The news seems full of stories like this nowadays:
KANSAS CITY, MO - A 16-year-old was on life support at a Kansas City hospital after his friend shot him while they were smoking pot. David Smith, 17, told police he didn't know the gun was loaded when he pointed it at his friend and pulled the trigger.
Police were called to a home at 4208 Park on Tuesday night after Smith called 911 and told the operator that he shot the victim. In the probable cause statement, witnesses at the scene told police that they were in the basement of the home smoking pot when the victim said the chair he was sitting in was his. Witnesses said Smith then raised the gun he had at his side and fired.
Smith told police in the probable cause statement that he had taken the clip out of the gun and put it on the floor next to him. Smith told police that when he raised the gun he didn't know the clip was in the gun. Smith told police he brought the gun to the house for protection.
A witness told police that after the group fled the basement, another witness retrieved the gun and asked Smith what to do with it. The witness said that Smith said, "I don't want any part of it anymore," and told the witness to get rid of it. The probable cause statement said the witness hid the gun in a house up the street, but later told police where it was.
Smith is charged with felony assault and felony armed criminal action.
Every year there are tragedies in which kids shoot and kill individuals after making threats. When this occurs, everyone asks themselves, "How could this happen?" …and "Why didn't we take the threat seriously?"
Most threats made by kids or teens are not carried out. Many such threats are the youngster's way of talking big or tough, or getting attention. Sometimes these threats are a reaction to a perceived hurt, rejection, or attack.
What threats should be taken seriously?
Examples of potentially dangerous or emergency situations with a youngster or teenager include:
• threats or warnings about hurting or killing oneself • threats or warnings about hurting or killing someone • threats to damage or destroy property • threats to run away from home
Psychologists and other mental health professionals agree that it is very difficult to predict a youngster's future behavior with complete accuracy. A person's past behavior, however, is still one of the best predictors of future behavior. For example, a youngster with a history of violent or assaultive behavior is more likely to carry out his/her threats and be violent.
When is there more risk associated with threats from kids and teens?
The presence of one or more of the following increases the risk of violent or dangerous behavior:
• a pattern of threats • access to guns or other weapons • being a victim of abuse or neglect (physical, sexual, or emotional) • blaming others and/or unwilling to accept responsibility for one's own actions • bringing a weapon to school • bullying or intimidating peers or younger kids • cruelty to animals • disciplinary problems at school or in the community (delinquent behavior) • family history of violent behavior or suicide attempts • fire-setting behavior • involvement with cults or gangs • little or no supervision or support from parents or other caring adult • mental illness, such as depression, mania, psychosis, or bipolar disorder • past destruction of property or vandalism • past suicide attempts or threats • past violent or aggressive behavior (including uncontrollable angry outbursts) • poor peer relationships and/or social isolation • preoccupation with themes and acts of violence in TV shows, movies, music, magazines, comics, books, video games, and Internet sites • recent experience of humiliation, shame, loss, or rejection • themes of death or depression repeatedly evident in conversation, written expressions, reading selections, or artwork • use of alcohol or illicit drugs • witnessing abuse or violence in the home
What should be done if parents or others are concerned?
When a youngster makes a serious threat it should not be dismissed as just idle talk. Parents, teachers, or other adults should immediately talk with the youngster. If it is determined that the youngster is at risk and the youngster refuses to talk, is argumentative, responds defensively, or continues to express violent or dangerous thoughts or plans, arrangements should be made for an immediate evaluation by a mental health professional with experience evaluating kids and teens. Evaluation of any serious threat must be done in the context of the individual child's past behavior, personality, and current stressors. In an emergency situation or if the youngster or family refuses help, it may be necessary to contact local police for assistance or take the youngster to the nearest emergency room for evaluation. Kids who have made serious threats must be carefully supervised while awaiting professional intervention. Immediate evaluation and appropriate ongoing treatment of youngsters who make serious threats can help the troubled youngster and reduce the risk of tragedy.
Watching movies, videos, and DVDs can be a fun activity in which kids and teenagers can use their imagination and fantasy. Moms & dads should, however, consider the following issues when planning to watch movies at a theater or at home:
• Younger kids may have trouble telling the difference between make-believe and reality. They can be upset when a parent figure dies in a movie or frightening things happen to kids. • Viewing movies with sex, violence, drug abuse, adult themes, and offensive language can have a negative effect on kids and teenagers. Many movies are not appropriate for kids or teenagers. • Some kids cannot tolerate the darkness of a movie theater, even with their moms & dads present. • Older kids and teenagers may copy risky and possibly dangerous things they see in movies. • Movies should not replace youngster-care or be left on as background noise. • If moms & dads are unsure whether a movie is appropriate, they should view the movie in private before watching it as a family. • Having a TV, VCR, or DVD player in kids and teenagers’ bedrooms encourages movie watching without adult supervision. • Although going to a movie theater can be exciting, movies can create anxiety for kids with loud noises and frightening and upsetting scenes.
Tips and Recommendations for Moms & dads:
• All ages of kids should have their movie watching supervised by their moms & dads or adult caretakers. • Check a movie’s Motion Picture Association of America (MPAA) rating and read reviews before it is viewed. Movie reviews can be found online, and on AACAP’s website. • Deciding when a teenager can go to a movie without parental supervision depends on the teenagers’ maturity and the friends going with your teenager. • Discuss upsetting or frightening events seen in a movie. • Moms & dads can and should be active participants in their kids and teenagers’ movie watching experiences. • Turn the movie off or leave the theater if your youngster becomes upset or frightened. • Use the same care and attention to a movie’s content when choosing a movie to watch at home for a youngster or teenager as you would a movie in the theater.
Watching movies together can be a rewarding experience. It can be an opportunity for your youngster to have fun with family and friends. If your youngster or teenager, however, develops strong and persistent emotional reactions or behavior from seeing a movie, then consider having your youngster evaluated by a qualified mental health professional.
