ATTENTION DEFICIT

"Attention Deficit Disorder" is a term that was introduced in the 1980 Diagnostic and Statistical Manual of the American Psychological Association to describe children who had previously been labeled "minimal brain dysfunction," "hyperkinetic," "organic brain disease," "clumsy child syndrome" or "nervous."

Amphetamines like Ritalin (methylphenidate), a drug that replicates the effects of cocaine in the brain, have been used since the 1950s by C. Keith Conners, Leon Eisenburg, and others, to treat children with learning disabilities. However, the man who is most often credited with creating and promoting the idea of "attention deficit disorder" is Russell Barkley, a psychiatrist at the University of South Carolina.

Currently there is not a single test that can accurately identify attention deficit; the common practice of diagnosing ADD based on failure to pass a vigilance test (a measure of boredom tolerance) is completey unscientific and misleading, as is the practice of diagnosing ADD based on questionnaires given to teachers or parents. These subjective measures are wildly variable given the academic background and experiences of those filling them out since few are likely to be able to tell the difference between symptoms of delayed development, sensory processing problems, high IQ, boredome intolerance and abnormal development.

in 1998 the National Institutes of Health published a consensus statement that stated:

Depending upon where you live, psychologists will diagnose ADD based on different criteria. In the US the criteria were established by the American Psychiatric Association (APA), who identified three types of ADD: inattentive, hyperactive, and both. The WHO (World Health Organization) recognizes only one type: inattention with hyperactivity.

The most common reason parents give for seeking medications for ADD for their child is that one of their child's teachers has complained or requested that the child be medicated. I can never say this to often: neither teachers nor parents are trained to recognize the symptoms of sensory processing disorders, cognitive disorders, or developmental disorders. Unless someone is knowledgeable about the neuroscience of cognitive development and sensory processing in the brain, they are highly likely to misdiagnose or misinterpret what they are observing.

Children, even very young children, are often prescribed amphetamines like methylphenidate (e.g. Ritalin) for ADD based on the mistaken belief that the medication will improve their child's academic performance or ability to learn. The very few papers that have actually looked at academic skill development and ADD medication have found that there is little or no improvement of academic skills after medication and some reserachers have found that there is a negative effect. (A list of citations on this topic can be found in the book, Sensory Processing Disorders by M.L. MacAlpine)

What is worrisome is that very little reserach has been done on how amphetamines affect the developing brain. We know that amphetamines like methylphenidate block dopamine receptors and prevent the recycling of dopamine back into neurons, which effectively increases the amount of dopamine in the frontal lobes. This increase in dopamine provides the "feel good" effect of amphetamines and this spike, together with altered levels of norepinephrine and serotonin, produce a feeling of power and competence (which is one of the reasons that amphetamines are so addictive). Unfortuately, these neurochemicals are also involved in things like maintaining sleep/wake cycles, hunger and satiety, arousal, heart rate, blood pressure, responding to stress, and, of course, learning. (for more information, check out the review by Yamashita et al from 2006).

The greatest problem with using drugs to artificially increase dopmine levels in the brain is that the brain will respond by shutting down its dopamine receptors and transporters and, if you don't stop, killing them off altogether in order to bring dopamine levels back to normal. Researchers have found that four months of exposure to methylphenidate results in a loss of about 20% of the dopamine receptors and 75% of dopamine transporters in sensory processing areas of the brain (see Vles et al,”Neuropediatrics. 2003 Apr;34(2):77-80).

As if this wasn't enough reason to avoid giving medications for ADD to children, consider the fact that cocaine and methylphenidate are so similar that they compete for the same binding sites in the brain and their uptake and distribution are identical (see Volkow et al, 1995 and 2005). In fact, one could argue that cocaine is less of a problem than methylpheidate in the brain because it is removed from the brain much faster. Any difference in effects between cocaine and methylphendiate is generlaly the result of expectation (which alters the way the brain responds). Cocaine addicts report that the effects of methylphenidate and cocaine are actually very much the same, producing similar senses of elation and empowerment. It is baffling to realize that physicians are willing to give young children amphetamines that are so similar to illegal drugs.