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Current media depictions of AD/HD

We seem to be seeing a new resurgence in media coverage that either question the basic existence or nature of AD/HD or the validity of diagnostic or prescription practices. I’m in Canada, but a lot of what I’ve seen tracks back to the NY Times coverage, which local media tend to plagiarise with the sensational elements and without the qualifications that the NYT runs.  That is a battle we probably have to fight one article and publication at a time, but a lot of these journalists also consult Additude. 

In that context, I am wondering if we might suggest a column or page in which practitioners and research experts could comment on some of the content it runs.  I see this morning a post relating to Mr. Amen’s latest “7 Types of AD/HD”  book.  A quick search of Amen €™s credentials turns up a lot of references ( €œsnake-oil salesman €, €œa picture is worth a thousand dollars €) that suggest his credibility is questionable, and he €™s also been criticised for scanning children when there is no clinical justification for the radiation exposure. 

I am in the course of reading his book and much of it does not seem consistent with either the existing (and justified) skepticism about the ability of any available neuro-imaging technology to spot the physical characteristics (if any) of conditions such as AD/HD and ASD.  It also isn €™t consistent with my own experiences as a person with AD/HD.  It is damaging to publish unbalanced or uncritical discussion of AD/HD issues, especially if the suggestion or inference is that it can be €œfixed € or €œhealed € in the face of strong evidence that it cannot.  Additude cannot afford to vet or peer-review the content it runs, but both media and readers with AD/HD could use some caveats attached to content like this - and in this case attention “focused” on links to some of the professional comments on the limits of neuro-imaging and his depiction of the disorder itself.

Replies

I completely agree with this writer except that I think ADDitude could and should vet what they print. As a professional diagnosing and treating ADHD, it is hard enough convincing some parents that their child has a neurologic condition that needs treatment. If they are seeing all kinds of articles that suggest that ADHD isn’t real, isn’t that bad, probably isn’t really a disability, these parents have a hard time believing ADHD is serious stuff.  If they are also seeing a lot of articles trumpeting a bunch of unproven treatments, they are less likely to go with what has been proven to work.
We all have a responsibility to provide our patients/ readers with what has been proven.

Posted by Terryjames on Mar 26, 2014 at 11:02pm

As a lay person I think this is a fantastic idea. I feel that the science and medical communities should put more pressure on the media to vet information and accurately report on scientific studies. As a woman with ADHD, PMDD, and PCOS, I frequently have to read articles about how the very real things I have experienced my whole life are nothing but inventions of the pharmaceutical industry. Even when just reporting on these conditions, most of the information is just flat out wrong, usually a result of trying to condense a lot of complicated science into a single page blurb. Maddening.

Posted by LLB827 on Mar 28, 2014 at 6:57pm

Just to be clear: “Mr Amens” is a medical doctor with psychiatric training, according to a professional bio at WebMD. I presume that the physicians themselves write these, since Dr Amen’s refers to his many articles and books, whereas I found nothing under his name when searching the standard medical databases at a local academic library.

I have watched (out of curiosity, not as a fan, patient, researcher or anything else) a Change Your Brain program on our PBS station, and my verdict would be that he is a “style over substance”, a popularizer; he reminded me of Christian evangelical preaching. But that style appeals to a lot of the public, apparently.

His content, however, about the basics of ADD and its treatment seems no better or no worse than any other popularizer. His 7 types of ADD typology and his use of SPECTscans give him the appearance of being at the cutting edge of diagnosis and treatment—a factor that no doubt adds to his credibility with certain kinds of audiences, while being a negative factor for others. He is certainly at the margins of mainstream clinical practice.

QuackWatch.org has a page of questions directed to him, with his responses and the MD quester’s response to those response. It can be found here:

http://www.quackwatch.org/06ResearchProjects/amen.html

His scans do strike me as a tremendous waste of health care dollar resources. Moreover, it feeds into and builds on a public presumption that testing can confirm pretty much any diagnosis. In his responses to the QuackWatch questions, he claims that the scans are never interpreted in isolation. Bracketing off the cost of the scans, this is what EVERY clinician says about EVERY neuropsychological test used for diagnosing ADHD, and still there are people being sent for testing. In the end it still comes down to good clinical judgment.

