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Sick, injured or merely different? Rising ADHD cases fuel running battle among mental health experts

Published: Tuesday, Feb. 18 2014 10:15 a.m. MST

Doctor shopping can follow, especially in the college years. “Pretty soon, these kids are getting into a dangerous range,” Conners said. He notes the case of Richard Fee, an aspiring medical student, profiled in The New York Times, who used ADHD drugs as a crutch to improve his grades. Fee ended up killing himself after going through forced but unmonitored Adderall withdrawal. Doctors had finally stopped giving him prescriptions after he had abused the drug to improve his school performance for an extended period.

And the drugs are everywhere on college campuses. Conners asked his son, who graduated from Duke University last year, how easy it is to get unprescribed Ritalin there. “Let me put it this way,” his son answered. “If you ask three kids for Ritalin, two of them will hand it to you right then.”

A social problem?

And yet, some reject the whole framework of ADHD as an illness.

Among the skeptics is Dr. Gary Greenberg, a psychotherapist and the author of “The Book of Woe,” which profiles the chaos in the psychiatric profession as it crafted its new diagnostic guidelines, the “DSM V,” which was released last year. Those new guidelines significantly loosened ADHD definitions, which critics say will lead to more dubious diagnoses.

ADHD is not an illness, Greenberg argues. There is no blood test, no brain scan, no x-ray for it. It is, he says, just a label we give to kids who are ill-suited for our increasingly narrow and unnatural educational and career options. Greenberg speaks passionately against using drugs to treat a problem imposed by poorly adapted social institutions.

“At the risk of being cliché,” Greenberg said, “we are facing a perfect storm.” Distractions are everywhere, especially the Internet, which exploded since 1994. Then we have the push for ever more “rigor” in the classroom. We are making enormous demands on the children, especially the boys. And schools don’t have the time or resources to deal with it.”

Yeoman farmers

Dr. Elias Sarkis, a family psychiatrist in Gainesville, Fla., agrees with Greenberg that there is no real pathology involved with ADHD, that it is really just our way of saying that some kids are not designed to sit for hours in a classroom or work a desk job. And yet, Sarkis sees no real way around diagnosis and treatment.

“School is a very difficult environment for children with ADHD," he said, “but there is no use blaming modern complexity. There is no place in today’s economy for the yeoman farmer on a two-acre farm. If my kid were ADHD, I wouldn’t sacrifice him while waiting for the world to change.”

Born in Lebanon with French as his first language, Sarkis attended medical school in France and has close ties to the French psychiatric community. French psychiatrists are extremely averse to using drugs, and Sarkis often gets in vigorous debates with his friends and colleagues there.

French psychiatrists prefer to treat ADHD with “play therapy,” a form of drug-free therapy that Sarkis says works well for anxiety disorders. “Play therapy can be a powerful tool,” Sarkis said. But he views it as a clumsy half measure with extreme ADHD.

Sarkis guesstimates real ADHD incidence at between 6 and 8 percent of school-age kids. “But I am not an epidemiologist,” he hastens to add.

Overworked doctors

Whether the real number is closer to 3 percent, as Keith Conners says, or 7, as Sarkis guesstimates, few disagree that the 11 percent of school-age children, with rates still climbing, is too high.

Conners says he has many friends who are primary care doctors caught in a crossfire. One told him he only gets 15 minutes to diagnose a child, and only a few minutes at a time for follow up. That’s all the insurance companies will pay for.

Most primary care doctors never get a chance to explore stress from the street environment or chaos or abuse at home, Conners says. Nor do they have time to offer the kind of behavioral management of psychotherapy that more complex cases would demand. The drugs, he says, often become a mask, covering real problems that go unaddressed.

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