Attention deficit is – ooh look! Kittens!

There’s an interesting discussion on Fark.com about attention deficit disorder, with a typically witty headline:

Adults being diagnosed with ADHD, or Attention Deficit Hyperact… Chee-tos — I could definitely go for some Chee-tos right now. But they’ll turn my fingers orange. I wonder how the Dolphins are doing. I think I’ll go read fark for a while

The discussion stems from a CBS news story that suggests 8 million US adults have ADHD, although to date the focus has been on children with the condition. The US DSM-IV medical manual lists these as the most common symptoms in children:

often fails to give close attention to details or makes careless mistakes; often has difficulty sustaining attention to tasks; often does not seem to listen when spoken to directly; often fails to follow instructions carefully and completely; losing or forgetting important things; feeling restless, often fidgeting with hands or feet, or squirming; running or climbing excessively; often talks excessively; often blurts out answers before hearing the whole question; often has difficulty awaiting turn.

That sounds awfully like me. In primary school I was occasionally locked in cupboards (true!) because of my incessant and irrelevant chattering, and I’d always get into trouble for tuning out at the slightest distraction. It’s something I still have today: if I don’t write things down I forget them (and even then, I still forget to do things – when I go shopping, I always end up missing something from the list); in conversation, I zoom off on wild tangents or forget what I’m talking about halfway through sentences; I have a mind like a sieve (it’s a constant source of amusement to my friends that if I go to the bar to get drinks in, I’ll have forgotten the order by the time I get there); and I can’t concentrate on one thing for very long – so right now I’m zooming between a blogger window, six news sites, a few blogs, email, a magazine article I’m writing, a magazine article I’m reading, some software downloads, text messages on my phone and so on. In the living room I’ve got six magazines and three novels open; when I use the net I often open a new browser window to go to a site and then wonder what site I was planning to visit. I’ve always used the phrase “magpie mind” to describe the sort of person I am: a glimpse of something shiny and my mind wanders off immediately.

That sort of mindset is great for my job: magazine articles tend to be “bitty”, so in addition to the main article you have lots of sidebars, boxouts and tangents. And because deadlines tend to come in chunks, I usually work on three or four different jobs at once (so for example in the last few days I’ve been reviewing software, writing two magazine features, collating stories for a news thing, arranging interviews for forthcoming features, tracking down software for next month, chasing payments for published stuff, and so on). That suits me fine, because I’m never on one thing for too long (even the really, really big jobs are split up into little, independent sections); it’s also why I was a dead loss when I had a day job, because I found it almost impossible to focus on really, really important things for long.

I’d imagine that if I were of school age in America right now, I’d probably be diagnosed as ADHD, or perhaps ADD; that means I’d probably be prescribed Ritalin or something similar. However, this university study suggests that it’s not a disorder; rather, it’s a sign of creativity. The study notes:

the brains of creative people appear to be more open to incoming stimuli from the surrounding environment. Other people’s brains might shut out this same information through a process called “latent inhibition” – defined as an animal’s unconscious capacity to ignore stimuli that experience has shown are irrelevant to its needs. Through psychological testing, the researchers showed that creative individuals are much more likely to have low levels of latent inhibition.

“This means that creative individuals remain in contact with the extra information constantly streaming in from the environment,” says co-author and U of T psychology professor Jordan Peterson. “The normal person classifies an object, and then forgets about it, even though that object is much more complex and interesting than he or she thinks. The creative person, by contrast, is always open to new possibilities.”

…those classified as eminent creative achievers – participants under age 21 who reported unusually high scores in a single area of creative achievement – were seven times more likely to have low latent inhibition scores.

The authors hypothesize that latent inhibition may be positive when combined with high intelligence and good working memory – the capacity to think about many things at once – but negative otherwise. Peterson states: “If you are open to new information, new ideas, you better be able to intelligently and carefully edit and choose. If you have 50 ideas, only two or three are likely to be good. You have to be able to discriminate or you’ll get swamped.”

It’s the “getting swamped” bit that’s controversial: in the Fark discussion, many people talk about their own experiences of ADD/ADHD and say that Ritalin (or self-medication with various things) helped tune out the distractions and enable them to focus on important things such as schoolwork or their job. As the Attention Deficit Disorder Association says:

Medication corrects their underlying chemical imbalance, giving them a fair chance of facing the challenges of growing up to become productive citizens.

Not everyone agrees.

Matthew Smith died aged 14 as a result of Ritalin side-effects, and his father has put together a site that warns other parents about ADHD treatment. He says:

Dr. Dorsey officially diagnosed Matthew with ADHD. The test used for the diagnosis was a five minute pencil twirling trick, resulting in me being handed a prescription for Methylphenidate/Ritalin.

He continues:

At no time were my wife and I ever told significant facts regarding the issue of ADHD and the drugs used to “treat it”. These significant facts withheld from us inevitably would have changed the road that we were headed down by ultimately altering the decisions we would have made.

We were not told that The Drug Enforcement Administration had classified Methylphenidate (Ritalin) as a Schedule II drug, comparable to Cocaine.

We were not told that Methylphenidate is also one of the top ten abused prescription drugs.

At no time were we informed of the unscientific nature of the disorder.

