Critique of the AMERICAN ACADEMY OF PEDIATRICS, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Committee on Quality Improvement Policy, Statement entitled "Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-deficit/Hyperactivity Disorder"

 [PEDIATRICS. 2001;108: 1033-1044 (October)]

by Fred A. Baughman Jr., MD, Neurology, Child Neurology (certified by the American Board of Psychiatry & Neurology)
1303 Hidden Mountain Drive
El Cajon, CA 92019
fred-alden@worldnet.att.net
written 10/3/01

In it's ADHD treatment guideline, just released, the American Academy of Pediatrics (AAP) states (1) "The initiation of treatment requires the accurate establishment of a diagnosis of ADHD," and (2), that "the American Academy of Pediatrics' clinical practice guideline on diagnosis of children with ADHD [1] provides direction in appropriately diagnosing this disorder.  Does their diagnosis guideline do any such thing?

In my letter to the editor of PEDIATRICS (journal of the AAP) regarding their previously published diagnosis guideline, I [2] wrote:

Clinical Practice Guideline opens: "Attention-deficit/hyperactivity disorder is the most common neurobehavioral disorder of childhood."
"Neurobehavioral," implies an abnormality of the brain; a disease.  And yet, no confirmatory, diagnostic, abnormality has been found.  With six million children said to have it, most of them on addictive, dangerous,
stimulants, ambiguity as to the scientific status of ADHD is not acceptable.

In medicine,  physicians are responsible for determining whether a disease is present or not, i.e., whether or not an abnormality has been detected.  If not, there is no medical/biological abnormality to treat; to make normal or more nearly normal.  And yet many, throughout medicine, persist in referring to ADHD as a disease, hoping, it will
justify medical/pharmacological interventions, and billing for them.  In a recent article in-of all places--the Journal of the American Medical Association, Vastag [3] proclaimed:

  In 1999, Darin Dougherty, MD, and colleagues [4].reported that people with ADHD have many more dopamine transporters than those without the condition.

Doughtery, et al, proved no such thing.  They provided so little information about the drugs their subjects were on that their research could not be replicated, even if someone wished to try to do so.  This was just another in a long line of false research claims and press releases, asserting that ADHD was an actual disease, when it is
not-when, given it's wholly subjective nature-it never can be.   The never-replicated claims of Zametkin et al [5], in 1990, sustained the epidemic-without-a-disease,  through the nineties.

Nor does the lack of scientific proof stop those at the AAP from referring to ADHD as a disease, and urging that it be treated, as if it were, with methylphenidate (Ritalin) and other, addictive, dangerous, sometimes deadly, Schedule II, amphetamines.

In April [6] Stein, a cochairperson on the APA Subcommittee on ADHD,wrote:

Factors that impact compliance (with prescription medication) include their belief that the treatment will be effective, the parents' understanding of the disease and  how treatment will alter or ameliorate symptoms, and the quality of the therapeutic alliance between the clinician, child, and parent.

Here, without a doubt, and without a shred of scientific proof, Stein, of the AAP,  conveys that ADHD is a disease.  Can there be any doubt the parent of a normal child, led to believe that their child is "diseased"/
"abnormal," will have a different view of their child and of their child's corrective needs, than of the parent told honestly that ADHD is nothing but a set of normal behaviors in a wholly normal child.

If the AAP has proof that ADHD is a disease; that the children are abnormal, diseased, why don't they say so.  Instead, they too, seem intent on conveying to the to patients and the public, albeit with no proof, that ADHD, a propaganda construct, is a disease, that children with it are "diseased"/ "abnormal."

At the November 16-18, 1998, National Institutes of Health Consensus Conference on ADHD, Carey [7], an invited speaker, made the following statements:

What is now most often described as ADHD in the United States appears to be a set of normal behavioral variations. This discrepancy leaves the validity of the construct in doubt.

ADHD behaviors are assumed to be largely or entirely due to abnormal brain function.  The DSM-IV does not say so, but textbooks and journals do.

We see.that the causes of these behaviors called ADHD are entirely speculative. And yet. parents and children are being told that these behaviors are due to a brain malfunction.  Can you not please strengthen the statement to discourage practitioners from making this statement
when there is not adequate proof to support that at this time?"

Nor is there the least bit of proof today, that ADHD is a bona fide disease, that the  millions of children said to have it are diseased/abnormal and in need of such medical/biological/pharmacological treatment as is invariably urged upon them.

As I urged previously [3] :

It is apparent that virtually all professionals of the extended ADHD 'industry' convey to parents, and to the public-at-large, that ADHD is a 'disease' and that children said to have it are 'diseased'-'abnormal.' This is a perversion of the scientific record and a violation of the
informed consent rights of all patients and of the public-at-large.

The wording of the AAP Guideline should be changed, forthwith, to reflect the scientific and medical facts of the matter.

In publishing this letter to the editor in the May issue of their journal, PEDIATRICS, no one from the APA  or their Subcommittee on ADHD responded in the least to the questions I raised, nor did the stop referring to ADHD as a "neurobehavioral disorder" implying something
neurologically (brain) abnormal/diseased within children thus labeled.

Their intentions seems clear: to continue to call normal children "abnormal"/ "diseased," and to continue to "treat" them with methylphenidate (Ritalin) and other amphetamines of the Schedule II, controlled, designation, as if they were.

The first, abnormality/disease/chemical imbalance such children have, is that due to the drugs they are given.

This is not the legitimate, ethical, practice of medicine.

Sincerely,

Fred A. Baughman Jr., MD
Fellow, American Academy of Neurology (board certified, N, CN)
1303 Hidden Mountain Drive
El Cajon, CA 92019
fred-alden@worldnet.att.net
fax 619 442 1932

References:

1. American Academy of Pediatrics, Committee on Quality Improvement and
Subcommittee on Attention-Deficit/Hyperactivity Disorder. Diagnosis and
evaluation of the child with attention-deficit/hyperactivity disorder.
Pediatrics. 2000;105:1158-1170.
2. Baughman F. Dopamine-transporter density in patients with ADHD. The
Lancet. 2000; 355:1460.
3. Brian Vastag, Pay Attention: Ritalin Acts Much Like Cocaine. JAMA,
August 23, 2001.
4. Dougherty DD, Bonab AA, Spencer TJ Rauch SL, et. al. Dopamine
transporter density in patients with attention deficit hyperactivity
disorder. Lancet. 1999;354:2132-2133.
5.  Zametkin AJ, et al.  Cerebral glucose metabolism in adults with
hyperactivity of childhood onset.  New England Journal of Medicine.
1990; 323:1361-1366.
6. Stein MT, et al. Challenging Case: Adolescence.  An adolescent who
abruptly stops his medication for attention-deficit hyperactivity
disorder. PEDIATRICS. 107; 2001:974-978 (Supplement).
7. Carey WB. NIH Consensus Conference on ADHD (transcript). November
16-18, 1998. Bethesda, MD.