There are no scientific tests for ADHD.[1] The diagnosis is dependent on third party (usually teacher and parent) reports of a child’s behaviour because as stated in DSM5 “no biological marker is diagnostic for ADHD”. These behaviours include, making careless mistakes, not paying attention or listening, not finishing school work or chores, disliking or avoiding homework, being disorganised, losing or forgetting things, interrupting, talking too much, not playing quietly.
The most commonly prescribed ADHD medications are amphetamines (e.g. dexamphetamine) or near amphetamines (e.g. Ritalin).[2] They are addictive and often abused and some adults seek a diagnosis of ADHD in order to misuse or sell them. In the USA methamphetamine (brand name Desoxyn)[3] is a ‘medication’ approved to treat children with ADHD’ as young as six.
There is nothing ‘ADHD specific’ about the effects of drugs.[4] Although responses vary, most people become temporarily more narrowly focused and compliant on low dose amphetamines whether or not they have been labelled ADHD. The claim that improved focus after taking ‘medication’ confirms that a diagnosis is correct is just plain wrong.
Across the globe the youngest children in a classroom are at a much higher risk of being diagnosed with and medicated for ADHD than there older classmates.[5] This happens both in countries with high and low ADHD diagnosis and medication use rates, indicating that even at low rates misdiagnosis is very common.
ADHD drugs sometimes mask the signs of serious problems such as sexual, emotional or physical abuse, bullying or trauma.[6] Some children are doubly abused when the original abuse is compounded by the harmful administration of amphetamines.
ADHD drugs have significant potential adverse effects.[7] They range from common short term effects like insomnia, loss of appetite and headaches, through to severe cardiovascular and psychiatric problems, addiction, growth retardation, suicidality and addiction.
ADHD stimulants (amphetamines and near amphetamines) are not smart drugs.[8] In low doses they usually narrow focus and increase compliance with instructions[9] which can allow an individual to concentrate on an assigned task. However, they can inhibit creativity[10] and there is evidence from Canada[11] and Australia[12] indicating that their long term use is associated with declining academic performance.
Despite multiple claims over the last twenty years of imminent breakthroughs the search for hypothesised ‘ADHD genes’ and the biochemical cause/s of ADHD have been unsuccessful.[13] In the future it is possible that geneticists may identify genes that influence behaviour, including individual differences in attentiveness and impulsivity, and therefore the likelihood of being labelled with ADHD. If this happens (and it is a very big if) this would not necessarily make ADHD a legitimate disease. All it would demonstrate is difference, and difference is not disease.
Boys are between 3 and 4 times more likely to be diagnosed with, and ‘medicated’ for, ADHD than girls.[14] This is not surprising. Many of the diagnostic criteria of ADHD, particularly the hyperactive/impulsive behaviours (including fidgeting, climbing and running about, being on the go, playing loudly and interrupting) are more common in boys than girls.
ADHD is very, very, big business and it is getting bigger. The global market sales for ‘ADHD medications’ was valued at an estimated US$16.4 billion in 2018 and is forecast to be worth US$24.9 Billion By 2025.[15] These figures do not include the payments received for diagnosing, researching, promoting and providing non-drug treatments. The estimated global ADHD drug sales for 2018 of US$16.4 billion is larger than the National Income (GDP) of 68 of the 186 countries for which the International Monetary Fund provided 2018 data. It was also bigger than the combined GDP of Antigua and Barbuda, Seychelles, Guinea-Bissau, Solomon Islands, Grenada, Gambia, St Kits and Nevis, Vanuatu, Samoa, Saint Vincent and the Grenadines, Comoros, Dominica, Tonga, Sao Tome and Principe, Federated States of Micronesia, Palau, Marshall Islands, Kiribati, and Tuvalu.[16]
First published 23 June 2019.
References
[1] For more detail see https://www.psychwatchaustralia.com/diagnosing-adhd
[2] For more detail see https://www.psychwatchaustralia.com/treating-adhd
[3] Desoxyn Prescribing Information available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/005378s026lbl.pdf
[4] For more detail see https://www.psychwatchaustralia.com/treating-adhd
[5] Whitely M, Raven M, Timimi S, Jureidini J, Phillimore J, Leo J, Moncrieff J, Landman P, Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: systematic review, Journal of Child Psychology and Psychiatry, October 2018. Available at https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12991
[6] For more detail see https://www.psychwatchaustralia.com/what-causes-adhd
[7] For more detail see https://www.psychwatchaustralia.com/treating-adhd
[8] Shaheen E. Lakhan, Annette Kirchgessner (2012) Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects; Brain and Behaviour. Available at https://onlinelibrary.wiley.com/doi/full/10.1002/brb3.78
[9] Lydia Furman, (2006) What Is Attention-Deficit Hyperactivity Disorder (ADHD)? Journal of Child Neurology. Available at https://www.researchgate.net/publication/7354308_What_Is_Attention-Deficit_Hyperactivity_Disorder_ADHD
[10] González-Carpio Hernández G1, Serrano Selva JP. (2016) Medication and creativity in Attention Deficit Hyperactivity Disorder (ADHD). Psicothema. Available at https://www.ncbi.nlm.nih.gov/pubmed/26820419
[11] Janet Currie, Mark Stabile, and Lauren Jones. (2014) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD? Journal of Health Economics. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815037/
[12] Government of Western Australia, Department of Health, (2010) Raine ADHD Study: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Department of Health, Perth. p.6. https://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf
[13] For more detail see https://www.psychwatchaustralia.com/adhd-genetics
[14] Dr. Ujjwal P. Ramtekkar, M.D., M.P.E., Dr. Angela M. Reiersen, M.D., M.P.E., Dr. Alexandre A. Todorov, Ph.D., andDr. Richard D. Todd, Ph.D., M.D. (2010) Sex and age differences in Attention-Deficit/Hyperactivity Disorder symptoms and diagnoses: Implications for DSM-V and ICD-11 Journal of American Academy of Child and Adolescent Psychiatry. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101894/
[15] Grand View Research (February 2019), Market Research Report - Attention Deficit Hyperactivity Disorder (ADHD) Market Analysis Report By Drug Type (Stimulant, Non-stimulant), By Demographic, By Distribution Channel (Hospital & Retail Pharmacy), And Segment Forecasts, 2019 – 2025. Available at https://www.grandviewresearch.com/industry-analysis/attention-deficit-hyperactivity-disorder-adhd-market
[16] "World Economic Outlook Database". International Monetary Fund. 10 April 2019.
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