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Tag search results for: "attention deficit hyperactivity disorder"
Statistics show that gender, race, geography, insurance, and income are the greatest risk factors that determine the likelihood that your child will be diagnosed with ADHD.

13.7% of boys in the U.S. are diagnosed with ADHD versus 5.9% of girls in the U.S.

11.5% of Native American children in the U.S. are diagnosed with ADHD versus 2.5% of Asian children in the U.S.

18.7% of kids in Kentucky have been diagnosed with ADHD versus 5.6% of kids in Nevada.

13.1% of children on Medicaid are diagnosed with ADHD versus 8.4% of children on private insurance versus 6.2% of children with no insurance.

13.1% of children whose family income is below the poverty threshold are diagnosed with ADHD versus 8.9% of children whose family income is 200-399% above the poverty threshold.

Still think ADHD is a disorder stemming from a chemical imbalance in the brain?

 

Testimony of Patti Johnson
Colorado State Board of Education member
2nd Congressional District
before the
U.S. House of Representatives
Subcommittee on Oversight and Investigations hearing entitled
"Behavioral Drugs in Schools: Questions and Concerns"

September 29, 2000


I have been a member of the Colorado State Board of Education for the last six years. One of my platforms when I ran for office was to empower parents in their right to direct the upbringing and education of their children.


Over the years I was contacted by a number of parents who had been pressured to put their children on various psychotropic drugs for a variety of so-called learning disorders, the most common of which was Attention Deficit Hyperactivity Disorder (ADHD). In some cases they were told their child would not be allowed to attend school if he did not begin taking psychotropic drugs.


One parent who was given the option of placing her son on a stimulant drug or removing him from school elected to home school her son. She told me that it just didn’t make sense that a straight A student would be labeled "learning disabled." A Douglas County parent I spoke with said she was told her son had ADHD. What she was being told about the behavior her son supposedly exhibited and what she observed were not consistent. She investigated the matter and the school’s special education director eventually admitted that she had coaxed the teacher to answer the questions of the checklist used to determine if the child had ADHD in a certain manner so her son "would get the help he needed." This infuriated her so badly she removed her son from the school.


A Jefferson County parent who contacted me said he at first complied with the school’s direction to have his son take a stimulant drug. The drug caused his son to become violent, he began taking steak knives out of the kitchen and stabbing his stuffed animals. When the parent took him off the drug, the principal of the school began pressuring him to resume the stimulant -- so much pressure that the matter is now in court and the father could forfeit parental rights if he disagrees with the decision of the court on whether or not to place his child on Ritalin. Many more examples exist.


When I investigated the issue I realized that the so-called psychiatric learning disorders are an effort to "medicalize" failures in instruction and discipline at the expense of the child’s well being and the rights of the parent. Some of the learning disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) illustrate this point.


For example, the fourth edition lists number "315.1, Mathematics Disorder." The diagnostic criteria for this is "Mathematical ability, as measured by individually administered standardized tests, is substantially below that expected given the person’s chronological age, measured intelligence, and age-appropriate education." Likewise, the diagnostic criteria for "315.2, Disorder of Written Expression" labels the child with this disorder if he scores low on written tests.


The label of ADHD is assigned if the child exhibits such symptoms as not listening when spoken to, is forgetful, fails to finish homework, fidgets, talks excessively, etc. -- the typical behavior of a normal child. Parents of children said to have these disorders are generally told that it is a neurological disorder or a chemical imbalance in the brain. Yet, at a Consensus Development Panel conducted by the National Institutes of Health on ADHD in November 1998, it was reported that "We do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction. Further research to establish the validity of the disorder continues to be a problem. This is not unique to ADHD, but applies as well to most psychiatric disorders..."


Educators are not allowed by law to practice medicine. Yet, the adjudication a child has one of these "disorders" and should be placed on "medication" and into special education is often done by a team which includes the parent, a teacher, a social worker, a special education teacher and the principal. The above factors led me to introduce a resolution before the Colorado State Board of Education entitled "Promoting the use of academic solutions to resolve problems with behavior, attention and learning." It reminded educators that their role was to teach and urged them to refrain from advising parents on medical matters. This was passed by a vote of 6 to 1 by the Board in November 1999.


Unfortunately, financial incentives exist for schools to label children with learning disorders. Understanding these incentives requires a brief review of the laws that affect special education.


The legislation which is now the Individuals With Disabilities Education Act (IDEA) was originally the Education for all Handicapped Children Act of 1975. The intent of this legislation was to ensure that children with actual physical handicaps -- sight impairment, hearing loss, etc. -- were given the public education they are entitled to.