Kids and TV Violence—
American kids watch an average of three to fours hours of television daily. Television can be a powerful influence in developing value systems and shaping behavior. Unfortunately, much of today's television programming is violent. Hundreds of studies of the effects of TV violence on kids and teenagers have found that kids may:
• imitate the violence they observe on television • identify with certain characters, victims and/or victimizers • gradually accept violence as a way to solve problems • become "immune" or numb to the horror of violence
Extensive viewing of television violence by kids causes greater aggressiveness. Sometimes, watching a single violent program can increase aggressiveness. Kids who view shows in which violence is very realistic, frequently repeated or unpunished, are more likely to imitate what they see. Kids with emotional, behavioral, learning or impulse control problems may be more easily influenced by TV violence. The impact of TV violence may be immediately evident in the youngster's behavior or may surface years later. Young people can even be affected when the family atmosphere shows no tendency toward violence.
While TV violence is not the only cause of aggressive or violent behavior, it is clearly a significant factor. Moms & dads can protect kids from excessive TV violence in the following ways:
• disapprove of the violent episodes in front of the kids, stressing the belief that such behavior is not the best way to resolve a problem • pay attention to the programs their kids are watching and watch some with them • point out that although the actor has not actually been hurt or killed, such violence in real life results in pain or death • refuse to let the kids see shows known to be violent, and change the channel or turn off the TV set when offensive material comes on, with an explanation of what is wrong with the program • set limits on the amount of time they spend with the television; consider removing the TV set from the youngster's bedroom • to offset peer pressure among friends and classmates, contact other moms & dads and agree to enforce similar rules about the length of time and type of program the kids may watch
Moms & dads can also use these measures to prevent harmful effects from television in other areas such as racial or sexual stereotyping. The amount of time kids watch TV, regardless of content, should be moderated because it decreases time spent on more beneficial activities such as reading, playing with friends, and developing hobbies. If moms & dads have serious difficulties setting limits, or have ongoing concerns about their youngster's behavior, they should contact a youngster and teenager psychiatrist for consultation and assistance.
The Influence of Music and Music Videos—
Singing and music have always played an important role in learning and the communication of culture. Kids learn from what their role models do and say. For many years, some kid's television very effectively used the combination of words, music and fast-paced animation to achieve learning.
Most moms & dads are concerned about what their young kids see and hear, but as kids grow older, moms & dads pay less attention to the music and videos that capture and hold their kid's interest.
Sharing music between generations in a family can be a pleasurable experience. Music also is often a major part of a teenager's separate world. It is quite common for teenagers to get pleasure from keeping adults out, which causes adults some distress.
A concern to many interested in the development and growth of teenagers is the negative and destructive themes of some kinds of music (rock, heavy metal, hip-hop, etc.), including best-selling albums promoted by major recording companies. The following themes, which are featured prominently in some lyrics, can be particularly troublesome:
• Suicide as an "alternative" or "solution" • Sex which focuses on control, sadism, masochism, incest, kids devaluing women, and violence toward women • Graphic violence • Drugs and alcohol abuse that is glamorized
Moms & dads can help their teenagers by paying attention to their teenager's purchasing, downloading, listening and viewing patterns, and by helping them identify music that may be destructive. An open discussion without criticism may be helpful.
Music is not usually a danger for a teenager whose life is balanced and healthy. But if a teenager is persistently preoccupied with music that has seriously destructive themes, and there are changes in behavior such as isolation, depression, alcohol or other drug abuse, evaluation by a qualified mental health professional should be considered.
Kids and Watching TV—
Television viewing is a major activity and influence on kids and teenagers. Kids in the United States watch an average of three to four hours of television a day. By the time of high school graduation, they will have spent more time watching television than they have in the classroom. While television can entertain, inform, and keep our kids company, it may also influence them in undesirable ways.
Time spent watching television takes away from important activities such as reading, school work, playing, exercise, family interaction, and social development. Kids also learn information from television that may be inappropriate or incorrect. They often cannot tell the difference between the fantasy presented on television versus reality. They are influenced by the thousands of commercials seen each year, many of which are for alcohol, junk food, fast foods, and toys.
Kids who watch a lot of television are likely to:
• Be overweight • Exercise less • Have lower grades in school • Read fewer books
Violence, sexuality, race and gender stereotypes, drug and alcohol abuse are common themes of television programs. Young kids are impressionable and may assume that what they see on television is typical, safe, and acceptable. As a result, television also exposes kids to behaviors and attitudes that may be overwhelming and difficult to understand.
Active parenting can ensure that kids have a positive experience with television. Moms & dads can help by:
• Placing limits on the amount of television viewing (per day and per week) • Selecting developmentally appropriate shows • Turning off shows you don't feel are appropriate for your youngster • Turning off the TV during family meals and study time • Viewing programs with your kids
In addition, moms & dads can help by doing the following: don't allow kids to watch long blocks of TV, but help them select individual programs. Choose shows that meet the developmental needs of your youngster. Kid's shows on public TV are appropriate, but soap operas, adult sitcoms, and adult talk shows are not. Set certain periods when the television will be off. Study times are for learning, not for sitting in front of the TV doing homework. Meal times are a good time for family members to talk with each other, not for watching television.
Encourage discussions with your kids about what they are seeing as you watch shows with them. Point out positive behavior, such as cooperation, friendship, and concern for others. While watching, make connections to history, books, places of interest, and personal events. Talk about your personal and family values as they relate to the show. Ask kids to compare what they are watching with real events. Talk about the realistic consequences of violence. Discuss the role of advertising and its influence on buying. Encourage your youngster to be involved in hobbies, sports, and peers. With proper guidance, your youngster can learn to use television in a healthy and positive way.
MAKE TV VIEWING AN ACTIVE PROCESS FOR YOUNGSTER AND PARENT!
Kids and the News—
Kids often see or hear the news many times a day through television, radio, newspapers, magazines, and the Internet. Seeing and hearing about local and world events, such as natural disasters, catastrophic events, and crime reports, may cause kids to experience stress, anxiety, and fears.