While the medical community is not prepared to use scanning for diagnostic purposes, the research articles I have read seem to be close to a broad (if still rather vague) consensus that the brain of someone with ADHD scans differently, and that those differences in scanning reflect the symptoms and behaviors of ADHD, and that the differences seen in the ADHD brains have statistical significance.

I suspect that, if the cost factor could be overcome, there would be growing numbers of clinicians sending patients for scans, even if the results revealed findings of “consistent with ADHD” or “frequently found in ADHD.” 

Further, Dr Amen is not alone in using research scan results in presentations to the general public. Such references are common, such that there is predictably someone in the audience asks the question, “If the brain imaging shows this, why can’t we do one as part of the diagnosis?”

Posted by ADD me on Apr 08, 2014 at 11:49pm

I’m not a radiologist, but I can read and I am enough of a scientist to understand that whatever the differences are between the brains of people with AD/HD, ASD, assorted specific LD and the like and neuro-typical people are either chemical, and will not be visible at all, or if they are physiological they are so small as to be well below the normal variance in brain dimensions.  Averaging a few thousand ADHD persons and an equal number of neuro-typicals might show, say, a small difference in the prefrontal cortex, AC cortex or amygdala, but that does not tell you whether a specific patient has a smaller ACC because he has ADHD or just because he has - a smaller ACC.

I would love to be corrected and told that a definitive scanning diagnostic is just around the corner, but anyone making such a claim will have a hard time convincing even this amateur scientist that he isn’t selling snake oil. 

fMRI tests are the exception to this because they show patterns of brain activity and that LD or ADHD brains are structured differently in the areas that are active in performing certain tasks.  That is great because it does give some tangible evidence that ADHD is neurological in nature and not bad parenting or a conspiracy of pharmacists, and it has a lot of research potential, but there is still so much variation in “normal” brain activity that it isn’t clear enough to be a definitive diagnostic tool.  My guess is that it could be made one in theory, but you’d have to do maybe 50-60 scans to figure out each subject’s normal range of brain activities for various thought or emotional scenarios.  And to what purpose? The present standards here in Canada require about 10 hours of the time of a trained psychologist or psychiatrist.  That is a whole lot cheaper than all those hours of MRI time, and it doesn’t expose patients - especially children - to radiation.

Posted by Cedar on Apr 19, 2014 at 8:50am

On the other line of discussion I started, I agree that there is a need for Additude to vet content it runs, and I have suggested that directly.  Nobody should run incorrect or unfounded information, and this is especially true for medical info because the snake-oil salespersons cause harm by diverting attention to actual treatments that do work. 

The man who started the myth that certain vaccines are linked to autism disorders was later struck off by the British Medical Association for academic or research fraud, and he was eventually convicted of criminal fraud (he had money invested in a competing vaccine), but hardly anyone knows this.  Meanwhile there are a lot of dead and brain-damaged children because they or their peers were not vaccinated by parents who bought (and still buy) this delusional bumf.

But at the same time, a healthy discussion of “alternative” or unproven treatments can sometimes be more productive in getting out the word than just blocking content.  There are a number of experts whose credentials are solid and a few words from them would go a long way, especially if Additude attests to their credibility.  There is a huge difference between someone like Amens making fantastic claims and selling thousands of books and the sort of legitimate divergences between experts like Hallowell, Brown and Barkley on things like ADHD and creativity and the nature and scope of executive functions.  The problem is that not everyone self-educates to the level of being able to tell the difference and pretty much every newly-diagnosed person or parent of such a person is a sitting duck for the snake-oil. 

Huge sums of money are being made on ADHD and honey attracts flies.  This is where the editors of Additude should come in. We need an anti-crap squad to send some of these folks packing.

As an example, since I originally posted this, I found a pretty solid rebuttal of the original NY Times pieces by Thomas E Brown that are on his website and maybe ran on page 82 of the NYT.  Re-rolling or posting links to those, assuming Brown consents would be a good start.

Posted by Cedar on Apr 19, 2014 at 9:11am

My name is Adam and my wife only take information from sources who have done their research from scientific based facts only. We do not mention any of the above to my sister, and Mother, since they only believe whatever superficial stuff is around.

My mom’s stubborness will be her downfall. She has undiagnosed adhd.

It’s very hard to filter out her impatience with, for instance, her need to have people’s information immediately, enrollment in medicaid

Does anyone have knowedge of add counselors who deal with sliding fees?

Posted by addsquasher47 on Apr 27, 2014 at 10:05am

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