Attention-deficit/hyperactivity disorder: are we helping or harming?
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6172 (Published 05 November 2013) Cite this as: BMJ 2013;347:f6172All rapid responses
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Yes, 'overdiagnosis of ADHD resides within the clinical subjectivity of impairment', but so does underdiagnosis.
Identifying social and psychological issues which may be mimicking or masking ADD / ADHD features requires specialist expertise. In the case of depression, state-run health systems, with their ideology of 'primary care good, specialist expertise bad', colluded with pharmaceutical companies over the last two decades, overdiagnosing and overtreating that condition and irresponsibly diminishing its credibility.
It would help ADD / ADHD specialists if we knew how much state-funded and pharma-funded published research is to be relied on. Incredibly, the President of the UK's Royal College of Psychiatrists has proposed that discussion of such issues has been too open and should only occur 'in a closed room' (Professor Sue Bailey, quoted in chapter 13 of James Davies' Cracked: Why Psychiatry is Doing More Harm Than Good).
Competing interests: No competing interests
It is unsatisfactory that the main problems with Attention Deficit Hyperactivity Disorder in children are still believed to be over-diagnosis and the cost of stimulant medication.
In reality it is the failure to recognize that concentration problems are usually due to impaired brain cell function which is usually caused by deficiencies of essential nutrients and toxic metals or toxic products of oxidation. I published this rapid response at www.bmj.com in 2004
Essential nutrients needed to treat ADHD
21 October 2004
For decades the incidence of attention deficit hyperactivity disorder (ADHD) has been increasing.1 It is therefore a pity that neither Coghill nor Markovich, in their debate about psychoactive drug use,2,3 mention the “burgeoning” clinical and basic research finding significant deficits of zinc and essential fatty acids (EFAs) in affected children.4-7 Recent randomised controlled trials demonstrate that nutritional supplements improve children’s brain function and behaviour.
Ward et al found significantly lower zinc levels in the urine, scalp hair, serum, 24-hour urine and fingernails of hyperactive children.8 Tartrazine induced a reduction in serum and saliva zinc and increase in urinary zinc, with a corresponding deterioration in behaviour/ emotional responses of the hyperactive children.
In our study, among dyslexic children, who also usually had attention difficulties and hyperactivity, all were zinc deficient in their passive sweat.9 Each dyslexic child had a lower sweat zinc level than their age and sex matched control partner from the same school and neighbourhood. Repletion of deficient nutrients cannot undo developmental damage to a child’s brain caused by maternal zinc deficiency in early pregnancy, and is therefore vitally important to allow affected children to have greater mental concentration and improved brain function with monitored nutritional repletion.10 If zinc is deficient, EFA pathways are likely to be blocked and B vitamins are likely to be deficient.11
Rather than give drugs to one in six of all children why not simply ensure children’s brains and lymphocytes are fed? Impaired brain function and adverse allergic, behavioural or mental reactions to common foods and chemicals can be prevented physiologically. Repletion of essential co- factors and high protein-low allergy-additive-free diets allow maintenance of normal homeostatic mechanisms, with adequate levels of endogenous psychoactive amines and unblocked amine pathways, which can respond flexibly to all types of stress. There is no excuse for ignoring this work and continuing to prescribe ever more drugs to children with undiagnosed and therefore untreated deficiencies.
1 Grant ECG. Re: A rise in the prevalence of ADHD.http://bmj.com/cgi/eletters/329/7467/643-c#75351, 23 Sep 2004
2 Coghill D. Education and debate Use of stimulants for attention deficit hyperactivity disorder: FOR. BMJ 2004 329: 907-908.
3 Marcovitch H. Education and debate Use of stimulants for attention deficit hyperactivity disorder. AGAINST BMJ 2004;329:908-909.
4 Bilici M, Yildirim F, Kandil S, et al. Double-blind, placebo- controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2004; 28: 181-90.
5 Akhondzadeh S, Mohammadi MR, Khademi M. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial [ISRCTN64132371]. BMC Psychiatry. 2004;4 : 9.
6 Hallahan B, Garland MR. Essential fatty acids and their role in the treatment of impulsivity disorders. Prostaglandins Leukot Essent Fatty Acids. 2004; 71: 211-6.
7 Arnold LE, Pinkham SM, Votolato N. Does zinc moderate essential fatty acid and amphetamine treatment of attention-deficit/hyperactivity disorder? J Child Adolesc Psychopharmacol. 2000 ;10:111-7.
8 Ward NI, Soulsbury KA, Zettel VH, et al. The influence of the chemical additive tartrazine on the zinc-status of hyperactive children – a double-blind placebo-controlled study. J Nutr Med 1990;1:51-57.
9 Grant ECG, Howard JM ,Davies S, Chasty H, Hornsby B, Galbraith J. Zinc deficiency in children with dyslexia: concentrations of zinc and other minerals in sweat and hair. BMJ 1989;296:607-9.
10 Grant ECG. Developmental dyslexia and zinc deficiency. Lancet 2004; 364: 247-8.
11 Colquhoun I, Bunday S. Med Hypotheses. A lack of essential fatty acids as a possible cause of hyperactivity in children. Med Hypotheses. 1981; 7: 673-9.
Competing interests: No competing interests
The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by The American Psychiatric Association (APA) contains a growing number of dubious, if not ludicrous, psychiatric disorders that parallel and promote a growing number of dubious, if not dangerous, psychiatric drugs produced by Big Pharma, thus suggesting that DSM and APA serve Big Pharma, not the public. Psychiatry stigmatizes, and Big Pharma commercializes.
Competing interests: I have a self-published e-book called "Peace Poetry & The LOVE Diet", which promotes peace, simplifies health, and demystifies addiction.
Re: Attention-deficit/hyperactivity disorder: are we helping or harming?
I wonder how many people realise that the diagnostic label ADHD validates entitlement to benefits for many families at highest risk of this disorder, regardless of its questionable status as a either a disease, a product of an increasingly dysfunctional society, or whatever else one may choose? And that this ADHD diagnosis is itself validated by prescription of methylphenidate, both for parents and for those with power to grant or disallow benefits.
For families in areas of post-induatrial dereliction, life is hard enough already, and I have no wish to add to their troubles, but it is in nobody's long term interest to ignore this powerful incentive to categorise the consequences of terminal capitalism as disease, rather than a social problem requiring social solutions.
Competing interests: No competing interests