This law was reauthorized in 1990 and the name changed to the Individuals with Disabilities Education Act. There were few procedural changes but the term "handicapped" was changed to "disabilities." The following year a memo was issued by the US Dept. of Education Office of Special Education and Rehabilitative Services which stated a child could qualify for special education if he was determined to have ADHD.


At this time, the IDEA legislation provided schools with an additional $400 per year for each child in special education. There followed a dramatic spike in the amount of methylphenidate consumed in the US. According to the DEA, the production and use of methylphenidate increased almost 6 fold between 1990 and 1995.


In IDEA as passed in 1999, the impairment category of "emotional disturbance." is defined in part to say the child has "An inability to learn that can not be explained by intellectual, sensory, or health factors." There is no mention of the fact that this may be due to a failure to instruct properly.


In December 1999, the Los Angeles Times reported that tens of thousands of California’s special education students were placed there not because they have a serious mental or emotional handicap, but because they were never taught to read properly. Reid Lyon, head of the federal government’s research efforts into reading and writing told the Times, "It’s where children who weren’t taught well go in many cases."


The intent of the original law, the Education for all Handicapped Children Act of 1975, was to ensure those with physical disabilities received a free and appropriate public education. These children are now being shortchanged because such a large percentage of special education funds are being diverted to vague psychiatric diagnoses. In 1998, 51.1 percent of special education children were in the category of "specific learning disabilities." These are the psychiatric diagnoses such as Mathematics Disorder, Disorder of Written expression and ADHD. Other disability categories also include psychiatric diagnoses.


IDEA legislation also contains a "child find" provision which requires states to actively seek out any children who may qualify for special education in order to receive federal special education funds. The child find program starts at birth in Colorado. This, of course, serves to push up the numbers of children labeled with ADHD.


The so-called learning disorders have, sadly, become a way for financially strapped schools to make ends meet. In many states, schools have become authorized Medicaid providers and funds can be collected in behalf of a child labeled with one of the learning or behavior disorders. This can be such a lucrative cash cow that in a letter dated October 8, 1996, the Illinois State Board of Education strongly encouraged the superintendent of one of its districts to participate in Medicaid incentives. The letter stated that Illinois had received $72,500,000 in federal Medicaid money in 1996 and that Medicaid dollars have been used for a variety of non-medical purposes and that "the potential for the dollars is limitless."


To assist schools in identifying children to label with "learning disorders," a number of checklists are made available to schools through the ERIC (Educational Resource and Information Center) database, which is a federal clearing house for educational materials. Yet, despite the expense created by such actions, these children are not receiving the education they are entitled to. Though the standards set for special education children are often lower, their graduation rate in the 1995 -1996 year was only 28.9 percent!


To the degree educators are expected to diagnose children, they are being distracted from their main duty which is to provide our children a quality education. Our schools are the only institution entrusted to attend to the academic needs of our children and their mission must not be diluted. I urge this committee to do everything in its power to get schools out of the business of labeling children and back to the job of teaching.


Thank you.


Patti Johnson
Colorado State Board of Education
Second Congressional District

Myths # 1-7: ADHD Drugs Improve Academic Performance (1) and Social Relationships (2); Reduce Depression (3), Substance Abuse (4), and Driving Accidents (5); and Promote More Stability in Employment (6) and Extra-Curricular Activities (7)

Mallinckrodt Methylin patient brochure: "Without diagnosis and proper management, ADHD can have devastating consequences, including failure in school, depression, violent behavior, substance abuse, relationship problems, and failure to keep a job."

FDA Response: "While the presentation excerpted above does not directly assert that Methylin will correct the problems of untreated ADHD, it is nevertheless misleading because it implies, in the context of the piece as a whole, that Methylin may reduce the likelihood or severity of the consequences of untreated ADHD listed above (i.e., poor academic performance, poor social-emotional development, violent behavior, substance abuse, and employment problems) when this has not been demonstrated by substantial evidence or substantial clinical experience. While Methylin is approved for the treatment of attention deficit disorders based on a demonstration of bioequivalence with the reference listed drug (RitalinCI (methylphenidate hydrochloride)), we are not aware of substantial evidence or substantial clinical experience demonstrating a positive effect of treatment with Methylin (or of treatment with the reference listed drug) on the outcomes listed above (i.e., academic performance, depression, violent behavior, substance abuse, and stable employment). If you have such data, please submit them to FDA for review."

Novartis Focalin XR web page: "Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), if untreated, are at risk for poor academic performance. Teen pregnancy, problems with peers, car accidents, and physical injuries occur at a higher rate. Untreated, children and teens with ADHD are also at risk of conduct disorders, delinquency, and drug or alcohol abuse. Typically, adults with untreated ADHD experience academic hardships. These often start in childhood and are likely to worsen during college years. Untreated adults take longer to complete learning degrees. They are likely to have lower economic status, lower rates of employment, and more work-related problems. Untreated adults also have more problems in their relationships, more driving accidents, and more addiction—from alcohol to gambling. Living with ADHD doesn't have to be this way. People with ADHD have treatment choices. The results of untreated ADHD are serious and should not be ignored. There is no cure for ADHD. Proper treatment can help control symptoms, helping to reduce these risks."

