Does ADHD Exist?

Child neurologist, Dr. Fred Baughman says ADHD and other psychiatric diagnoses are fraudulent and over-diagnosed. Other experts counter that ADHD is a legitimate diagnosis.

Fred Baughman, MD

You take the position that ADHD and many of these other psychiatric diagnoses are fraudulent. Why?

An active opponent of the ADHD diagnosis, Baughman has been a child neurologist, in private practice, for 35 years. He is also a medical expert for the Citizens Commission on Human Rights (CCHR), an advocacy group founded by the Church of Scientology in 1969.

The American Psychiatric Association's diagnostic manual, the DSM, lists 18 behaviors, from which a teacher can check off behaviors she observes in the potential patient or student. Likewise, the parent or caregiver does the same thing. In the current DSM, if one checks six or more of the nine, the individual is deemed to have ADHD.

Let there be no mistake about it. Present-day psychiatry, led by the National Institute of Mental Health in league with the American Psychiatric Association and the American Academy of Child Adolescent Psychiatry, represents ADHD . . . to be a biologic abnormality of the brain, a so-called neurobiologic disorder. Their representation to the entire public and to all the teachers and all mental health professionals is that, having ticked off six or more of these nine behaviors, one has diagnosed an organic or a physical abnormality of the brain.

Their neurobiologic propaganda has been so intense for so many years, that the country believes in this. ... We've got probably, conservatively . . . six million [children in the United States] on medications for ADHD and a total of nine million with neurobiologic psychiatric diagnoses of one sort or another, on one or more psychotropic drugs. Here we're talking about as many kids as you've got people in New York City, and to me, this is a catastrophe. These are all normal children. Psychiatry has never validated ADHD as a biologic entity, so their fraud and their misrepresentation is in saying to the parents of the patients in the office, saying to the public of the United States, that this and every other psychiatric diagnosis is, in fact, a brain disease.

Establishing whether it's actually a biological brain disease seems to be a less important issue. The question is whether there aren't certain conditions with symptoms that can't be aided and addressed with psychotropic medications. What's wrong with that?

Well, what they've done essentially is to propose that there are children who, up to the time they walk down the schoolhouse path, seem to everyone to be entirely normal. But what they have proposed is that there are children who are misbehaving at school and at home who are inherently unable to achieve self-control because they've got something wrong in their brain. This ignores whether or not their parenting is optimal, and whether or not their de facto parenting in school or disciplining at school in the hands of a teacher is optimal or not. ...

But in the real world, parenting will never be optimal. Schooling is rarely optimal. But we've got a class of people telling us, psychiatrists and family physicians, that there is a drug that can help children that have a certain set of symptoms. What's wrong with that?

I think that the deficiency is, in fact, in the adults . . . It's a terrible misstep not to require any correction of the adults who are responsible for the development of the child. . . . By denying that there is any problem at all in the adults, and just accepting that it's a chemical imbalance and you're going to take a pill for it, I think you're going to leave unaddressed and undone . . . things that must be done, and should be done, and are being done in proper homes, and are being done in parochial and private schools throughout the country. . . .

Peter Breggin

Psychiatrist and author of Talking Back to Ritalin: What Doctors Aren't Telling You About Stimulants and ADHD, Breggin founded the nonprofit Center for the Study of Psychiatry and Psychology. He has been a vocal opponent of the ADHD diagnosis and he strongly opposes prescribing psychiatric medications to children.

How do you respond to the parents who give glowing testimonies about how that drug has helped their child?

In America today, it's easy to go out and get glowing testimony from parents about how wonderfully their children have been doing on Ritalin. There was a caged animal, a polar bear, in the zoo in Toronto, who was pacing up and down and looking uncomfortable, and looking like he'd really like to go back to the Arctic or the Antarctic. And they put him on Prozac, and he stopped pacing. His name was Snowball. He sat quietly and looked happy. And animal rights people gathered to the zoo and protested the drugging of a polar bear to make him into a good caged animal, and he was taken off the drug.