There have also been several changes in how news is reported that have given rise to the increased potential for kids to experience negative effects. These changes include the following:
• detailed and repetitive visual coverage of natural disasters and violent acts • increased reporting of the details of the private lives of public figures and role models • pressure to get news to the public as part of the competitive nature of the entertainment industry • television channels and Internet services and sites which report the news 24 hours a day • television channels broadcasting live events as they are unfolding, in "real time"
While there has been great public debate about providing television ratings to warn moms & dads about violence and sex in regular programming, news shows have only recently been added to these discussions. Research has shown that kids and teenagers are prone to imitate what they see and hear in the news, a kind of contagion effect described as "copy cat" events. Chronic and persistent exposure to such violence can lead to fear, desensitization (numbing), and in some kids an increase in aggressive and violent behaviors. Studies also show that media broadcasts to not always choose to show things that accurately reflect local or national trends.
For example, statistics report a decrease in the incidence of crime, yet, the reporting of crime in the news has increased 240%. Local news shows often lead with or break into programming to announce crime reports and devote as much as 30% of the broadcast time to detailed crime reporting.
The possible negative effects of news can be lessened by moms & dads, teachers, or other adults by watching the news with the youngster and talking about what has been seen or heard. The youngster's age, maturity, developmental level, life experiences, and vulnerabilities should guide how much and what kind of news the youngster watches.
Guidelines for minimizing the negative effects of watching the news include:
• ask the youngster what he/she has heard and what questions he/she may have • look for signs that the news may have triggered fears or anxieties such as sleeplessness, fears, bed-wetting, crying, or talking about being afraid • make sure you have adequate time and a quiet place to talk if you anticipate that the news is going to be troubling or upsetting to the youngster • monitor the amount of time your youngster watches news shows • provide reassurance regarding his/her own safety in simple words emphasizing that you are going to be there to keep him/her safe • watch the news with your youngster
Moms & dads should remember that it is important to talk to the youngster or teenager about what he/she has seen or heard. This allows moms & dads to lessen the potential negative effects of the news and to discuss their own ideas and values. While kids cannot be completely protected from outside events, moms & dads can help them feel safe and help them to better understand the world around them.
The causes, diagnosis, and the treatment of attention-deficit hyperactivity disorder (ADHD) have been the subject of active debate at least since the 1970s. For various reasons, ATTENTION-DEFICIT HYPERACTIVITY DISORDER remains one of the most controversial psychiatric disorders despite being a well-validated clinical diagnosis. Possible over diagnosis of ATTENTION-DEFICIT HYPERACTIVITY DISORDER, the use of stimulant medications in kids, and the methods by which ATTENTION-DEFICIT HYPERACTIVITY DISORDER is diagnosed and treated are some of the main areas of controversy.
Although the diagnosis has a high level of support from clinicians and most medical authorities, a number of alternative theories explaining the symptoms of ATTENTION-DEFICIT HYPERACTIVITY DISORDER have been proposed which range between describing ATTENTION-DEFICIT HYPERACTIVITY DISORDER as part of the normal spectrum of behavior instead of a disorder to rejecting its existence outright. These views include the Hunter vs. farmer theory, Neurodiversity, and the Social construct theory of ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Additionally, a lack of clarity on exactly what qualifies as ATTENTION-DEFICIT HYPERACTIVITY DISORDER and changes over time in diagnostic criteria have caused confusion and concerns about misdiagnosis.[10]
The best course of ATTENTION-DEFICIT HYPERACTIVITY DISORDER management is also a source of debate. Stimulants are the most commonly prescribed medication for ATTENTION-DEFICIT HYPERACTIVITY DISORDER, and, according to the National Institute of Mental Health, "under medical supervision, stimulant medications are considered safe".[11] However, the use of stimulant medications for the treatment of ATTENTION-DEFICIT HYPERACTIVITY DISORDER has generated controversy because of undesirable side effects, uncertain long term effects, and social and ethical issues regarding their use and dispensation. Kids comprise the majority of ATTENTION-DEFICIT HYPERACTIVITY DISORDER diagnoses, but because they are unable to give informed consent due to their age, treatment decisions are ultimately determined by their legal guardians on their behalf. Ethical and legal issues also arise from the promotion of stimulants to treat ATTENTION-DEFICIT HYPERACTIVITY DISORDER by groups and individuals who receive money from drug companies.
Status as a disorder
The controversy surrounding ATTENTION-DEFICIT HYPERACTIVITY DISORDER involves clinicians, teachers, policymakers, moms & dads and the media with opinions regarding ATTENTION-DEFICIT HYPERACTIVITY DISORDER ranging from those who do not believe it exists to those who believe that there is genetic and physiological basis for the condition. Controversy continues to grow over the diagnosis, treatment and cause and etiology of ATTENTION-DEFICIT HYPERACTIVITY DISORDER, as well as concerns surrounding the long term effects of the stimulants used to treat ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[12][13] Most healthcare providers accept that ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a genuine disorder while significant controversy surrounds how it is diagnosed and treated.[13]
Researchers from McMaster University identified five features of ATTENTION-DEFICIT HYPERACTIVITY DISORDER that contribute to its controversial nature:
Diagnostic criteria have changed frequently.
It is a clinical diagnosis for which there is no laboratory or radiological confirmatory tests or specific physical features.
The rates of diagnosis and of treatment substantially differ across countries.[14]
Therapy often includes stimulant drugs that are thought to have abuse potential.
There is no curative treatment, so long-term therapies are required.
[]Skepticism about the diagnosis
Skepticism about the validity of the diagnosis is a minority opinion in the general U.S. population. A 2002 survey found that of the 64% who had heard of ATTENTION-DEFICIT HYPERACTIVITY DISORDER, 78% believed it to be a "real disease".[15] In the United States, African-American moms & dads state that their friends and family are often unsure about the legitimacy of ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[16] In a small study from 1999 of nine Australian health care professionals, three were skeptical of ATTENTION-DEFICIT HYPERACTIVITY DISORDER as a valid diagnosis.[17] In 1998 Fred Baughman stated "ATTENTION-DEFICIT HYPERACTIVITY DISORDER is total, 100% fraud" as a counter claim to Russell Barkley's 1995 comment that "ATTENTION-DEFICIT HYPERACTIVITY DISORDER is real".[18]
In 2002, Russell Barkley, a well-known proponent of drug treatments of ATTENTION-DEFICIT HYPERACTIVITY DISORDER, published The International Consensus Statement on Attention Deficit Hyperactivity Disorder (ATTENTION-DEFICIT HYPERACTIVITY DISORDER), signed by a group of 86 psychiatrists and psychologists, which asserts the existence of ATTENTION-DEFICIT HYPERACTIVITY DISORDER and denies the existence of controversy within the medical community.[19] Two critiques of their statements have since been published in the peer reviewed literature questioning the negative tone they have used to describe researchers with views differing from their own.
