6/18/13. Drs. Cohen (physician) and Rasmussen (historian) tell us about the history of stimulant use, and how stimulants have made our nation of kids on speed.
These doctors know not what they are talking about. After 35 years of treating children, adolescents, adults and families I know that stimulant medication saves lives of those properly diagnosed with ADHD and associated disorders.
The relentless attacks on psychiatric medication never let up.
My letter to the editor:
Regarding Drs. Pieter Cohen’s and Nicolas Rasmussen’s article, “A Nation of Kids on Speed,” these authors make evident that attention-deficit/hyperactivity disorder is a well-known disorder that is not known well.
What is not known well:
· There is a wealth of scientific data on the clinical description, epidemiology, developmental course, prognosis, etiology, evaluation, co-existing disorders, differential diagnosis, and treatments for ADHD.
· There are some excellent long-term studies about the positive effects of stimulant medication for ADHD.
· The psychostimulants methylphenidate (Ritalin) and amphetamine (Adderall) are the oldest and most established pharmacological agents in child mental health.
· The benefits of stimulant medication for ADHD have been studied over more than 50 years.
· Medications are underused in some regions and are prescribed too freely in others.
· There is strong evidence that ADHD is a genetic disorder.
· Most people who suffer from ADHD never get diagnosed or take medication.
· People who have undiagnosed ADHD are at risk for substance abuse, depression, anxieties, and suicide.
· These medications work for the vast majority of people who are properly diagnosed.
The authors correctly note that psychological diagnosis is based on symptoms --- and as many recent criticisms of the DSM-V have pointed out, we have a psychiatric diagnostic manual that is more reliable (consistent) than valid (the disorder exists). We rely on symptoms to treat such disorders as ADHD because we have no valid biological tests to diagnose ADHD or any psychological disorder. Our psychiatric diagnoses are significantly handicapped because we have no idea how the water of the brain generates the wine of consciousness.
Of course our reliance on symptoms does not mean we know nothing about psychiatric disorders. Even Drs. Cohen and Rasmussen insert one sentence in their half-page article that, “Stimulants can certainly benefit some young children with truly disabling ADHD.” They go on to claim, “history has already taught us that overprescribing stimulant to millions of Americans leads to dependence, addiction, and overdose.”
History may have taught this to Drs. Cohen and Rasmussen, but the clinical experience of many psychologists and psychiatrists informed by rigorous, peer-reviewed scientific research on ADHD, has shown that many children, adolescents, and adults find stimulant medication like glasses-for-the-mind, enhancing focus, organization, planning, and effective self-monitoring.
Do some people abuse stimulants – of course. People with substance abuse problems abuse stimulants --- and some vulnerable people may be use stimulants to “self-medicate” to “treat” undiagnosed psychiatric problems, or use stimulants to stay up all night, or whatever people do who are impulsive, have faulty judgment and try to cope with psychic despair.
Psychiatric medications such as stimulants sometimes offer life-enhancing measures to improve the faulty “hard drive” improving mood stability, the ability to filter out external distractions, or improve self-control. Psychological therapies, often helpful with people with ADHD, do much to repair “software,” providing supportive settings to promote hope, reroute faulty “instructions” and teach people how to live better.
Until we have a medical test to identify ADHD, no amount of scientific knowledge, clinical experience, or testimonials from parents and youngsters will convince Drs. Cohen and Rasmusssen of the importance of treating ADHD across the life-span.
I hope that Drs. Cohen’s and Rasmussen’s efforts to protect us from the dangers of the misuse of medication for ADHD does not generate the side-effects of growing-up with untreated ADHD --- side-effects such as school failure, depression, delinquency, and suicide.
Steven J. Ceresnie, Ph.D.