From: fulk@cs.rochester.edu (Mark Fulk)
Subject: Re: Attention Deficit Disorder Resources
Organization: Computer Science Department University of Rochester
Date: Mon, 5 Oct 1992 15:56:05 GMT

In article <ykdp-t#@lynx.unm.edu> bhjelle@carina.unm.edu () writes:
>In article <1992Oct4.171542.16866@spdcc.com> dyer@spdcc.com (Steve Dyer) writes:
>>
>>Drugs like dextroamphetamine and Ritalin have a generic effect in improving
>>attention; they are not specific for kids with ADD.  It's just that the
>>effect is much more dramatic in those individuals.
>>
>Absolutely!
>
>This is why testimonials from parents of children carrying the ADD
>label are of no help. *Any*  kid will become more attentive, given
>Ritalin. 

Don't forget the halo effect.  Most troublesome kids will seem better
if someone tells the parents and teachers that the kid is being treated.

>In Albuquerque, there is an ADD "industry". There are well-known
>local practitioners who diagnose every kid they see with ADD, as
>a means of generating repeat business. Some even put the entire
>family on dextroamphetamine. Now *that* will bring mom back for
>more!
>
>Whatever ADD is, in Albuquerque it is grossly overdiagnosed. I wonder
>if the symptoms of ADD aren't a continuum of normal behavior,
>with kids exhibiting the most severe behavior in need of control.
>Much of the rest is done to keep teachers and school nurses happy.
>
>Brian

Much the same is true in Rochester.  Aware parents of very bright children
in Rochester have learned to recognize a referral to the Genesee Valley
Mental Health Center for what it is: a demand that one's child be drugged.

I have numerous friends with non-docile, very bright, children who have
been put through this particular gauntlet; interestingly, one common
feature seems to be that these parents did NOT put their children into
full-day daycare when young.

ADD and ADHD have all the signs of a disease fashion.  They have changed
names and detailed descriptions several times over the years.  The claimed
incidence has climbed from a few per thousand to ten percent.  The initial
diagnostic criteria, which I believe indicate a real disorder, have been
debased beyond recognition.  (By the way, I think DSM-IIIR predates the
debasement.  I don't have a copy handy, but as I recall, it had a fairly
reasonable description of ``hyperactivity.'')

The most common ADD diagnoses (in Rochester) are now made by pediatricians,
based on parental and teacher reports, and by certain psychologists, often
based on 20 minute interviews.  One psychologist told some friends of mine
that their child had ADHD; the parents objected that the child had a
tremendous attention span, contradicting what all the references said was
the main criterion; the psychologist responded that he used his own
definition of ADHD and they were all wet.  This after a twenty minute
interview with the child!

The original studies on Ritalin recommended a long double-blind trial to
establish effectiveness in each case.  This because of the tremendous
power of the ``halo'' effect, essentially a placebo effect on teachers
and parents.  I have yet to run into a family with a child on Ritalin
(or any other drug for ADD/ADHD) that experienced such a trial, out of
about a dozen.

I don't doubt that ADD/ADHD is real.  I haven't met a case that I think
is real, yet, but perhaps I will in the future, and perhaps I have been
wrong.  I have met a number of families with very bright children, some of
whom are problems to their parents or to their teachers.  In every case,
the real causes seem to me to be either parenting or classroom skills.
In many of these cases I've seen a change of classroom, or some support to
the parents, result in dramatic improvement in the child's behavior.  All
of these families have, at one time or another, been told that their child
_definitely_ has ADD or ADHD.  In my daughter's kindergarten class, six out
of thirty-six kids were so diagnosed!

There have been many such popular diagnoses.  I remember that ten years
ago, every difficult brain-damaged or retarded child my wife saw was
diagnosed by someone (most often the parents) as _autistic_.  It was
clearly a case of people grabbing onto something that seemed more hopeful
than, say, severe cerebral palsy with mental retardation.  There was also
the matter of the existence of rich foundations for helping autistic kids,
who are, in reality, fairly rare (1/4,000, if I recall correctly).

The particular tenacity of misdiagnosed ADD/ADHD results from the frustrations
of teachers who cannot control their classrooms.  One particular danger seems
to be that it is especially the bright, imaginative, but difficult children
who get singled out.
-- 
Mark A. Fulk			University of Rochester
Computer Science Department	fulk@cs.rochester.edu
Newsgroups: misc.kids,alt.sex