We have lost track of what childhood is about, of what parenthood and teaching is about. We now think it's about having good quiet children who make it easy for us to go to work. It's about having submissive children who will sit in a boring classroom of 30, often with teachers who don't know how to use visual aids and all the other exciting technologies that kids are used to. Or there are teachers who are forced to pressure their children to get grades on standardized tests, and don't have the time to pay individual attention to them. We're in a situation in America in which the personal growth and development and happiness of our children is not the priority; it's rather the smooth functioning of overstressed families and schools. . . .

There are no miracle drugs. Speed--these drugs are forms of speed--don't improve human life. They reduce human life. And if you want less of a child, these drugs are very effective. These parents have also been lied to: flat-out lied to. They've been told that children have a neurobiological disorder. They've been told their children have biochemical imbalances and genetic defects. On what basis? That they fit into a checklist of attention deficit disorder, which is just a list of behaviors that teachers would like to see stopped in a classroom? That's all it is. . . .

One of the really obscene things that has happened is that psychiatry has sold the idea that if you criticize drugs, you're making parents feel guilty. What an obscenity that is. We are supposed to be responsible for our children. . . . If we're not responsible for raising our children, what are we responsible for? If children aren't entrusted to us for the specific purpose of our turning ourselves inside-out to be good parents, what is life about? It is a disgrace that my profession has pandered to the guilt of parents by saying, "We'll relieve you of guilt. We'll tell you your child has a brain disease, and that the problem can be treated by a drug."

That's pandering to the worst desires that we have as parents--all of us--which is to say, "I'm not guilty of this problem." . . . I'd rather be guilty as a parent, and say, "I did wrong," than say, "Son, you have a brain disease." Sure, we're all tempted. We're all tempted, when we're in conflict with our children, to hold them responsible. And how much easier it is if we don't even have to hold them responsible. . . .

Let's talk about the lawsuits that have been filed against the Novartis, the manufacturer of Ritalin.

On Tuesday, May 2, a class action suit was brought against the manufacturers of Ritalin and Novartis, against [CHADD], a parents' group that has been heavily funded by the drug companies, and the American Psychiatric Association--for the fraudulent overemphasis on the ADHD diagnosis and treatment with Ritalin. The American Psychiatric Association, CHADD, and the drug manufacturer are accused of conspiracy. The case has been brought in Texas by the law firm of Waters & Krause, and is now actually in the courts. . . . Probably there's going to be a series of related cases, or at least a number of attorneys coming together, around this issue of fraud and conspiracy in the promotion of the diagnosis and the promotion of the drug.

So that will hinge on showing what? Damage to the children?

No damage is required to be shown to the children in this case, because it's not that kind of product liability case. All that the parents have to show is that they spent money on Ritalin, when they were in fact fraudulently induced to think that it would be worth something. . . .

There's actually a great deal of evidence for a conspiratorial relationship. According to international law, you cannot directly promote a highly addictive Schedule II drug to the public. Ritalin is in Schedule II along with amphetamine, methamphetamine, cocaine and morphine. And you're not allowed to put ads in the newspaper for that. You're not allowed, according to international conventions, to directly promote to the public.

Professor of psychiatry and neurology at the University of Massachusetts Medical Center in Worcester. Author of numerous books on ADHD, including ADHD and the Nature of Self-Control and Taking Charge of ADHD: The Complete, Authoritative Guide for Parents.

There are 6,000 studies, hundreds of double-blind studies, and yet, there's still controversy. Why?

There is controversy about ADHD, I believe, partly because we are using a medication to treat the disorder, and people find that to be of concern. But there's also concern because ADHD is a disorder that appears to violate a very deeply held assumption that laypeople have about children's behavior. All of us were brought up believing, almost unconsciously, that children's misbehavior is largely due to the way they're raised by their parents and the way they're educated by their teachers. If you wind up with a child who is out of control and disruptive and not obeying, that that has to be a problem with child rearing. ... Well, along comes this disorder that produces tremendous disruption in children's behavior, but it has nothing to do with learning, and it isn't the result of bad parenting. And therefore it violates these very deeply held ideas about bad children and their misbehavior.

