Judging by today's news stories, our modern developed countries show care and concern for troubled children and youth by creating a wide variety of psychiatric labels and psychiatric drugs applicable to young people, which is constantly reviewed and modified. You can call me cynical, you can call me a Luddite, but I've got a rather stong suspicion that this is not what the young people of today need.
Western Australia apparently still leads the nation in rates of prescription of ADHD drugs. How long has WA been the national leader in child psychiatric pathologizing? What is happening in Western Australia? I believe WA has a booming economy and also has many families in which a parent works away from home in the mining industry. Are West Aussie families so obsessed with earning buck that they are neglecting their kids? Someone has to ask this question. Readers from Western Australia please feel free to let me know what you think in a comment.
A new study by WA researchers has found a link between the use of such drugs and raised blood pressure and poor academic achievement in the kids on these drugs. The thing that really annoys me about some of the media coverage of this study is that the finding that these drugs do not improve academic performance is being treated as though it is new knowledge. This is not true at all. Many years ago I was most interested in the ADHD controversy in Australia, and I was surprised to read in some review or clinical guideline or position paper put out by a peak body in the profession of psychology (it could have been the Australian Psychological Society)that it is a well-established fact that ADHD drugs do not improve academic performance, based on the findings of credible studies. The drug apparently just make the kids behave better in class and sit still, which surely does not solve any problems from the child's point of view.
Did you see the story at the web site of New Scientist about a murder trial concerning the death of a 4 year old girl in the US? The mother reportedly gave the child an overdose of the psych drugs the child had been prescribed for "juvenile bipolar disorder". JBD is a very worrying recent fad in child psychiatric diagnosis. It is for good reasons that this diagnosis is controversial. I don't think it is as popular here in Australia as it is in the US, which is a good thing I'm sure. I have no faith that the proposed dignostic category that is being put forward in the US as a superior alternative to JBD as a diagnosis will improve the situation. Apparently the American Psychiatric Association are proposing a new category - Temper Dysregulation Disorder with Dysphoria (TDD). Here we have more labels and drugs for kids, when it is so obvious that what struggling families in the United States really need is a decent nationalised health care system (like the public health systems that all other civilized first-world nations have), a humane welfare system, a healthier economy (like the one we have in Australia) and a culture that values children's welfare more than wealth, and that identifies social problems in society and does not blame or medicalise the victims.
Another recent media story adds to my concern about the way that we are pathologizing and labeling the troubles of young people. Professor Patrick McGorry, 2010 Australian of the Year was featured on Monica Attard's Sunday Profile on ABC Radio National in January of this year. Attard asked the professor about the popularity of Borderline Personality Disorder as a diagnosis for troubled Austrlian young people. Prof McGorry acknowledged that BPD is a controversial diagnosis, then he went on to defend it's clinical validity. Based on his description of the symptoms of BPD, I thought it was a list of behaviours that one could well find in a troubled undiagnosed autistic teen, but you could accuse me of being overly focused on autism as a diagnosis. I do know one thing, though - BPD has been identified by more authoritative people than myself as a diagnosis that autistic people have in the past been incorrectly given. I refer specifically to Asperger syndrome authority Prof. Christopher Gillberg and author Prof. Roy Grinker.
It appears that there are good reasons why the journalist Monica Attard raised questions about BPD. One only needs to look at web sites of organizations that Prof. McGorry leads to see that there is a questionable emphasis on providing information about BPD (and a lack of comparable information put forward by these information services about autistic spectrum conditions). Check it out for yourself. I have included links below to Orygen and Headspace. Can you find any fact sheet at either web site about autism or Asperger syndrome? No? Any fact sheets offered about any personality disorder besides Borderline? No? But the Orygen web site does offer a fact sheet about BPD. This seems odd to me. And why no fact sheet about autism or AS offered by Headspace while a search on the term "Asperger's" at this web site retrieves 1000 results? I guess one could argue that autism is not a mental illness, and this is why these mental illness related web sites do not explicitly offer info about autism. I would reply that autism is often misdiagnosed as a mental illness, and is quite often co-occuring with mental illness, so info should be given if only for the purposes of differential diagnosis and self-diagnosis. And then I guess you could argue that diagnosis and differential diagnosis should only be done by qualified professionals, and mere laypeople do not need information applicable to these things. To that I would say something offensive. I guess we have got to expect that there will be, or is already, a boom in the rate of diagnosis of Borderline PD in Australia. More labels and pills. Just what what the young people of Australia need.
