Chris Phillips
Professor Daniel Wesley
English Composition II 1302-062
10 December 2012
ADD/ADHD: A Proposal
I’m hesitant to write about ADD/ADHD. It just seems like two-faced ground. Judging by the comments I’ve read online, in magazines, and my own experience, expressing an opinion about this identification or anything dealing in child psychiatry will be met with censure from both sides. I was reading an article “Ritalin Gone Wild” in the New York Times, and I felt obliged to write.
If you have not read “Ritalin Gone Wild”, I persuade you to do so. In my opinion, I agree with the article except for the mention about “children born into poverty therefore [being] more vulnerable to behavior problems”.
Unsurprisingly, the article has fascinated many online detectors. Let us check out this response from the NYT, accusing Dr Sroufe for “blaming parents” for ADD/ADHD. When I read the original article, Dr Sroufe did not do that. Instead, he noted that ADD/ADHD symptoms may not or at all come from a congenital neurological defect or “chemical imbalance”, but that ecological influences may be more significant. He also says that, ADD/ADHD drugs do work; children and adults do perform better on meds, but the successes do fail over time, perhaps a drug answer does not change ecological situation in the first place.
I could not agree more. I think this statement is true for much of what is treated in psychiatry; it is predominantly related to children and adolescents. Children are exposed to a vast amount of influences as they try to traverse their way in the world, not to mention that their brains and bodies mature quickly and are highly susceptible. Ecological influences are boundless.
I have a radical proposal which may never, be implemented, but which might help solve the troubles raised by the NYT article.
First you will notice that I refer to ADD/ADHD signs and symptoms and not ADD/ADHD itself. This is a critical difference. With anything else in psychiatry, diagnosing ADD/ADHD relies on records of signs and symptoms. ADD/ADHD-like signs and symptoms are exceedingly common, particularly in children. The official ADD/ADHD analytical criteria from the DSM-IV, click here. To be sure, an identification of ADD/ADHD requires that these signs and symptoms must be appropriate adjustment to the environment or situation and inconsistent with developmental level. When you ask the right number of questions in the right order you can make a diagnosis from about any child with ADD/ADHD. That’s not entirely a hard thing to do. Try it! Look at the criteria, and think of a child in your office who you know that is doing poorly in class or school, gets in fights, refuses to do homework, and daydreams in class. When the ADD/ADHD criteria are on your mind you have to act like a psychiatrist. You are likely to ask these kinds of questions, and I promise you’ll get positive answers.
That’s an awful way of making identification, but it is what happens in psychiatrists’ and pediatricians’ offices every day. There are more “legitimate” ways to diagnose ADD/ADHD: rating scales like the Vanderbilt or Connors surveys, a wide range neuropsychiatric assessments, or luxurious imaging tests. In practices, they often let sub standard scores on the surveys “slide” and prescribe ADD/ADHD medications. There are plenty of neuropsychiatric assessments that are often indecisive; and, as Dr Sroufe points out, children with poor inspiration or immature capacity to regulate their behavior will most likely have an anomalous brain scan. It does not mean they have a problem or a disorder. My proposal is to throw away the diagnosis of ADHD in general
First, if you get rid of the diagnosis of ADHD, you can still do what you’ve been doing. You can still assess children with attention or concentration issues, or hyperactive problems, and you can still use stimulant medicine to provide relief as long as you’ve obtained the same informed permission that you have done all along. Doctors do this all the time in practicing medicine. If you complain of constant toe pain, you don’t get diagnosed with gout at first; instead, you might get a focused physical exam of both feet and then be recommending a trial of Non-steroidal anti-inflammatory drugs (NSAIDs). So if the pain returns, or doesn’t get better, or you have other symptoms associated with gout, The Doctor may check uric acid levels, or do a synovial fluid analysis, or prescribe Allopurinol sodium.
That what medicine is all about: A Doctor see symptoms that propose a diagnosis, and they provide involvement to help ease the symptoms while paying close attention to the natural flow of the illness, correcting the diagnosis over time, and repeatedly modifying the therapy to treat the primary diagnosis and/or eradicating the risk factors. With the ultimate goal to minimize dangerous and, or expensive interventions and to achieve some degree of important recovery.
This is exactly what Doctors don’t do in most cases of ADD/ADHD, or in psychiatry. Whereas exceptions certainly exist, often the diagnosis of ADD/ADHD and the treatment in most cases, work surprisingly well. Is that the end of the story? Children get diagnosed, children take medication, children do better with other children in school, and the parents are content, everyone’s happy. What were causes of the symptoms in the first place? Can it be fixed or should it be fixed? When can the treatment be stopped or should it be stopped? How can we prevent long-term harmful effects from the medication?
On the other hand, if they don’t make a diagnosis of ADD/ADHD, but in its place document that the child has “focusing” or “attention” or “hyperactivity” problems then it bestowed on us to continue looking for the causes of the symptoms. For some children, it could be a disordered home atmosphere. For some, it could be from neglect, or substance abuse. For other children, it could be the parenting style or a relation which is not ideal for a child’s social or genetic makeup. I don’t want to write “poor parenting skills” because then I’ll get hate mail. For other children there may be a genetic abnormality maybe a smaller dorsolateral prefrontal cortex or delayed brain maturation.
ADD/ADHD offers an exclusive stage upon which to try this unbiased, non-DSM-based approach. Getting rid of the diagnosis of “ADD/ADHD” would have a number of advantages. It would persuade doctors to search more intensely for root causes; it would allow doctors to be more diverse in their treatment; it would put a stop to all from using it as a label or as an “excuse” for a child’s behavior; and it would force us to give truly special individual care. There will be the parents and doctors who ask for the psycho-stimulants because they work for their children with the symptoms of inattention or distractibility. For the ones who deliberately fake the signs and symptoms because they want to abuse the stimulant or because they want to get ahead in College, but that’s already happening! This proposal would create a flood of “false negative” ADD/ADHD diagnoses, but it would also reduce the “false positives,” that are more damaging to Nosology a field that is already shaky.
An approach like this should and could be comprehensive to other conditions in psychiatry. I do believe that some of “ADD/ADHD” is truly a disorder and perhaps ADD/ADHD has multiple disorders wrapped in one, and the same is most likely true with bipolar disorders I, II, and III, clinical depression and other disorders. But when the labels are used haphazardly and DSM-5 doesn’t look to offer any help in the matter, the diagnoses becomes predetermined labels and bar us into an approach that may completely miss the point, at worst, cause noteworthy harm. Maybe Parents and Doctors should rethink this.

Works Cited
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Bremner, Doug. "New Questionable Diagnoses on the Horizon from the DSM-5 Committee." Before You Take That Pill. Before You Take That Pill, 8 Nov. 2011. Web. 8 Dec. 2012.
DELL'ANTONIA, KJ. "If Ritalin Has ‘Gone Wrong,’ What’s the Right Way to Cope?" Motherlode If Ritalin Has Gone Wrong Whats the Right Way to Cope Comments. The New York Times, 30 Jan. 2012. Web. 12 Dec. 2012.
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