In 2002, 8% of readers of the British Medical Journal who answered an online survey listed ATTENTION-DEFICIT HYPERACTIVITY DISORDER as one of the 10 top "non-diseases".[22]
Robins and Guze [23] criteria assert that the validity of any diagnosis must derive from empirical research and that some of this research must examine the neurobiological causes and correlates of disorders. The Robins and Guze criteria view the validity of diagnoses as arising from empirical studies demonstrating the following:
1) the diagnosis has well-defined clinical correlates
2) the diagnosis can be delimited from other diagnoses
3) the disorder has a characteristic course and outcome
4) the disorder shows evidence of heritability from family and genetic studies
5) data from laboratory studies demonstrate other neurobiological correlates of the disorder
6) the disorder shows a characteristic response to treatment.
A 2005 review recognizes the ongoing controversial nature of ATTENTION-DEFICIT HYPERACTIVITY DISORDER among both clinicians and the general public. It found that it fulfills the Robins and Guze criteria which support the idea that ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a valid diagnostic category.[24] A 2008 review however came to the opposite conclusion and states that: "ATTENTION-DEFICIT HYPERACTIVITY DISORDER is unlikely to exist as an identifiable disease"[25]
[]Concerns about methods of diagnosis
ATTENTION-DEFICIT HYPERACTIVITY DISORDER is controversial in part because most kids are diagnosed and treated based on decisions made by their moms & dads and clinicians with teachers being the primary source of diagnostic information. Only a minority, about 20%, of kids who end up with a diagnosis of ATTENTION-DEFICIT HYPERACTIVITY DISORDER show hyperactive behavior in the physician's office.
The number of individuals diagnosed with ATTENTION-DEFICIT HYPERACTIVITY DISORDER in the U.S. and UK has grown dramatically over a short period of time. Critics of the diagnosis, such as Dan P. Hallahan and James M. Kauffman in their book Exceptional Learners: Introduction to Special Education, have argued that this increase is due to the ATTENTION-DEFICIT HYPERACTIVITY DISORDER diagnostic criteria being sufficiently general or vague to allow virtually anybody with persistent unwanted behaviors to be classified as having ATTENTION-DEFICIT HYPERACTIVITY DISORDER of one type or another, and that the symptoms are not supported by sufficient empirical data.[29]
Tools that are designed to analyze a person's behavior, such as the Brown scale or the Conners scale, for example, attempt to assist moms & dads and providers in making a diagnosis by evaluating an individual on typical behaviors such as "Hums or makes other odd noises", "Daydreams" and "Acts 'smart'"; the scales rating the pervasiveness of these behaviors range from "never" to "very often". Connorsstates that, based on the scale, a valid diagnosis can be achieved; critics, however, counter Connors' proposition by pointing out the breadth with which these behaviors may be interpreted.[] This becomes especially relevant when family and cultural norms are taken into consideration; this premise leads to the assumption that a diagnosis based on such a scale may actually be more subjective than objective.
Some of the criticism does not reject the concept of ATTENTION-DEFICIT HYPERACTIVITY DISORDER as a valid disorder, but alleges that kids with problematic behavior are often diagnosed with ATTENTION-DEFICIT HYPERACTIVITY DISORDER when the behavior may result from other causes. Critics state that some kids diagnosed with ATTENTION-DEFICIT HYPERACTIVITY DISORDER, or labeled ATTENTION-DEFICIT HYPERACTIVITY DISORDER by moms & dads or teachers, are normal but do not behave in the way that responsible adults want them to behave.[30] There is concern about teachers being used to assist in diagnosing students with ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Dr. Thomas Armstrong states that teachers may have a deep, often subconscious, emotional investment in the diagnosis, because it could mean having a troublesome youngster out of the classroom. Social criticsmake a connection between the extra funding some schools receive for kids with ATTENTION-DEFICIT HYPERACTIVITY DISORDER and the increase in the diagnosis.
ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a subjective diagnosis with no definitive clinical test.[33] This leads to situations where one doctor would say a youngster needs psychotropic medication while another doctor could say the youngster is perfectly normal.[34] Concern exists that "elevated but still developmentally normal levels of motor activity, impulsiveness, or inattention" traits of childhood could be inappropriately interpreted as ATTENTION-DEFICIT HYPERACTIVITY DISORDER.
[]Over / under diagnosis
In 2005 82% of teachers in the United States consider ATTENTION-DEFICIT HYPERACTIVITY DISORDER to be over diagnosed while 3% consider it to be under diagnosed. In China 19% of teachers consider ATTENTION-DEFICIT HYPERACTIVITY DISORDER to be over diagnosed while 57% consider it to be under diagnosed.[37]
[]Changing diagnostic criteria
For over seventy years in the United States, symptoms of what is now called ATTENTION-DEFICIT HYPERACTIVITY DISORDER have had different labels.[38] The fact that the diagnostic criteria and the name used to describe the set of characteristics that make up ATTENTION-DEFICIT HYPERACTIVITY DISORDER have changed over time has lead to concerns.[39]
[]Views of ATTENTION-DEFICIT HYPERACTIVITY DISORDER outside North America
The view that ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a problem requiring medical intervention is more prevalent in English-speaking North America than in the rest of the world. In Great Britain and France roughly one percent of kids are diagnosed with hyperkinetic syndrome, the equivalent of ATTENTION-DEFICIT HYPERACTIVITY DISORDER in the International Classification of Diseases, the diagnostic system used by most medical professionals outside North America.
The British Psychological Society said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: "The idea that kids who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians."
