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Why Doctors don't Agree on ADHD and ADD

15th March, 2010.

Why are there so many different opinions on the subject of ADD and ADHD? The confusion lies in the basic paradigms from which the different groups approach the condition. ADHD and ADD are not diagnosed with physiological criteria, but only through subjective perceptions of behaviour.

This means that ADD and ADHD diagnoses are not objective. Dr. Mary Ann Block, author of “No More ADHD” wrote:

ADHD is not like diabetes and Ritalin is not like insulin. Diabetes is a real medical condition that can be objectively diagnosed. ADHD is an invented label with no objective, valid means of identification. Insulin is a natural hormone produced by the body and it is essential for life. Ritalin is a chemically derived amphetamine-like drug that is not necessary for life. Diabetes is an insulin deficiency. Attention and behavioural problems are not a Ritalin deficiency

The basic difficulty of understanding something differently from the way we have been told or taught has followed us through the millennia. The problem existed in the days of the Greek philosophers and probably dates back to the first humans.

Many have lamented about this. In the field of psychology, Salvador Minuchin, one of the ten most influential therapists of all time, and well-known innovator in the field of family therapy, said:

How did people respond to our research findings? By defending their own paradigms. In response to new knowledge, there is always the question of how to maintain oneself doing the things one was trained in.

Despite this, there are many exceptions within the fields of psychology and psychiatry of professionals who are aware of the shortcomings in these fields and are eager to learn about any methods that can benefit their clients.

How can so many intelligent and educated professionals arrive at such profoundly different conclusions?

It starts at school where we are taught facts mixed with theories, and because we are tested on them, we tend to learn all as fact. over the years we are conditioned to accept what we are taught. There is very little time to discuss each issue in detail. This is how it has been throughout the millennia.

At university, the student is usually young and fresh out of school, and therefore easily moulded. The lecturers teach with an air of authority, and do not let the student wander out of their paradigms. There is much encouragement to be free thinkers, but there is a strong pressure to stay within the lecturer's paradigm. Within that framework there can be a dynamic debate, but never, never, can the student stray outside that framework.

This together with the study pressure and the excitement of the new life inhibit the student from enquiring. So, as has happened over thousands of years, the student absorbs what the lecturer presents, packaged in the university's accepted paradigms. When the student has graduated, there is seldom a great desire to go through the three, four, seven or twelve years of study and analyse if they were derived from error free paradigms.

New ideas are seldom accepted easily. The idea of little germs causing diseases was ridiculed 150 years ago. In 1847, Dr. Ignaz Semmelweiss, a Hungarian doctor in a Vienna hospital, discovered that there was a higher rate of death from puerperal fever among women after giving birth, assisted by doctors who failed to wash their hands between examinations. Semmelweiss made a regulation that doctors were required to wash in a chloride of lime solution after autopsies and with soap and water between patient visits. Doctors also had to change into clean lab coats before examining patients. As a result, hospital mortality rates from these infections declined dramatically.

Even after his success Semmelweiss was mocked by senior physicians, who did not believe in the new fangled idea of tiny germs causing these infections, and considered washing hands after digging in a corpse as silly.

How do we get knowledge?

first principles through paradigms to knowledge

Subconsciously we start with what is called first principles. These are not derived from anything, as they would then not be first principles anymore.

Before we even think of some concept we already have a first principle.

First principles are unprovable.

From first principles, assumptions are made, which are usually the logical conclusions of the first principles. These are the source for our paradigms and belief systems.

Out of the paradigms we derive hypotheses, which, when proven become theories. When hypotheses and theories become generally accepted, they are regarded as facts and considered as knowledge.

When a professional gives an opinion in an authoritative manner, especially when no alternatives are presented, it is legitimate to ask questions giving a clue from where the 'knowledge' was derived.

The “medication only” and the “it's genetic” schools of thought, both originate in the first principles and subsequent assumptions, that all that exists is materia and we can know everything through our senses. The immaterial does not exist in this view.

Cognitive Behavioural Therapy and Neuro Linguistic Programming accept there is something we do not know or understand, but we can influence through cause and effect, and do not need to know and describe everything in detail.

