There is a lyric in the song If I Ever Lose My Faith In You by Sting that goes like this:
I never saw no miracle of science
That didn’t go from a blessing to a curse.
That line came to mind recently as I was reading an article written by Leon Eisenberg, MD in 2007. In it Dr. Eisenberg, a child psychiatrist who pioneered the first rigorous studies of autism and hyperkinetic syndrome (now ADHD), comments on the progression of the term ADHD and his growing discomfort in the rise in diagnoses and corresponding pharmacological treatments.
The article, entitled Commentary with a Historical Perspective by a Child Psychiatrist: When “ADHD” was “the Brain-Damaged Child” highlights Eisenberg’s early work and research into the then relatively uncharted waters of child psychology. He describes his influence in shifting the paradigm from psychogenesis that held a social/situational cause to one of biological/neurological origin. ( Please note that currently there is a lot of social media hype calling Eisenberg the “father of ADHD” and that he had a deathbed confession. That’s not what I am writing about. If you want to learn more about that hype, read this account on Snopes.com.)
In the late 1960′s, Eisenberg was the lead researcher in the efficacy of drugs like dextroamphetamine (Dexedrine, ProCentra, Dextrostat) and methylphenidate (Concerta, Daytrana, Ritalin, Methylin). Both of these drugs are central nervous system stimulants and have been known since 1937 to calm overactive children. But until Eisenberg’s research, the information was never subject to double-blind randomized testing. Still, Eisenberg missed a key point in his research which he recounts in his article:
“It is useful to recall, in this connection, Judith Rapoport’s studies in the late 1970s. Because hyperkinetic children became less active when they took what were by definition stimulant drugs, as though they were taking sedatives, their response was characterized as “paradoxical”. When Judy (alone of all of us with the insight and the courage to do it!) put the matter to empirical test by giving a single dose of dextroamphetamine to normal as well as hyperactive children and to normal college-aged men, all groups showed decreased motor activity, increased vigilance, and improved performance on a learning task. However, the adults reported euphoria, whereas the children reported feeling “tired” or simply “different” (Rapoport et al 1978; 1980). The “paradox” was age-related, not “disease”-related. That lesson continues to escape many today. A “therapeutic” response to stimulant drugs is taken as “confirmation” of the diagnosis of ADHD. Have we converted a dimensional spectrum that covers the entire population arbitrarily into a diagnosis by imprecise cut-off values? Have child psychiatrists and pediatricians become carpenters with hammers who see all problems as nails?”
The point is that all children responded the same way to the stimulant drugs, regardless of their hyperactivity. But Eisenberg’s work in reclassifying the hyperkinetic diagnosis from social to biological and his research showing the efficacy of a pharmacological solution had already set into motion a blessing that was unstoppable. Eisenberg:
“In many public school jurisdictions, the diagnosis led to additional services for such children because of the implication that their problems were “organic” or “endogenous” as opposed to psychological or psychogenic. For that very reason, parents welcomed it. Furthermore, the term “proved” they were not responsible for their child’s problems.”
“What none of us anticipated was the explosion in the diagnosis and treatment of what became ADHD (Morrow et al 1998; Batoosingh 1995; Zito et al 1999; Olfson et al 2003; CDC 2005). Methylphenidate consumption in “defined daily doses” rose from 60 million in 1987 to 360 million in 1999 and prescriptions for methylphenidate from 4 million to 11 million and for amphetamines from 1.3 million to about 6 million from 1991 to 1999 (Hearing 2000).”
In fact, research in North Carolina in 2000 and 2003 demonstrated an unequivocal presence of ADHD in 9 – 16 year old children of only 0.9%. Oddly, accross the United States almost 10% of school aged children are diagnosed with ADHD and take pharmaceutical medication. Marilyn Wedge, Ph.D., in her article published in Psychology Today entitled Why French Kids Don’t Have ADHD, describes a cultural difference in how we view ADHD. According to Wedge, French psychiatrists still view ADHD as a social/situational condition and never adopted Eisenberg’s view that it was a biological/neurological condition. As a result, the percentage of children diagnosed and medicated for ADHD in France is less than 0.5%, much closer to the results of the North Carolina research.
But perhaps it is Eisenberg himself who reveals the underlying tide that has taken his scientific blessing to the curse that it is for many children today:
“Psychotropic drugs have become a multibillion dollar market. Sponsorship of research by drug companies is pervasive in academia (Studdert et al 2004). Systematic bias is apparent when companies sponsor research on their own products. Company sponsored studies are more than four times more likely to have outcomes favoring the sponsor than are studies with neutral sponsorship (Lexchin et al 2003; Als-Nielsen et al 2003).”
If we truly love our children, perhaps it is time to rethink how we view their behavior and our response when they misbehave.