"Child psychiatric diagnosis on trial"
New Scientist
http://www.newscientist.com/article/dn18534-child-psychiatric-diagnosis-on-trial.html
"Doubt over ADHD drugs"
The West Australian
http://au.news.yahoo.com/thewest/a/-/wa/6813302/doubt-over-adhd-drugs/
"Professor Patrick McGorry, 2010 Australian of the Year"
Sunday Profile
ABC Radio National
http://www.abc.net.au/rn/sundayprofile/stories/2010/2806382.htm
Headspace
http://www.headspace.org.au/
Orygen
http://oyh.org.au/
"Misdiagnosed, miscategorized, under-investigated, mistreated and misunderstood: diagnostic, administrative, research, informal and historical labels that have been given in the past and/or in contemporary times to people on the autistic spectrum"
Incorrect Pleasures (this blog)
http://incorrectpleasures.blogspot.com/2008/11/misdiagnosed-miscategorized-under.html
Lili
ReplyDeleteI can tell you why. It's all about money and greed. Let's look at our american medical system. What the doctors do is they treat the symtoms but not cure the underlying problem.
This is why my wife changed her mind about being in the medical field. She would get into hot water for curing the disease instead of treating the symptoms.
Here is another thing that could be possible. The more problems they put forth they more solutions they provide. The more solutions they provide the more money that gets added to their pockets.
I don't know how it is in Australia but I believe this is how it is here. This is why you see so many kids on ritalin who really don't need it.
The honest truth is the educational wants the ADHD kids to learn in a way that is unnatural for them. I believe that ADHD may really be just a personality type. This is keirsey's belief as well.
http://www.keirsey.com/
http://www.keirsey.com/articles.aspx
Check this article about ADD as well. http://www.keirsey.com/add_hoax.aspx
Maybe we need to start questioning the DSM and those write it.
There's a lot in your comments that I agree with, Cube Angel. I'm about to have a much-needed and well-deserved "nanna nap" in this summer heat, so I'll try to find time to look at those links later.
ReplyDeleteYou may already know my opinions on ADHD - I've shared my opinions often enough around the internet. I believe ADHD is just a dustbin diagnosis - perhaps there is a core of cases of a genuine syndrome characterised by short attention spans, high levels of physical activity and impulsiveness, but I think many of the kids with this label would be better described as Conduct Disorder/psychopath, classic autism, Asperger syndrome, genetic syndrome, brain damaged, FAS, child neglect or intellectual disability.
I recently read an interesting and frustrating letter to a newspaper about the ADHD controversy in Australia. It was written by the parent of a teen diagnosed with ADHD. It was a plea for tolerance. The parent explained how demoralizing our school system is for a child who had real disabilities in reading and writing, and explained that the drugs are just about the only help available in such situations. The parent explained that ADHD kids are often also diagnosed with "comorbid" conditions. The parent also explained that this child was placed in situations at school in which the most able kids share a class with the least able kids. This left me feeling frustrated for many reasons.
Firstly, as I think the parent observed, there is a huge emphasis on literacy in primary schools in Australia now days. Little kids are expected to have the skills of sophisticated literary reviewers, and be able to speak in front of a class like the most articulate commentator. This is an unecessary burden on kids, and it is an example of the current over-feminization of education. In contrast, systemizing and manual skills are almost absent from primary school education. As far as I'm concerned this is a war against boys. Secondly, the parent just accepted that students of all ability levels will inevitably be schooled together, destroying the self-estemm of the least able and frustrating the most gifted to the point at which children at both extremes develop mental health problems. It doesn't have to be this way! I actually found a government primary school that streamed kids for the core subjects. This can be done in any primary school, but there must be some political reason why it usually isn't. Thirdly, why are we all pretending that ADHD is a distinct, stand-alone disorder, when the reality is that it is often found with a cluster of other disabilities? Would it be more honest and sensible to describe many ADHD kids as intellectually disabled kids? Why is our society too immature to face the reality that there are many people who are significantly above or below the norm in intelligence? If we can't even face the truth, then we can't effectively deal with the situation at hand.