We were not told that there was widespread controversy among the medical establishment in regards to the validity of the disorder.

Furthermore, we were not provided with information involving the dangers of using Methylphenidate (Ritalin) as “treatment” for Attention Deficit Hyperactivity Disorder. One of these dangers includes the fact that Methylphenidate causes constriction of veins and arteries, causing the heart to work overtime and inevitably leading to damage to the organ itself.

We were not made aware of the large number of children’s deaths, that have been linked with these types of drugs used as “treatment”.

Matthew died from heart damage, which the coroner attributed to long-term use of Ritalin.

There’s no doubt that for some people, Ritalin works; however, there’s a real concern that educators are a little too keen to say “your kid’s got ADHD” and for doctors to prescribe Ritalin. As the bereaved parent puts it:

Did you know that schools receive additional money from state and federal government for every child labeled and drugged? This clearly demonstrates a possible “financial incentive” for schools to label and drug children. It also backs up the alarming rise/increase in the labeling and drugging that has taken place in the last decade within our schools.

Did you know that parents receiving welfare money from the government can get additional funds for every child that they have labeled and drugged? In this way, many lower socio-economic parents (many times single mothers) are reeled into the drugging by these financial incentives waved in front of them in hard times, making lifestyle changes possible.

It’s certainly a controversial issue, and it’s a relatively recent one. As Spiked Online notes:

Ritalin has been available for 40 years, but again, its use for the treatment of ADHD only took off in the mid-1990s. In some states in the USA, between three and five percent of primary school children have been diagnosed with ADHD; estimates of the number of American children on Ritalin vary between 1.7 million and 2.5 million. According to NICE [the National Institute of Clinical Excellence], an estimated 366 000 children between six and 16 in England and Wales (around five percent of all schoolchildren) meet the diagnostic criteria for some form of ADHD. A core group of more than 73 000 (one percent) are believed to have severe ‘combined type’ ADHD, with all three features [inattentiveness, impulsiveness and hyperactivity]: this is the group for which it recommends treatment with Ritalin.

The article continues:

Advocates of ADHD, who consider that it is ‘underdiagnosed and undertreated’ in Britain, have welcomed the NICE report as a vindication of their campaign for greater recognition of this disorder (5). They believe that ADHD is a ‘genetic, neurological’ condition and that evidence of brain dysfunction has been found in various cerebral imaging studies. These claims regarding ADHD – which have been made about a wide range of conditions from schizophrenia and manic depressive psychosis to alcoholism and homosexuality – remain controversial.

…the key problem underlying the ADHD controversy is the trend for defining a wider and wider range of experience and behaviour in psychiatric terms, ‘turning a problem into a disease’. The tendency to medicalise social problems is encouraged by the availability of treatments – either tablets or talking cures – which offer a ready solution to difficulties experienced by individuals, families and communities.

In his paper Becoming Neurochemical Selves[PDF link], Nikolas Rose writes:

alliances are formed between drug companies anxious to market a product for a particular condition, biosocial groups organised by and for those who suffer from a condition thought to be of that type, and doctors eager to diagnose under-diagnosed problems (Moynihan, Heath and Henry, 2002; Moynihan, 2003). Disease awareness campaigns, directly or indirectly funded by the pharmaceutical company who have the patent for the treatment, point to the misery cause by the apparent symptoms of this undiagnosed or untreated condition, and interpret available data so as to maximise beliefs about prevalence. They aim to draw the attention of lay persons and medical practitioners to the existence of the disease and the availability of treatment, shaping their fears and anxieties into a clinical form. These often involve the use of public relations firms to place stories in the media, providing victims who will tell their stories and supplying experts who will explain them in terms of the new disorder. Amongst the examples given by Moynihan et al including baldness and Propecia, erectile dysfunction and Viagra, irritable bowel syndrome and Lotronex, and Pfizer’s promotion of the new disease entity of “female sexual dysfunction” is the promotion by Roche of its antidepressant Auroxix (moclobemide) for the treatment of social phobia in Australia in 1997. This involved the use of the public relations company to place stories in the press, an alliance with a patients group called the Obsessive Compulsive and Anxiety Disorders Federation of Victoria, funding a large conference on social phobia, and promoting maximal estimates of prevalence. These are not covert tactics, as a quick glance at the Practical Guides published on the Web by the magazine Pharmaceutical Marketing will show.

As Rose notes: “One of the criticisms of the private madhouses before the spread of public asylums was that they were generating what was termed ‘a trade in lunacy’ in which profit was to be made by incarceration leading to all manner of corruption”. It could be argued that we’re heading for a modern-day equivalent, fuelled by the endless appetite for health stories in newspapers and magazines (very few of which are written by people who have any particular knowledge of health, let alone science) that promise pills to cure all our ills. As Rose points out:

The most widely prescribed of the new generation of psychiatric drugs treat conditions whose borders are fuzzy, whose coherence and very existence as illness or disorders are matters of dispute, and which are not so much intended to cure a specific transformation from a normal to a pathological state as to modify the ways in which vicissitudes in the life of the recipient are experienced, lived and understood.

I was going to add something else, but I’ve forgotten what I was going to say.

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