Brain Cancer Statistics

Shortly after Sroufe's article appeared, Harold S. Koplewicz Md, President of the Child Mind Institute, wrote a point-by-point rebuttal of it; if you're concerned in this issue, the article by Koplewicz bears reading and can be found online. I won't bother to summarize the whole piece, but suffice it to say that he brings some fairly persuasive evidence in hold of the effectiveness of stimulants to treat Adhd symptoms in children and raises foremost questions about the validity of the studies cited by Dr. Sroufe and the conclusions drawn from them.

I still have major objections to the current ways we think about and treat Adhd symptoms, however, and I'm not ready to write off Dr. Sroufe, as Koplewicz does. First of all, any consulation that asks the interrogate 'What is Adhd?' misses the point; Adhd is not a disease condition, as the label would have us believe. Instead, as defined by the Apa in its Diagnostic and Statistical Manual, it's a set of behavioral markers that many citizen believe indicate a disease state, but can unquestionably be produced by any amount of different conditions, along with brain abnormalities, early physical insults, emotional trauma, etc.

The disease model of the current Dsm, along with marketing strategies employed by the pharmaceutical industry, conduce to the coarse misconception that an actual "disease state" has been identified not only for Adhd, but also for depression and other psychological conditions. By and large, the effects of the most coarse psychiatric medications in use today were unquestionably discovered by accident; once their neuro-chemical effects were better (though not entirely) understood, an underlying disease state was then hypothesized but never proven. As I continually state on in my articles here on eZine, there is no evidence whatsoever to hold the system that depression symptoms are caused by insufficient serotonin in the neural synapses.

Even if we accept that Adhd symptoms succeed from different conditions, isn't it inherent that the stimulants currently prescribed remedy these symptoms, anything their origin? Evidence from a great many scientific studies suggests that unquestionably they do. But I'm more skeptical about this kind of evidence than most people; whenever man insists that a drug's effectiveness has been "proven", I want to ask exactly what that means. For the purposes of Fda approval, a drug's effectiveness must be demonstrated via clinical trials designed in scientifically approved ways and there must be a statistically significant incompatibility between results for groups receiving placebo vs. The actual drug; that doesn't necessarily say a lot about the degree of the drug's effectiveness, however.

For instance, new cancer drugs that expand the life of a final patient by only three months often receive Fda approval because that's a statistically primary incompatibility in outcomes, but such drugs unquestionably don't cure or eliminate the illness. Koplewicz does make it clear that there is no cure for Adhd, but in my view, he doesn't look hard adequate at what these stimulants unquestionably do and do not do for Adhd symptoms. How much do they help? Which symptoms do they remedy and which are unaffected? What are the side effects and do they outweigh the benefits?

Yes, these stimulants help you focus attention and achieve repetitive mental work more unquestionably -- and for many, that alone is approximately miraculous. They can also help enormously with qoute behavior in the classroom. Over the past week, I've spent quite a bit of time visiting online forums where citizen discuss their reactions to Adderall, Ritalin and other stimulants. This may be anecdotal, unscientific evidence but there's no interrogate in my mind that these drugs have dramatically changed the lives of many, many people. I've also read a large amount of accounts from citizen who felt dull, apathetic or zombie-like while taking these medications; many of them underwent disturbing personality changes and some had psychotic episodes.

In The Gift of Adhd, Dr. Lara Honos Webb describes a man on Ritalin as "like a horse with blinders, plodding along. He's inviting forward, getting things done, but he's less open to inspiration." While Adderall and Ritalin are unquestionably helpful for a great many people, like all psychiatric medications they are a blunt instrument, inflicting all sorts of collateral damage. Koplewicz makes light of the side effects and insists there are no long term consequences of taking them; but if you want a scary read, take a look at the chapters on Adhd medications and the rise of childhood bipolar disorder in Robert Whitaker's The Anatomy of an Epidemic.

What I found most troubling about Koplewicz's rebuttal, however, was the contemptuous, short-shrift he gives to Dr. Sroufe's thoughts about the role of environment in the development of Adhd symptoms. He finds it "distressing" that Sroufe believes "ordinary parents who make commonplace mistakes while a child's early development could yield the kind of brain changes we see in children with Adhd." Koplewicz also finds it "bizarre" that Sroufe believes house stresses like domestic violence, lack of communal hold from friends or relatives and chaotic living situations might conduce to the development of Adhd symptoms; he's particularly perturbed by Sroufe's statement that "patterns of parental intrusiveness that involve stimulation for which the baby is not prepared" also play a role."

Why is it "bizarre" to wonder if intrusive parents who model or demonstrate distracting behavior can affect their child's capacity to pay attention? Not to mention that this isn't a case of "ordinary parents" production "ordinary mistakes" -- or any kind of mistake, for that matter; these are influential patterns of behavior, likely based on the parent's own psychological difficulties. In his work on attachment theory, Allan Schore has shown how failures of attachment cause the brain of an child to found abnormally. Is it such a leap to think whether repetitive types of intrusiveness and distraction by parents might also affect the development of their child's brain?

From a psychodynamic perspective, that not only seems plausible but I've worked with clients who have discussed such behavior by their parents and how it affected them. We believe that other types of parental behavior and parent-child interactions affect development; why is it so outlandish to believe that distractibility might be modeled? I think the larger issue here is one of guilt, and rescuing parents from the idea that they may have a role to play in their child's condition.

In a piece for the online version of Time, Judith Warner argues that Sroufe's ideas about the role of the environment are a giant step backwards, a return to blaming parents for their child's health in the way that accountability for childhood autism was once laid at the feet of "refrigerator mothers." This line of charge seems a little over-the-top to me; I think that Ms. Warner, like many people, can't distinguish between blaming and attributing influence. Her article is full of words like "stigma", "blame" and "victims"; unquestionably there's a middle ground between pointing accusatory fingers, on the one hand, and exploring how parent-child interactions might affect the development of Adhd symptoms. In the end, Ms. Warner's critique devolves into ad hominem assaults on Sroufe's character and motivation, not a terribly persuasive mode of consulation to my mind.

In revisiting the interrogate of Adhd symptoms and their origins, I came away feeling that the issue has not been settled. As always, I continue to believe that psychiatric medications have their uses, especially in the short-term, and I'll try to keep an open mind about their usage in treating deficits in attention. But I'll also continue to wonder about the psychological dimension, and whether explanations and eventual help may be found from a psychodynamic exploration of these issues.