Norwegian National Broadcasting (NRK) sent a short television series in early 2005 on the extreme increase in the use of Ritalin and Concerta for kids. Sales were six times higher in 2004 than in 2002. The series included the announcement of a successful group therapy program for 127 unmedicated kids aged four to eight, some with ATTENTION-DEFICIT HYPERACTIVITY DISORDER and some with oppositional defiant disorder.[42]
[]Anti-psychiatry movement
Members of the Anti-Psychiatry movement such as Fred Baughman and Peter Breggin have extensively used the popular media to criticize ATTENTION-DEFICIT HYPERACTIVITY DISORDER and medications used for ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Fred Baughman has also published articles about ATTENTION-DEFICIT HYPERACTIVITY DISORDER in peer reviewed journals.[47] They have testified at Congressional hearings on the use of Ritalin and supported legal challenges such as the Ritalin class action lawsuits. There is also a movement called critical psychiatry that often refers to their writings, but in contrast to Scientologists (see below), they are not "anti-psychiatry," but critics of some of its practices and offer alternative models and perspectives.
[]Scientology
Scientology has been vocal critics of ATTENTION-DEFICIT HYPERACTIVITY DISORDER and its treatments.[49] Scientology states that "the controversy over the many deaths and irreversible damage caused by psychiatric drugs prescribed for kids labeled with... ATTENTION-DEFICIT HYPERACTIVITY DISORDER continues to grow".[50] The church states that mental disorders are a fraud, [51] "mental and behavioral problems are largely incorrect diagnoses that cover symptoms and don't handle the real problems, which may be physical or spiritual".[52] Specifically Scientology attributes all psychological disorders to the accumulation of psychic trauma retained from millions of years of human evolution and the interference of alien and human ghosts called thetans.[53]
[]Personality trait
Some believe that many of the traits of those diagnosed with ATTENTION-DEFICIT HYPERACTIVITY DISORDER are personality traits and are not indicative of a disorder. These traits may be undesirable in modern society, leading to difficulty functioning in society, and thus have been labeled as a disorder.[54]
[]Questions concerning the cause
The pathophysiology of ATTENTION-DEFICIT HYPERACTIVITY DISORDER is unclear and there are a number of competing theories.[55]
[]ATTENTION-DEFICIT HYPERACTIVITY DISORDER as a biological illness
One of the most controversial issues regarding ATTENTION-DEFICIT HYPERACTIVITY DISORDER is whether it is wholly or even predominantly a biological illness leading to a chemical or structural defect in the brain. The current predominance of opinion in medicine is that ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a mixture of genetics and the environment however the pathophysiology is unclear at this time.[56]Differences in the brain between ATTENTION-DEFICIT HYPERACTIVITY DISORDER and non-ATTENTION-DEFICIT HYPERACTIVITY DISORDER patients have been discovered,[57][58][59][60][61][62] but it is uncertain if or how these differences give rise to the symptoms of ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Xavier Castellanos, the former head of ATTENTION-DEFICIT HYPERACTIVITY DISORDER research at the National Institute of Mental Health (NIMH), is "firmly convinced that ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a biological illness", but he also noted, regarding our understanding ATTENTION-DEFICIT HYPERACTIVITY DISORDER and the brain, "We don't yet know what's going on in ATTENTION-DEFICIT HYPERACTIVITY DISORDER." [63]
In "Rethinking ATTENTION-DEFICIT HYPERACTIVITY DISORDER: International Perspectives" an alternative paradigm for ATTENTION-DEFICIT HYPERACTIVITY DISORDER argues that, while biological factors may obviously play a large role in difficulties sitting still and/or concentrating on schoolwork in somekids, the vast majority of kids manifesting this behavior do not have a biological deficit.[64] For a variety of reasons they have failed to integrate into their psychology the ability to work at chores that are expected of them. Their restlessness and daydreaming is similar to the behavior of other, normal kids when they are not engaged, and are bored and trapped by circumstances. Very frequently, kids with ATTENTION-DEFICIT HYPERACTIVITY DISORDER have no difficulty concentrating on activities that they find to be interesting. When they are taught by a charismatic entertaining teacher, they similarly can concentrate.[65]
Although ATTENTION-DEFICIT HYPERACTIVITY DISORDER is said to be highly heritable and twin studies suggest genetics are a factor in about 75% of ATTENTION-DEFICIT HYPERACTIVITY DISORDER cases, [66] some nevertheless question the genetic connection. Dr. Joseph Glenmullen states, "No claim of a gene for a psychiatric condition has stood the test of time, in spite of popular misinformation."Although many theories exist, there is no definitive biological, neurological, or genetic etiology for 'mental illness'."[67] His critics argue that ATTENTION-DEFICIT HYPERACTIVITY DISORDER is a heterogeneous disorder [68] caused by a complex interaction of genetic and environmental factors and thus cannot be modeled accurately using the single gene theory. Authors of a review of ATTENTION-DEFICIT HYPERACTIVITY DISORDER etiology have noted: "Although several genome-wide searches have identified chromosomal regions that are predicted to contain genes that contribute to ATTENTION-DEFICIT HYPERACTIVITY DISORDER susceptibility, to date no single gene with a major contribution to ATTENTION-DEFICIT HYPERACTIVITY DISORDER has been identified."[69]
[]Neuroimaging and ATTENTION-DEFICIT HYPERACTIVITY DISORDER
Various types of neuroimaging suggest there are differences in the brain, such as thinner regions of the cortex, between individuals with and without ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[70] The methodology of some lobar volumetric studies used to evaluate cortex thinning in ATTENTION-DEFICIT HYPERACTIVITY DISORDER has been criticized as having "troubling reductionistic emphasis."[71] Critics contend that in some studies, the controls for stimulant medication usage were inadequate which makes it impossible to determine whether ATTENTION-DEFICIT HYPERACTIVITY DISORDER itself or psychotropic medication used to treat ATTENTION-DEFICIT HYPERACTIVITY DISORDER is responsible for decreased thickness observed in certain brain regions.[72][73] Jonathan Leo and David Cohen, who reject the characterization of ATTENTION-DEFICIT HYPERACTIVITY DISORDER as a disorder, believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.[74]
[]Hunter vs. farmer theory of ATTENTION-DEFICIT HYPERACTIVITY DISORDER
The hunter vs. farmer theory is a hypothesis proposed by author Thom Hartmann about the origins of attention-deficit hyperactivity disorder (ATTENTION-DEFICIT HYPERACTIVITY DISORDER). He believes that these conditions may be a result of adaptive behavior of the species, his theory states that those with ATTENTION-DEFICIT HYPERACTIVITY DISORDER retain some of the older hunter characteristics.[75]
[]Neurodiversity