You mentioned ADHD in relation to personality. Apparently ADHD is associated with very low scores on the personality dimension of Conscientiousness. That is from page 265 of the book "Personality" by Daniel Nettle. If you wish you can discover your own personality type in a scientifically valid way here: http://www.personal.psu.edu/~j5j/IPIP/
"Would it be more honest and sensible to describe many ADHD kids as intellectually disabled kids?"
ReplyDeleteLili, when we mean intelligent do we mean IQ?
Do you have the hard core data to back this up? For example, do you have access to IQ scores for all ADHD kids.
On the IQ test, a person could be a genius in a few areas and be severely retarded in a few other areas. Are they intellectually gifted or are they intellectually disabled? Or could it be both?
What are the premises and data that you used to come to your conclusions? For all I know I could be wrong and maybe I'm not seeing it.
Cube Angel asked:
ReplyDelete"On the IQ test, a person could be a genius in a few areas and be severely retarded in a few other areas. Are they intellectually gifted or are they intellectually disabled? Or could it be both?"
When I was a student of the science of psychology many years ago at the best university in the city where I live, we were taught about the concept of "g". If I remember this correctly, "g" stands for "general intelligence factor" which means in brief, if you do well in one test of intelligence you will probably do well in any other as well. This means some people are generally bright, some people are generally not smart, but most people are average, and it is unusual for anyone to have highly discrepant scores in different tests of intelligence. As far as I know, there are plenty of people who don't want to believe this, and would prefer to believe theories such as Gardner's multiple intelligences or the late Stephen Jay Gould's ideology, but the concept of "g" is still the best supported by the hard scientific evidence.
It is important to note that while Stephen Jay Gould wrote a higly influential book about psychology and IQ and history which rubbished the concept of "g", he was a paleontologist, not a psychologist or a historian. Academics who stray into academic areas in which they do not have expertise often end up in conflict with academics who are more suitably qualified.
Now, back in the olden days when I was a psych student we were also taught that there are interesting exceptions to this concept of "g" -"idiot savants". These so-called idiot savants were presented as being plainly very abnormal because they do not conform to this idea of "g" - they were supposedly very clever in some areas of cognition and complete idiots in others. Back then this couldn't be explained, and savants were presented to psych students as an interesting mystery. These days I think that these so-called idiot savants probably only looked like idiots because they had communication and language disabilities that prevented them from doing as well as they otherwise would in some tests of intelligence. This belief is supported by recent research into the Raven's Progressive Matrices IQ test and autism. So I don't believe savant syndrome disproves the theory of "g" any more than blindness or deafness does. They are all disabilities that need to be taken into account during IQ testing. This doesn't make IQ testing invalid. And I'd also like to say that I don't think that the existence of many "2E" people (twice exceptional people who have both intellectual giftedness and some type of learning or behavioural disability) disproves the idea of "g" either. My guess is that their areas of poor performance would be pretty much limited to areas of disability, but I'll admit that I'm no expert in this area. Lastly, our own kids display highly uneven scores in academic tests. Some of our kids each have one specific area in which they consistently do extremely well when tested, and do above average in all academic areas. Once again, I don't see our kids as disproving the concept of "g", as they are generally above average, but I'll admit that the specific gifts are hard to explain. Gifted kids often display this type of uneveness, but they are generally bright in all areas.
I hope I haven't sent you to sleep with my long reply. Your questions deserve to be taken seriously.
Further reading:
Wikipedia on "General Intelligence Factor"
http://en.wikipedia.org/wiki/General_intelligence_factor
"Not every child is secretly a genius" by Christopher Ferguson in The Chronicle Review
http://chronicle.com/article/Not-Every-Child-Is-Secretly/48001/
"The puzzle of hidden ability" by Sharon Begley in Newsweek
http://www.newsweek.com/id/32250