This is why we see two sides in conflict. The medication side say they are scientific and that Cognitive Behavioral Therapy is not scientific because they cannot give a materialistic explanation of the mechanism whereby their methods work. This is ironically, an unscientific view, as science has always progressed by researching phenomena that cannot be explained, otherwise there is nothing to research.

Those advocating diet and supplements as cures are in the tree making new hypotheses and testing these, which is also more scientific than the so called “scientists” advocating medication.

The industrial revolution happened through of normal working people, the craftsmen and inventors. It was not a product of university educated people.

It is not impossible for a reasonably educated person to have more knowledge of a subject than a professional, especially if there is a motivational stimulus involved, such as helping one’s child or spouse. The professional’s education is a broad-based education attempting to give the student a broad overview of the subject. Specialisation and depth in few fields come at a later stage, and each individual studies a narrow field there. ADHD or ADD specialization is not necessarily in a doctor’s CV.

The doctor being consulted might have studied ADHD at medical school. The subject was passed many years before. A course over two months, or three hours a week for a semester, and based on one or two books, gives a limited insight into a complex subject. If the books were biased towards ADHD and ADD medication, and pharmaceutical companies hosted the subsequent seminars on ADHD the doctor has attended, then the physician will, by default, be ignorant on the subject. However, since the doctor does not know that he does not know, he is under the delusion that he is competent in the field of ADHD, even knowing the “latest research.” Even what is considered “latest research” can be biased and needs to be carefully evaluated.

Research is not published as absolute fact, but to allow other researchers in the particular field to evaluate what the authors have concluded. There is evidence that there is systematic under reporting in pharmaceutical companies drug trials, especially antidepressant trials.

A physician might tell a questioning parent that there is no evidence food dyes cause ADHD symptoms. The physician is naively repeating information given at some seminar. Firstly this has been shown to be the cause in many ADHD cases, but not for all cases.

The statistics are said to not show a statistically significant difference. The same “statistical insignificance” in found in antidepressant trials, but there it is defended to justify putting the drug on the market. In the one case the statistics are accepted and in the other rejected. Both times they are in the pharmaceutical companies favour.

If, for example, in a trial 100 patients with depression are given a placebo, and 100 patients are given the active antidepressant. The results show an improvement in 30 patients who received the placebo, and in 50 patients who received the active antidepressant pills. But 30% were actually placebo, leaving only 20% of the patients being helped by the anti depressant.

A concerned parent, in contrast, starting out in ignorance (which is a good place to start) reading half a dozen or more books from different viewpoints over a year, has a far better understanding of the ADD and ADHD condition. That parent has a vested interest in the knowledge. That parent can continue an in-depth study reading scientific publications in university libraries, and be competent in the field of ADHD/ADD.

The physician and psychologist has not gained knowledge in an objective and neutral manner. They have been presented a biased set of information based on their particular institution's leanings. The lay person coming to the subject is initially confused by conflicting opinions, but can approach the subject in an objective and neutral manner as the lay person is not being force fed a certain opinion.

Although this is difficult, it is not an impossible task. There is not the need to understand peripheral subjects in depth. Unfortunately the medical profession is, generally speaking, rather insecure on this point. Other professions, such as engineering, do not suffer this pathological insecurity. An engineer does not feel threatened by a knowledgeable layman understanding structural and mathematical concepts, questioning construction methods.

Maybe the Hypocritic Oath is partly to blame. It does say that those taking the oath must keep their secrets to themselves and not let outsiders into those secrets.

For some people who exhibit ADHD or ADD behavior patterns, medication is the best solution. This should be used to enable the person be able to benefit from cognitive behavioural therapy, or learning coping skill strategies. To give medication as a first and only option, is from the physician's side naivety, ignorance, laziness (in not verifying information given), or plain irresponsibly sloppy.

A parent should not rely on the physician, since there are other experienced physicians with an opposite opinion. The parent listening to a “medications only” doctor are either naive, ignorant, or maybe so relieved to get a break that they cannot think straight. It is after all the doctor's responsibility, but unfortunately, many are deluded and are ignorant of where the source of their education lies.

Two physicians can undergo the same education; one will blindly follow his prescribed text books and lecturers, while the other will think. Same education, but a very different result.

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