Proponents of this theory assert that atypical (neurodivergent) neurological development is a normal human difference that is to be tolerated and respected as any other human difference. They usually support treatment or therapy, but may or may not agree with the use of medication. Social critics argue that while biological factors may obviously play a large role in difficulties sitting still and/or concentrating on schoolwork in some kids, for a variety of reasons they have failed to integrate into the social expectations that others have of them. [76]
[]Social construct theory of ATTENTION-DEFICIT HYPERACTIVITY DISORDER
Social critics question whether ATTENTION-DEFICIT HYPERACTIVITY DISORDER is wholly or even predominantly a biological illness. A minority of these critics maintain that ATTENTION-DEFICIT HYPERACTIVITY DISORDER was "invented and not discovered". They believe that no disorder exists and that the behavior observed is not abnormal and can be better explained by environmental causes or just the personality of the "patient."[77]
[]Concerns about medication
The National Institute of Mental Health recommends stimulants for the treatment of ATTENTION-DEFICIT HYPERACTIVITY DISORDER, and states that, "under medical supervision, stimulant medications are considered safe".[11] A 2007 drug class review found no evidence of any differences in efficacy or side effects in the stimulants commonly prescribed.[78] However, the use of stimulant medications for the treatment of ATTENTION-DEFICIT HYPERACTIVITY DISORDER has generated controversy because of undesirable side effects, uncertain long term effects, and social and ethical issues regarding their use and dispensation.
[]Frequency of stimulant use
In the 1990s the United States used 90% of the stimulants produced globally, in the 2000s this has decreased to 80% due to increased use in other areas of the world.[79] The UK uses one tenth while France and Italy use one twentieth the methyphenadate per capita as the USA.[79]
[]Concerns about side effects and long term effectiveness
Some moms & dads and professionals have raised questions about the side effects of drugs and their long term use.[80] Studies have shown that stimulants offer no benefits over behavioral management for periods over 3 years. Other side effects of concern include addiction, growth retardation, suicidal thoughts and effects on the heart. This has led to interest in non-drug treatments such as omega 3 oils which can help symptoms of ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[83] On February 9, 2006, the U.S. Food and Drug Administration voted to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[84]
A 2008 review found that the use of stimulants improved teachers' and moms & dads' ratings of behavior; however, it did not improve academic achievement.[82] Stimulants neither increased nor decreased rates of delinquency or substance abuse at 3 years.[82] Intensive treatment for 14 months has no effect on long term outcomes 8 years later.[85] No significant differences between the various drugs in terms of efficacy or side effects have been found.[86][87] A meta analysis of clinical trials found that about 70% of kids improve after being treated with stimulants in the short term but found that this conclusion may be biased due to the high number of low quality clinical trials in the literature. There have been no randomized placebo controlled clinical trials investigating the long term effectiveness of methylphenidate (Ritalin) beyond 4 weeks. Thus the long term effectiveness of methylphenidate has not been scientifically demonstrated. Serious concerns of publication bias regarding the use of methylphenidate for ATTENTION-DEFICIT HYPERACTIVITY DISORDER has also been noted.[88]
Animal research on the neurotoxicity of amphetamines has found contradictatory results. For example in rats doses of amphetamines equivalent to those used therapeutically to treat ATTENTION-DEFICIT HYPERACTIVITY DISORDER were suggestive of benefits to the dopamine system, whereas in primates therapeutic equivalent doses were found to cause neurotoxicity.[89]
[]Long term effects
Methylphenidate, an amphetamine derivative and potent central nervous system stimulant, can also lead to a psychosis from chronic use. Although the safety profile of short-term methylphenidate therapy in clinical trials has been well established, repeated use of psycho stimulants such as methylphenidate is less clear. Long term effects of methylphenidate, such as drug addiction, withdrawal reactions and psychosis, have received very little research attention and thus are largely unknown.[92] Knowledge of the effects of chronic use of methylphenidate is poorly understood with regard to persisting behavioral and neuroadaptational effects.[93] Stimulants can cause delayed growth in kids for up to 3 years. Animal studies have led to concerns of the safety of long term use of stimulants in the developing brain of humans.[94] A study has shown persisting molecular changes to the dopamine system, specifically the reward system, when methylphenidate is given to adolescent rats.[95] Whether long term stimulants cause similar changes in the brain of kids leading to increased substance abuse is unclear.[96] There is limited data regarding long term use of stimulants which suggests that there may be modest benefits in correctly diagnosed kids with ATTENTION-DEFICIT HYPERACTIVITY DISORDER but there are also overall modest risks.[97] Effects resulting from long term use of methylphenidate most likely result from changes induced in the dopamine system.[98] Methylphenidate has an incidence 0.1 % of psychosis in short term clinical trials.[99] A small study of just under 100 kids which assessed long term outcome of stimulant use found that 6% of the kids became psychotic after months or years of stimulant therapy. Typically psychosis abates soon after stopping stimulant therapy. As the study size was small and was not standardized, larger studies have been recommended. The long term effects on the developing brain and on mental health disorders in later life of chronic use of methylphenidate is unknown. Despite this, between 0.51% to 1.23% of kids between the ages of 2 and 6 years take stimulants in the USA. Stimulants drugs are not approved for this age group.
Concerns have been raised that long-term therapy might cause paranoia, schizophrenia and behavioral sensitization, similar to other stimulants.[103] Psychotic symptoms from methylphenidate can include hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, euphoria, grandiosity, paranoid delusions, confusion, increased aggression and irritability. It is unpredictable in whom methylphenidate psychosis will occur. Family history of mental illness does not predict the incidence of stimulant toxicosis in ATTENTION-DEFICIT HYPERACTIVITY DISORDERkids. High rates of childhood stimulant use have been noted in patients with a diagnosis of schizophrenia and bipolar disorder independent of ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Individuals with a diagnosis of bipolar or schizophrenia who were prescribed stimulants during childhood typically have a significantly earlier onset of the psychotic disorder and suffer a more severe clinical course of psychotic disorder in kids who are vulnerable to psychotic disorders.
