a link between IQ and ADHD? Low IQ is also associated with low lifetime earnings and has resulted in a concentration of low IQ amongst the poor.

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This is another of those things that seems to result in an irreconcilable dichotomy of opinions.

1) It's outrageous that we're mass medicating children in this way; and

2) We have to stop those cheating students getting their hands on it, because it gives them an unfair advantage.

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I was looking at Autism a while back, and one paper has stuck in my mind. Autism isn't a clearly defined condition, where you either have it or you don't, but you basically lie somewhere on the Autism spectrum. The authors of the paper found that your diagnosis for Autism was determined by how much money the health authority had allocated to treating Autism. If they had a small allocation, then you had to be a long way down the spectrum to be diagnosed as autistic, where as if they had a large budge for treatment, then you only had to be a small way down the spectrum. The conclusion was that the diagnosis followed the money, rather than the other way round.

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It's a perfectly possible explanation. ADHD is a natural self-selector for americans and people living in deprived areas.

No, obviously not. I do know a perfectly normal boy who was on Ritalin for a year and a half because he was diagnosed with ADHD (however that was in HongKong).

If the number of diagnoses shifts by 50% in 5 years, there are a number of explanations:

1. It was previously very underdiagnosed.

2. People with ADHD genes are breeding like crazy, relative to the rest of the populace.

3. Some environmental factors are causing it to manifest more.

4. The range of behaviours determined to conform to ADHD has widened.

5. The use of medication as opposed to other treatments has increased.

1 and 4 may just be the same thing expressed differently according to personal bias. I rather suspect all of these play a part although to what expent I have no clue.

Some articles are now suggesting the prevalence is 7% of the populace.

I would select 1, 3, 4 and 5.

1/4 -Diagnosis is more rigourous these days - and it's worth pointing out that some general categories of learning difficulties have been dropping as a result; a similar thing has been happening with ASD.

As far as 3.. well, as above I've pointed out that contrary to what the papers would have us believe, academic expectations on kids, especially younger kids, are much higher nowadays. And that's a real problem for ADHD, because the younger kids with ADHD have far more problems with sitting still and learning. Goodness knows how he'll be next year when they start spelling tests.. (age 6!)

5 - You have to realize that Doctors are instinctively reluctant to hand out psychoactive drugs for 6 year olds. On the other hand, there is a lot of research showing that drugs+behaviour management works 'best' - as in long term educational outcomes, mental health, socialisation etc.

Finally.. it has to be said that Ritalin does not improve the behavior of non-ADHD kids, it's certainly not a sedative. Plus it's been around and used since the 1950s, which at the very least means there is a lot of data on safety and effectiveness, and because it's fast/short term acting, you can even just use it for schooldays and not at weekends.

In a similar vein, depression medication has quadrupled in the last 20 years and continues to increase. "The Office for National Statistics analysis showed that doctors in England issued 39.1 million prescriptions for anti-depressant drugs such as Prozac in 2009"

Our population seems to either be increasingly mentally unwell, or increasingly resorting to drugs to cope with being mentally unwell in extraordinary numbers. Either way I find it extremely troubling.

We live in an age when people are working long hours, bombarded with illustrations of a lifestyle that is basically unattainable, financially insecure, separated from friends and family and fed on a constant diet of media scare stories. The surprising thing is that we are not all on antidepressants..

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This is another of those things that seems to result in an irreconcilable dichotomy of opinions.

1) It's outrageous that we're mass medicating children in this way; and

2) We have to stop those cheating students getting their hands on it, because it gives them an unfair advantage.

The google term for (2) is 'Modafinil' / ProVigil

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Americans are more medicated than the rest of the world and less healthy too.

I wonder which came first.

Sometimes i think its just doctors and pharma getting rich at peoples expense. Of course, that would never happen here...

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