FDA Response: "While these presentations do not directly assert that Focalin XR will correct the problems of untreated ADHD or lead to the hoped for outcomes, they are misleading nonetheless because the only sensible interpretation of placing the consequences of untreated ADHD in pieces promoting the use of Focalin XR for ADHD is to imply that Focalin XR may reduce the likelihood or severity of the consequences of untreated ADHD listed above (i.e., poor social–emotional development and job success, poor academic performance, impaired driving, smoking and substance abuse) and induce the desired treatment outcomes when this has not been demonstrated by substantial evidence or substantial clinical experience... While Focalin XR is indicated for the treatment of ADHD, FDA is not aware of substantial evidence or substantial clinical experience demonstrating that Focalin XR can help patients avoid these consequences."

Johnson & Johnson Concerta professional convention panel: "CONCERTA® helps children improve academic performance throughout the day."

FDA Response: "This presentation is misleading because it implies that use of Concerta will lead to an improvement in academic performance throughout the day when this has not been shown by substantial evidence or substantial clinical experience."

Johnson & Johnson Concerta web page: "Adolescence is a time of greater independence and responsibility. For most teens, the after-school hours are filled with plenty of activities, including: sports, clubs, part-time jobs, socializing with friends, household chores, and, of course, homework. ADHD can have an impact on all of these activities, so you want to be sure your teen's medication is doing its job. CONCERTA® provides consistent symptom management throughout the day, for up to 12 hours, helping your teen focus and manage behavior. This may benefit your teen's ability to socialize with family and friends, and pursue interests and hobbies outside of school. You also won’t have to worry about whether your teen needs another dose of medication, because a single dose in the morning is all it takes. As a parent, you naturally want your teen to do well in all areas of his or her daily life. With once-daily CONCERTA®, you can be confident that symptoms are being managed no matter what he or she is doing."

FDA Response: "This presentation is misleading because it asserts improvement with Concerta in a broad array of adolescent after school activities, such as athletics, clubs, and performance in part-time jobs, when this has not been demonstrated by substantial evidence. While Concerta has been shown to improve total scores on the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS), which measures ADHD symptoms such as fidgeting, not listening, and talking excessively, what has not been shown is that this improvement in ADHD-RS total scores is correlated with a positive effect on adolescents’ ability to pursue interests and hobbies outside of school and to do 'well in all areas of [their] daily life.'"

Myth # 8: People Treated With ADHD Drugs Are Less Likely To Commit Suicide

BMJ study: "At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44)."

Myth # 9: ADHD is genetic, or neurobiologic, or caused by a chemical imbalance in the brain.

WHO study: "An average of 50% of children with ADHD (range: 32.8%–84.1% across countries) continued to meet DSM-IV criteria for ADHD as adults."

If ADHD is genetic, neurobiological or due to a hard-wired chemical imbalance in the brain, then why do half of children diagnosed with ADHD outgrow it by the time they reach adulthood? Can you outgrow Down syndrome? Cerebral Palsy?

Myth # 10: Only ADHD Drugs Reduce ADHD Symptoms.

Journal of Developmental and Behavioral Pediatrics
study: "One meta-analytic review of the effects of stimulant medication on ADHD children found an average effect size of 0.32 for response to administration of a placebo, indicating that there was approximately 30% improvement in children with ADHD who were given a placebo compared with children with ADHD who were given nothing, although results across studies were highly variable. Several other independently conducted reviews of stimulant medication for children with ADHD also report that the average rate of positive response to placebos ranges from about 20% to 30%."

What? A sugar pill will improve ADHD symptoms by 30%? Without the dangerous side effects?

How can that be?  The study goes on to explain...

"Evidence suggests that parents and teachers tend to evaluate children with ADHD more positively when they believe the child has been administered stimulant medication and they tend to attribute positive changes to medication even when medication has not actually been administered."

The study reveals the fatal flaw with diagnosing ADHD in the first place and when measuring the effects of stimulant medication on ADHD symptoms, namely that it's all in the eye of the beholder, ie. subjective... 

"The fact that subjective measures are the most widely used measures of treatment response in children with ADHD argues for the need to better understand how medication expectancies influence these measures and argues for the need to design trials that can accurately assess the direct pharmacologic effects separately from placebo effects."

NIMH 3-year follow-up study and 8-year follow-up study find that ADHD medication is no more effective than non-medication therapy.