And as long as you have this conflict between science telling you that the disorder is largely genetic and biological, and the public believing that it arises from social causes, you're going to continue to have tremendous controversy in the mind of the public.

Now, there is no controversy among practicing scientists who have devoted their careers to this disorder. No scientific meetings mention any controversies about the disorder, about its validity as a disorder, about the usefulness of using stimulant medications like Ritalin for it. There simply is no controversy. The science speaks for itself. And the science is overwhelming that the answer to these questions is in the affirmative: it's a real disorder; it's valid; and it can be managed, in many cases, by using stimulant medication in combination with other treatments.

Many people in the public ask, "Where were these kids when I was growing up? I've never heard of this before." Well, these kids were there. They were the class clowns. They were the juvenile delinquents. They were the school dropouts. They were the kids who quit school at 14 or 15 because they weren't doing well. But they were able to go to work on their parents' farm, or they were able to go out and get in a trade or get into the military early. So they were out there.

. . . Back then, we didn't have a professional label for them. We preferred to think of them more in moral terms. They were the lazy kids, the no-good kids, the dropouts, the delinquents, the lay-about ne'er-do-wells who were doing nothing with their life. Now we know better. Now we know that it is a real disability, that it is a valid condition, and that we shouldn't be judging them so critically from a moral stance. . . .

Skeptics say that there's no biological marker--that it is the one condition out there where there is no blood test, and that no one knows what causes it.

That's tremendously naïve, and it shows a great deal of illiteracy about science and about the mental health professions. A disorder doesn't have to have a blood test to be valid. If that were the case, all mental disorders would be invalid--schizophrenia, manic depression, Tourette's Syndrome--all of these would be thrown out. ... There is no lab test for any mental disorder right now in our science. That doesn't make them invalid.

William Dodson

A psychiatrist in Denver, Colorado, Dodson ascribes ADHD mostly to biological causes. He is paid by Shire Richwood, the makers of Adderall, to educate other physicians about the drug's efficacy.

. . . In this country, there is a tenet of faith that says that any difficulty in life can be overcome if you have a good character, if you try hard enough and long enough. And so they don't like that tenet of faith challenge, that there are some children who come from the womb genetically predisposed to being inattentive, compulsive, somewhat reckless, and perhaps aggressive, no matter how hard they try. Trying harder is ineffective.

These people confuse an explanation for misbehavior and failure with an excuse. In point of fact, when people are diagnosed with ADHD, more is expected of them, not less. Now that you've got the diagnosis, now that you're on medication, our expectations for your performance in life are going to increase. But there are a lot of people who say, "I don't want to let the person off. I don't want this to be an excuse." But it's not an excuse. It's an explanation. . . .

I would ask those people to prepare themselves for that day 15 or 20 years from now when their child comes to them and says the following, "Now, let me get this straight. You saw that I was struggling. You saw that I was failing in school. You saw that I couldn't fall asleep at night. You saw that I was having trouble with my interpersonal relationships. You knew that it was ADHD. You knew that it had a good safe treatment. And you didn't even let me try? Explain that to me."

Those folks had better start working on their answer right now, because they're going to need 15 or 20 years to come up with a compelling answer for their child who asks them that question. "You saw me struggling and you did nothing?" That's a good question. And to me, it's a far more compelling one than saying, "We don't have perfect answers, therefore, let's do nothing."

Peter Jenson

Formerly the head of child psychiatry at the National Institute of Mental Health, Jensen was the principal author of the landmark NIMH study: NIMH, the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA). He is now the director of Columbia University's Center for the Advancement of Children's Mental Health.

There doesn't seem to be a lot of consensus about ADHD, even among your own peers.