Young ATTENTION-DEFICIT HYPERACTIVITY DISORDER patients taking stimulant medication may have a reduced rate of height and weight gain during adolescence, but stimulant medication has little effect on the ultimate weight and height of the medicated patient.[107] It is unclear whether the delay in growth is due to stimulant medication or ATTENTION-DEFICIT HYPERACTIVITY DISORDER itself; ethical problems in giving stimulant medication to kids without ATTENTION-DEFICIT HYPERACTIVITY DISORDER as experimental controls makes such studies problematic. Some patients will take a period of time off of medication, called a "drug holiday," in hopes of allowing the normal rate of height and weight attainment to resume.Stimulant medication may also inhibit cartilage growth, liver development and central nervous systemgrowth factors.[108] Periodic CBC, differential, and platelet counts are recommended during prolonged use of methylphenidate.[12]
[]Coercion
It is often not a youngster's decision to take medication, especially those under the age of six, a group that is seeing a dramatic increase in the prescription of psychiatric medications. Some schools have attempted to require treatment with medications before allowing a youngster to attend school.[109] The United States has passed a bill against this practice.[109] Thus ethical concerns regarding forced treatment or coercion of a minor arise. Some suspect that kids are using stimulants as a cognitive enhancer at the request of their achievement oriented moms & dads.[110]
[]Non specific nature
Stimulants are often seen as cognitive enhancers or smart drugs. Their effects are non-specific with similar results seen in kids and adults with and without ATTENTION-DEFICIT HYPERACTIVITY DISORDER. One finds improved concentration and behavior in all.[111][112][113][114] Due to their non-specific activity, stimulants have been used by writers to increase productivity,[115] as well as by the United States Air Force to improve concentration in combat.[116] A small number of scientists recommend wide spread use by the population to increase brain power.[110]
[]Stimulant misuse
Stimulants are controlled psychotropic substances. They are classified as Schedule II substances (Schedule II: Potential for abuse; potential for psychological or physical addiction; currently accepted medical use).[117]
Controversy has surrounded whether methylphenidate is as commonly abused as other stimulants with many believing that its rate of abuse is much lower than other stimulants. However, the majority of studies assessing its abuse potential scores have determined that it has an abuse potential similar to that of cocaine and d-amphetamine.[118]
Both kids with and without ATTENTION-DEFICIT HYPERACTIVITY DISORDER abuse stimulants, with ATTENTION-DEFICIT HYPERACTIVITY DISORDER individuals being at the highest risk of abusing or diverting their stimulant prescriptions. Between 16 and 29 percent of students who are prescribed stimulants report diverting their prescriptions. Between 5 and 9 percent of grade/primary and high school kids and between 5 and 35 percent of college students have used non-prescribed stimulants. Most often their motivation is to concentrate, improve alertness, "get high," or to experiment.[119]
Stimulant medications may be resold by patients as recreational drugs, and methylphenidate (Ritalin) is used as a study aid by some students without ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[120]
Non-medical prescription stimulant use is high. A 2003 study found that non prescription use within the last year by college students in the US was 4.1%.A 2008 meta analysis found even higher rates of non prescribed stimulant use. It found 5% to 9% of grade school and high school kids and 5% to 35% of college students used a non-prescribed stimulant in the last year.[122]
[]Substance use disorders
There has been controversy surrounding whether ATTENTION-DEFICIT HYPERACTIVITY DISORDER is associated with increased rates of problematic substance misuse. The available evidence suggests that there is no increased risk of substance use disorders in ATTENTION-DEFICIT HYPERACTIVITY DISORDERkids unless there is a co-existing conduct disorder.[123] Studies investigating whether stimulant medication can lead to drug abuse later in life found that despite the higher rate of substance abuse among ATTENTION-DEFICIT HYPERACTIVITY DISORDER patients as a whole, stimulant medication use in childhood did not affect or lowered, the risk for substance of abuse in adulthood compared to un-medicated individuals with ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[124]
A study found that those who had received stimulants during childhood showed the highest number of cocaine abusers in adulthood - twice that of the other groups - thus suggesting that stimulant use during childhood was associated with sensitizing or predisposing kids to cocaine abuse later in life. Smoking tobacco also appeared to increase the risk of cocaine abuse in this population but even after controlling for tobacco exposure cocaine abuse was still significantly higher in adults who had been medicated with stimulants as kids. This risk was still present 15 years after stimulant medication exposure.
