ADHD—Conceptions and Misconceptions, some additional thoughts

In my previous article I gave an overview of the diagnosis and treatment of ADHD. There remain some ideas I want to stress, and some excerpts that need to be clarified:

An astute reader who is a researcher in ADHD pointed out that SPECT (which I also spelled incorrectly on one or two occasions) is not (yet) in common use nor is it yet commonly accepted by all clinicians treating ADHD. She therefore was critical of my reference to it as a “major tool.”

The term “major tool” is ambiguous, so let me clarify: It has, among those who are familiar with its use, a significant place in their stock of useful tools. As a tool it can play a distinct place, should other coincident problems in the brain, be suspected, in addition to the fact that it can demonstrate the changes and areas of blood flow characteristic of ADHD. Also, as a tool, brain scans[i] not usually critical to the initial diagnosis of ADHD. Diagnosis, as I have said, is based upon interview and psychometric testing.

Every major development in medicine was initially received with skepticism. One satirist said that a new idea goes through four stages: First, it is ignored. Second, it is ridiculed. Third, it is attacked. Fourth, after it is well accepted, it is regarded as common knowledge and not worthy of additional comment.

Every day in my programmed searches I find an article that proposes some “natural” or “non-drug” remedy for ADHD. Invariably, no research is quoted that would prove it useful. Also invariably, some coincident attack is made on the medical treatment and on the integrity or motives of those of us who support the proven methods of treatment.

Before I comment on the drug companies, I want to address this issue of “natural” or “holistic” treatment for illnesses:

There is an understandable and intuitive reason in which the hope for natural remedies makes perfect sense. It seems—and it is—inherently artificial to treat the human body with substances foreign to it, particularly when they have side effects. Unfortunately however, the fact remains that ever since “The Fall” and our expulsion from The Garden of Eden, we have been obliged to live by “the sweat of…(our)…brow.” Such things as artificially fashioned medicines and the use of surgery have been our earned curse, and turning on and attacking one another will do nothing to alter that tragic fact.

The “drug companies” are typically targeted. They are accused of either creating illnesses such as ADHD—often in collusion with the medical profession—in these nefarious efforts.

I have no inherent love for drug companies, and I would be the first to condemn the recent spate of advertisements that appeals to the innocent patient public to pressure their doctors to prescribe such-and-such a medication. Despite these facts, the companies are in a marketplace for sales; and if their product does not do what it purports to do, the product will not sell. Moreover, should there be significant side effects from the use of a particular product, the companies risk terrible financial liability and worse. There are abundant examples of this.

The medications used in ADHD and allied disorders have been around for a longer time than ADHD has been recognized. That means that they were proven to do the job in other illnesses, and without a high incidence of side effects—before ADHD was even recognized.

Here’s a proposed form letter you might consider sending to those who advocate other methods of treatment:

Dear (Sir/Madam)

I am interested in knowing more about your proposed treatment for ADHD. In addition to any material you would provide, I have a few questions:

1) What is the research and statistics that proves the efficacy of your treatment?

2) Do you have head-to-head studies that prove the efficacy of your treatment equal to—or better than—conventional medical treatment?

3) As you know, there are standard tests, which demonstrate untreated ADHD. Do you do both initial and follow-up testing to see the results of your treatment?

4) Mindful of the fact that delays in seeking treatment can cause considerable damage, what responsibility can you commit to should your treatment fail? (This would only be asked if the party receiving your questions advises against any medication while using their proposed treatment.)”

A word about EMDR and the Dore treatment:

EMDR has been used in a variety of disorders, and is based upon the empirical assertion that by directing eye-movements in a specific manner, certain mental and other disorders can be significantly treated. One researcher recently contacted me and said that it has had a beneficial effect in prisoners. I do not know what his data shows, but, if this were true, it would be a reason to do studies to see if, in fact, it were the ADHD cases that were responding.

DORE is a treatment based upon a unique way of re-training the cerebellum. At the DORE site online, it is described as “individually prescribed eye, balance, and sensory exercises to stimulate the cerebellum.” Evidence suggests it may prove to be a significant tool. The effects are allegedly permanent. It is expensive, costing in the range of $4000. It has been recommended by respected ADHD pioneers, but not as a replacement for medication.

A word of caution is in order, however: There are testimonials from parents who say that these children going through the DORE program are no longer in need of medication. For this to be taken at face value, it has to be asserted by the treating institution and based upon standard tests. Without follow-up measurement (testing) one cannot say this, because although overt behavior may initially appear to be improved, the manifestations of untreated or inadequately treated ADHD can be missed, and therefore the long-term effects can be permanent.

ADHD is not a disorder that, although not fatal, can be revisited with treatment from time to time, or periodically, or if and when the family or patients get around to it. In children it is critical to treat; and the more time is wasted in inadequate or bogus treatments, the more serious and permanent the damage will be.

Worse yet, are those individuals who decide to treat during the week but to go off treatment on the weekends. This is even more dangerous because it further masks the symptoms. ADHD is an ongoing disorder affecting executive functions twenty-four hours a day.

Even in those adults who have been successfully treated, there are behavior patterns—defense mechanisms—that individual adopt in the process of coping, that are very difficult to eradicate. This includes criminal behavior, numerous phobias, and some forms of Borderline Personality Disorder (BPD.)

In summary, there are other, adjuvant treatments, some of which can be helpful in the treatment of ADHD; but to date there is no treatment that has proven to be superior or even equal to the use of medication.[ii] Ideally, some day we will know enough to have a way of curing or preventing ADHD. Unfortunately, that day has not yet arrived.

i] See Psychiatric Times article

ii] With the possible exception of those rare cases which are precipitated by certain food allergies. This is extremely rare, and the specific foods can be seen clearly to produce a distinct state of this disorder.