I think there's consensus among most medical professionals that ADHD is a neurobehavioral disorder, that it's severe, that it affects boys somewhat probably more than girls, and that it's treatable. Now, where consensus begins to break down is how workable the treatments are, and effective and safe over the long-term; and what the exact causes of it are. And it likely has many different causes.

There isn't good consensus about the best way to draw the boundaries between ADHD and other syndromes. But I think you will find that most experts do agree that it's a real disorder that we can characterize reliably, that it has bad outcomes if left on its own, that we can do something about it, and that there is a research agenda that does need further pressing forward and carrying out. . . .

The job of medical science is to decide when it's a real medical condition that has suffering and impairment and lowers the quality of life--and sometimes not only lowers the quality of life, but lessens productivity and even actual days of life. Depression is a good example; we know there that life is actually shortened by suicide.

But kids with ADHD are also at risk for dying somewhat earlier. They are at risk for accidents. It's true for most of the psychiatric disorders. We don't know all the reasons why that is. Sometimes it's accidents, sometimes it's something like suicide. Sometimes it's because people don't obtain adequate health care. There are a lot of mysteries here. But the diseases of the mind shouldn't be treated any differently than the diseases of the other parts of the body, and we've done that too much, I think, as a society. . . .

What about the idea that ADHD is not a disease--that it's simply behavior that's a result of ineffective parenting?

There's no question that a child's behavior affects adults, and adults' behavior affects children. We call that "the human condition." Can it be the case that some children's difficulties are because they're not being handled appropriately? Absolutely true, of course. But does that explain ADHD? Well, all of the studies suggest just the opposite, in fact. When we do these studies to teach parents the most elegant, best parenting strategies that we know how to do--including things you have to get a PhD in parenting to learn--when we give parents and teachers those skills, does it make these problems go away? No. It reduces them a little bit, but there's something different for many of these children. . . .

There is a real need to get the message out, to help parents understand ADHD. This is not something a child chooses just to do. "Oh, I think I'm going to have real difficulties attending," or, "I don't want to attend," or "I want to look out the window and not attend to the blackboard." If you study these kids as we have, these kids feel bad about themselves. They don't want to be this way. In many ways, it's like a learning disability. Whereas you can maybe sit and listen and attend to me for hours on end, these kids' minds are off after 10 or 15 or 20 seconds. . . . Most kids can track this kind of situation, or a classroom situation, for minutes, tens of minutes, twenties of minutes, or even an hour on task, with minor deviations. . . . These kids can't. It's not that they're willfully disobedient or that we have bad teachers. . . .

Harold Koplewicz

Vice chairman of psychiatry at New York University, Koplewicz believes that ADHD is a legitimate brain disorder. He wroteIt's Nobody's Fault: New Hope and Help for Difficult Children and Their Parents. He is director for the New York University Child Study Center.

A lot of people out there say that all of this is just a fraud, that you've invented this disorder, along with hundreds of other psychiatrists and along with the pharmaceutical industry, which just wants to make more money. They say that there is no litmus test diagnosing ADHD, and this is just a whole bunch of subjective symptoms. What do you say to those people?

I think that the most important part is that when you're able to systematically study what these kids look like long-term, you start to recognize that without treatment, these children lose out on a normal life. They can't get the joy of getting decent grades. They can't get the joy of being picked to be on a team. They get very demoralized. They don't necessarily get depressed, but life becomes a very demoralizing place. If you're yelled at on a continual basis at your job, you'll quit. If you go to school on a regular basis and you're constantly missing out on whatever is being taught and you start to feel that you're foolish and stupid, you learn to quit. And that's maybe one of the reasons why you drop out. . . .

To suggest that this is a fraud, that somehow children are being abused by these treatments, is really an outrage, because for these kids, to not get treated is really the greatest abuse and neglect.

next: Controversies in the Diagnosis and Treatment of ADHD: One Doctor's Perspective
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