Russell Barkley, a well known ATTENTION-DEFICIT HYPERACTIVITY DISORDER researcher, admits to taking money from drug companies for speaking and consultancy fees. There are concerns that this may bias his publications.[130]
In 2008, it was revealed that Joseph Biederman of Harvard, a frequently cited ATTENTION-DEFICIT HYPERACTIVITY DISORDER expert, failed to report to Harvard that he had received 1.6 million dollars from drug companies between 2000 and 2007.[131]E. Fuller Torrey, executive director of the Stanley Medical Research Institute which finances psychiatric studies, said “In the area of youngster psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.”[131]
Kids and Adults with Attention-Deficit/Hyperactivity Disorder, CHADD, and an ATTENTION-DEFICIT HYPERACTIVITY DISORDER advocacy group based in Landover, MD received a total of $1,169,000 in 2007 from pharmaceutical companies. These donations made up 26 percent of their budget. This is viewed by some as a major conflict of interest.[133]
[]Concerns about the impact of labeling
Moms & dads could be concerned that telling kids they have a brain disorder could possibly harm their self-esteem. Barkley believes labeling is a double-edged sword; there are many pitfalls to labeling but by using a precise label, services can be accessed. He also believes that labeling can help the individual understand and make an informed decision how best to deal with the disorder using evidence based knowledge.[134] Furthermore studies also show that the education of the siblings and moms & dads has at least a short term impact on the outcome of treatment.[135] Barkley states this about ATTENTION-DEFICIT HYPERACTIVITY DISORDER rights: "because of various legislation that has been passed to protect them."There are special education laws with the Americans with Disabilities Act, for example, mentioning ATTENTION-DEFICIT HYPERACTIVITY DISORDER as an eligible condition. If you change the label, and again refer to it as just some variation in normal temperament, these individuals will lose access to these services, and will lose these hard-won protections that keep them from being discriminated against. . . ."[134] Psychiatrist Harvey Parker, who founded CHAAD, states, "we should be celebrating the fact that school districts across the country are beginning to understand and recognize kids with ATTENTION-DEFICIT HYPERACTIVITY DISORDER, and are finding ways of treating them. We should celebrate the fact that the general public doesn't look at ATTENTION-DEFICIT HYPERACTIVITY DISORDER kids as "bad" kids, as brats, but as kids who have a problem that they can overcome".[136]
Social critics believe that this knowledge can effectively become a self-fulfilling prophecy mainly through self-doubt. Thomas Armstrong states that the ATTENTION-DEFICIT HYPERACTIVITY DISORDER label is a "tragic decoy" which severely erodes the potential to see the best in a youngster.[137] Armstrong has adopted the term neurodiversity (first used by autistic rights activists) as an alternative, less damaging, label.[138]Thom Hartmann has said that the brain disorder label is "a pretty wretched label for any youngster to have to bear."[139]
Kids may be ridiculed at school by their peers for using psychiatric medications including those for ATTENTION-DEFICIT HYPERACTIVITY DISORDER.[140]
[]ATTENTION-DEFICIT HYPERACTIVITY DISORDER in politics and the media
The media have reported on many issues related to ATTENTION-DEFICIT HYPERACTIVITY DISORDER and have also reported on controversial opinions of individuals.
In 2001 PBS's Frontline ran a TV show entitled "Medicating kids". The program included a selection of interviews with representatives of various points of view. In one segment, entitled backlash, retired neurologistFred Baughman and Peter Breggin, founder of the 'International Center for the Study of Psychiatry and Psychology', whom PBS described as "outspoken critics who insist [ATTENTION-DEFICIT HYPERACTIVITY DISORDER] is a fraud perpetrated by the psychiatric and pharmaceutical industries on families anxious to understand their kid’s behavior,"[142] were interviewed on the legitimacy of the disorder. Russell Barkley and Xavier Castellanos, then head of ATTENTION-DEFICIT HYPERACTIVITY DISORDER research at the National Institute of Mental Health (NIMH), defended the viability of the disorder, although Castellanos stated that little is scientifically understood.[143] Lawrence Diller was interviewed on the business of ATTENTION-DEFICIT HYPERACTIVITY DISORDER along with a representative from Shire Plc. The validity of the work of many of the ATTENTION-DEFICIT HYPERACTIVITY DISORDER "experts" (e.g. Dr. Biederman), Drug Companies & Doctors: A Story of Corruption, has been called in to question by Marcia Angell, former or of The New England Journal of Medicine.
A number of notable individuals have given controversial opinions on ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Scientologist Tom Cruise's interview with Matt Lauer was widely watched by the public. In this interview he spoke about postpartum depression and also referred to Ritalin and Adderall (a mix of amphetamines) as being "street drugs" rather than as ATTENTION-DEFICIT HYPERACTIVITY DISORDER medication. This has some basis in fact, as the sale of stimulants on campuses is not uncommon; they are used by non ATTENTION-DEFICIT HYPERACTIVITY DISORDER students to tackle drudgery.[145] In England BaronessSusan Greenfield, a leading neuroscientist,[146] wanted a wide-ranging inquiry in the House of Lords into the dramatic increase in the diagnosis of ATTENTION-DEFICIT HYPERACTIVITY DISORDER in the UK and possible causes.[147] This followed a 2007 BBC Panorama program which highlighted US research (The Multimodal Treatment Study of Kids with ATTENTION-DEFICIT HYPERACTIVITY DISORDER by the University of Buffalo showing treatment results of 600) suggesting drugs are no better than therapy for ATTENTION-DEFICIT HYPERACTIVITY DISORDER in the long-term. In the UK medication use is increasing dramatically.[] Other notable individuals have made controversial statements about ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Terence Kealey, a clinical biochemist, has stated his belief that ATTENTION-DEFICIT HYPERACTIVITY DISORDER medication is used to control unruly boy’s behavior.[148] Newspaper columnists such as Benedict Carey have also written controversial articles on ATTENTION-DEFICIT HYPERACTIVITY DISORDER.
Hearings were held in the US Congress. A series of lawsuits culminating with the failed Ritalin class action lawsuits were in the courts. Antipsychiatry critics such as Peter Breggin and Fred Baughman received a lot of press coverage including PBS's "Medicating kids" which featured interviewees whose opinions regarding ATTENTION-DEFICIT HYPERACTIVITY DISORDER ranged from doubting its existence to support of the notion of genetic and physiological basis for the condition. This timing also coincided with a dramatic increase in the use of stimulant medication which since has leveled off.[152]
According to an article in the Los Angeles Times, "the uproar over Ritalin was triggered almost single-handedly by the Scientology movement."[153] The Citizens Commission on Human Rights, an anti-psychiatry group formed by Scientologists in 1969, conducted a major campaign against Ritalin in the 1980s and lobbied Congress for an investigation of Ritalin.[153]Scientology publications identified the "real target of the campaign" as "the psychiatric profession itself" and said that the campaign "brought wide acceptance of the fact that (the commission) [sic] and the Scientologists are the ones effectively doing something about [...] psychiatric drugging".[153] Scientology states "the controversy over the many deaths and irreversible damage caused by psychiatric drugs prescribed for kids labeled with... ATTENTION-DEFICIT HYPERACTIVITY DISORDER continues to grow".[154]
[]History
The controversies around ATTENTION-DEFICIT HYPERACTIVITY DISORDER have been on-going at least since the 1970s. Questioning of the safety of stimulants began in the 1990s among the general population when anti-Ritalin advocates denounced it as "kiddie cocaine".[26]
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