One in Thirty Eight

Anyone catch the article in Newsday today, “Study in South Korea finds higher rate of autism,” by The Associated Press Carla K. Johnson (AP Medical Writer) (http://www.newsday.com/news/health/study-in-south-korea-finds-higher-rate-of-autism-1.2864765)?  Seems that South Korea puts the autism rate at one (1) in thirty eight (38)!  Is autism truly that prevalent?  It seems like it sometimes . . .

Personally, I don’t know what to say about the study.  It was based on an extremely large survey (55,000 students), follow up and some testing, although there is speculation that the population that responded to the survey may have been disproportionately made up of parents with children with issues, and it was indicated that very few of the children actually went through an entire diagnostic procedure.  How accurate was the survey?  And, how can it be so very different from our own CDC’s estimate of one (1) in one hundred (100) (although, I have mentioned it before, that estimate is probably low).

But it makes you think.  How do we define “autism”?  How do we diagnose it?  How accurate can we possibly be when it comes to disorders that are so subjective in nature?

What’s really at issue, though, is once it is diagnosed, what do we do about it?

And, again, sorry to anyone following this blog.  I am still working on my book about my son, and how we helped him “recover” from ADHD, ODD, and PDD.  The first half is done – the part about our story (from a father’s perspective).  The second half, the one with all the relevant research about the methods we used, is taking a while.  Seems there’s a whole lot of stuff that supports what we did.  I’m still trying to glean through the best of it.

ADHD, Adderall and Lindsay Lohan

So, heard the latest? I am not making this up.

Adderall May Have Unhinged Lindsay Lohan (8/20/2010 12:30 AM PDT by TMZ Staff)
Lindsay Lohan's Adderall dependence -- the result of a medical misdiagnosis -- may have been the reason she went off the rails.

[T]he docs at the UCLA rehab facility believe Lindsay was misdiagnosed with Attention Deficit Hyperactivity Disorder ... and then prescribed Adderall to treat the phantom affliction.

Dr. Joe Haraszti -- a prominent L.A. addiction specialist [states that] people who take Adderall when they don't need it can experience similar effects as people who use cocaine or methamphetamine.

Dr. Haraszti tells us ... people who unnecessarily take Adderall can display manic symptoms ... "and often do things like 'driving around until all hours of the morning ... smoking heavily ... tweeting ... and texting all night long." The doc adds, "They can become very impulsive."

"The doc also notes that people in that situation "might then complain of insomnia and then take Ambien or other sleep aids to help fall asleep ... it's a vicious cycle."

Dr. Marc Kern -- another addiction expert -- tells us alcohol abuse is also very common among patients who take Adderall.

Dr. Kern tells us, 'The Adderall counteracts the sedative side effects of alcohol use … making these people often drink more than someone who does not take the drug."

That is, pretty much, word for word, the article about Ms. Lohan, ADHD and Adderall. Now, let’s play a game. How many things are terribly wrong about the information contained in this article?

Here are my top three:

1. How is someone like Lindsay Lohan “misdiagnosed?” One would assume that she has access to the best medical practitioners around, right? So, are her doctors so inept that they could not diagnose a “disorder” that affects anywhere from 8% to 15% (or more, depending upon your information source) of the population?

Or, is it more likely, that the “disorder” is so vaguely defined, subjectively diagnosed, and misunderstood, both in its manifestation and causes, that it too difficult to diagnose correctly?
In either event, if Ms. Lohan is truly misdiagnosed, either through her doctors’ lack of skill or the inherent vagueness of this “disorder,” how do we know that our kids are not also being misdiagnosed?

2. “[P]eople who take Adderall when they don't need it can experience similar effects as people who use cocaine or methamphetamine.”

Ah, this one’s a bit trickier. Yes, people who take Adderall “can experience similar effects as people who use cocaine or methamphetamine.” No issue there. That’s because Adderall, Ritalin, and the like ARE IN THE SAME CHEMICAL FAMILY AS COCAINE AND METHAMPHETAMINE!! (in fact, Ritalin’s real name is “methyiphenidate”). And, like cocaine, they are all Schedule II controlled substances! (see http://www.justice.gov/dea/pubs/scheduling.html).

Thus, “like cocaine, Ritalin is a powerful stimulant that increases alertness and productivity. Ritalin and cocaine also look and act the same. Both have a similar chemical structure.” http://learn.genetics.utah.edu/content/addiction/issues/ritalin.html

So, what’s terribly wrong with this statement? First, Adderall affects EVERYONE the same way, whether you have ADHD or not! That’s why you can’t use the drug’s so-called effectiveness as a diagnostic tool. So, when you give your “ADHD” kid Adderall, he/she may “experience similar effects as people who use cocaine or methamphetamine,” including as
“Dr. Haraszti tells us … manic symptoms ... and impulsiv[ity]."

And lets not forget what Dr. Kern has to say: “alcohol abuse is also very common among patients who take Adderall.”

3. Just a headcount – how many of you parents out there were told either that (a) ADHD was very difficult to properly diagnose; or (b) that drugs like Ritalin and Adderall are class II controlled substances, just like cocaine, with a similar chemical structure as cocaine, that can cause “manic symptoms, impulsivity, and/or alcohol abuse”?

I’ll bet you were told, like me, these drugs were perfectly safe, with few if any side-effects. And, if your son/daughter had diabetes, you’d give him/her insulin, wouldn’t you?

How NOT to diagnose ADD

Got a call from a mom the other day. Concerned that her son might have ADD, she brought him to the family pediatrician. However, the doctor said he could not diagnose ADD with certainty. Instead, Mom told me the doctor said, "he would prescribe the ADD medication, and if it worked [?], then they would know for sure her son had ADD."

My jaw dropped into my lap. This is so wrong, that in my humble opinion, it borders on malpractice.

First, how on Earth can you prescribe a powerful, psychotropic drug to a child without having at least a reasonable certainty that the child suffers from the disorder which that drug is supposed to treat? These are serious drugs with serious known side-effects we're talking about!

Imagine fearing you had cancer, and you seek a diagnosis from your doctor. Your doctor says he can't tell for sure whether you have cancer, but, he'll start you on chemotherapy. If it works -- whatever that means -- then you'll know you had cancer.

Sound right to you?

Second, using drugs to diagnose ADD was rejected as an approach over a decade ago! The fact of the matter is, when given in prescription appropriate doses, these drugs have the SAME effect on "normal" folks as they do on those with ADD. Thus, the drugs "work" no matter to whom they are given.

Finally, has this mom's doctor not read anything about these drugs being abused on college campuses by students seeking an edge? If these students are using these drugs to enhance their attention and studying skills, how can you possibly use them as a diagnostic tool?

When did the prescription of these drugs become so commonplace, so automatic, so nonchalant, that we forget that there are dangers attached to the practice? That it is not "normal" to need these drugs? That we are doing no more than putting these poor children into a drug-induced state?

Again, I understand the use of medications. When you've tried everything else, and nothing is working, and you are desperate for your child to have a happy, successful life. I get it. I've been there. I've done that.

But, it is a last resort! One taken after very careful consideration. You would think a doctor would know that.