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Critique of the AMERICAN ACADEMY OF PEDIATRICS, Subcommittee on
Attention-Deficit/Hyperactivity Disorder, Committee on Quality Improvement
Policy, Statement entitled "Clinical Practice Guideline: Treatment of the
School-Aged Child With Attention-deficit/Hyperactivity Disorder"
[PEDIATRICS. 2001;108: 1033-1044 (October)]

by Fred A. Baughman Jr., MD, Neurology, Child Neurology
Fellow, American Academy of Neurology
1303 Hidden Mountain Drive
El Cajon, CA 92019
Email: Fred Baughman, Jr. MD
written 10/3/01

In it’s ADHD TREATMENT guideline, just released, the American Academy of
Pediatrics (AAP) states (1) "The initiation of treatment requires the accurate
establishment of a diagnosis of ADHD," and (2), that "the American Academy of
Pediatric’s clinical practice guideline on DIAGNOSIS of children with ADHD [1]
provides direction in appropriately diagnosing this disorder.  Does their
DIAGNOSIS guideline do any such thing?

In my letter to the editor of PEDIATRICS regarding their previously published
diagnosis guideline, I [2] wrote:

Clinical Practice Guideline opens:  "Attention-deficit/hyperactivity disorder is
the most common neurobehavioral disorder of childhood."  "Neurobehavioral,"
implies an abnormality of the brain; a disease.  And yet, no confirmatory,
diagnostic, abnormality has been found.  With six million children said to have
it, most of them on addictive, dangerous, stimulants, ambiguity as to the
scientific status of ADHD is not acceptable.

In medicine, all physicians are responsible for determining whether a disease is
present or not, i.e., whether or not an abnormality has been defined.  If not,
there is no medical/biological abnormality to treat; to make normal or more
nearly normal.  And yet many throughout medicine, persist in referring to ADHD
as a disease, hoping, it will justify medical/pharmacological interventions, and
billing for them.  In a recent article in—of all places-- the Journal of the
American Medical Association, Vastag [3] proclaimed:

  In 1999, Darin Dougherty, MD, and colleagues [4]…reported that people
  with ADHD have many more dopamine transporters than those without the

Doughtery, et al, proved no such thing.  They provided so little information
about the drugs their subjects were on that their research could not prove
anything.  This was just another in an endless line of false research claims and
press releases, asserting that ADHD is an actual disease, when it is not,
and—given it’s wholly subjective nature-- never can be.   The never-replicated
claims of Zametkin et al [5], in 1990, sustained the
epidemic-without-a-disease,  through the nineties.

Nor does the lack of scientific proof stop those at the AAP from referring to
ADHD as a disease, and urging that it be treated, as if it were, with
methylphenidate (Ritalin) and other, addictive, dangerous, sometimes deadly,
Schedule II, amphetamines.

In April [6] Stein, a cochairperson on the APA Subcommittee on ADHD, wrote:

Factors that impact compliance (with prescription medication) include their
belief that the treatment will be effective, the parents’ understanding of the
disease and  how treatment will alter or ameliorate symptoms, and the quality of
the therapeutic alliance between the clinician, child, and parent.

Here, without a doubt, and without a shred of scientific proof, Stein, of the
AAP,  conveys that ADHD is a disease.  Can their be any doubt the parent of a
normal child, led to believe that their child is "diseased"/ "abnormal," will
have a different view of their child and of their child’s corrective needs, than
of the parent told honestly that ADHD is nothing but a set of normal behaviors
in a wholly normal child.

If the AAP has proof that ADHD is a disease; that the children are abnormal,
diseased, why don’t they say so.  Instead, they seem intent on conveying to the
to patients and the public, albeit with no proof, that ADHD, a propaganda
construct, is a disease, that children with it are "diseased"/ "abnormal."

At the November 16-18, 1998, National Institutes of Health Consensus Conference
on ADHD, Carey [7], an invited speaker, observed:

What is now most often described as ADHD in the United States appears to be a
set of normal behavioral variations… This discrepancy leaves the validity of the
construct in doubt.

ADHD behaviors are assumed to be largely or entirely due to abnormal brain
function.  The DSM-IV does not say so, but textbooks and journals do.

We see…that the causes of these behaviors called ADHD are entirely speculative.
And yet… parents and children are being told that these behaviors are due to a
brain malfunction.  Can you not please strengthen the statement to discourage
practitioners from making this statement when there is not adequate proof to
support that at this time?"

Nor is there the least bit of proof today, that ADHD is a bona fide disease,
that the  millions of children said to have it are diseased/abnormal and in need
of such medical/biological/pharmacological treatment as is invariably urged upon

As I urged previously [3] :

It is apparent that virtually all professionals of the extended ADHD ‘industry’
convey to parents, and to the public-at-large, that ADHD is a ‘disease’ and that
children said to have it are ‘diseased’-‘abnormal.’  This is a perversion of the
scientific record and a violation of the informed consent rights of all patients
and of the public-at-large.

The wording of the AAP Guideline should be changed, forthwith, to reflect the
scientific and medical facts of the matter.

In publishing this letter to the editor in the May issue of their journal,
PEDIATRICS, no one from the APA  or their Subcommittee on ADHD responded in the
least to the questions I raised, nor did the stop referring to ADHD as a
"neurobehavioral disorder" implying something neurologically abnormal/diseased
within children thus labeled.

Their intentions seems clear--to continue to call normal children "abnormal"/
"diseased," and to continue to "treat" them with methylphenidate (Ritalin) and
other amphetamines of the Schedule II, controlled, designation, as if they

The first, abnormality/disease/chemical imbalance such children have, is that
due to the drugs they are given.  This is not the legitimate, ethical, practice
of medicine.


Fred A. Baughman Jr., MD
Fellow, American Academy of Neurology (board certified, N, CN)
1303 Hidden Mountain Drive
El Cajon, CA 92019
fax 619 442 1932


1. American Academy of Pediatrics, Committee on Quality Improvement and
Subcommittee on Attention-Deficit/Hyperactivity Disorder. Diagnosis and
evaluation of the child with attention-deficit/hyperactivity disorder.
Pediatrics. 2000;105:1158-1170.
2. Baughman F. Dopamine-transporter density in patients with ADHD. The
Lancet. 2000; 355:1460.
3. Brian Vastag, Pay Attention: Ritalin Acts Much Like Cocaine. JAMA,
August 23,2001.
4. Dougherty DD, Bonab AA, Spencer TJ Rauch SL, et. al. Dopamine transporter
density in patients with attention deficit hyperactivity disorder. Lancet.
5.  Zametkin AJ, et al.  Cerebral glucose metabolism in adults with
hyperactivity of childhood onset.  New England Journal of Medicine. 1990;
6. Stein MT, et al. Challenging Case: Adolescence.  An adolescent who
stops his medication for attention-deficit hyperactivity disorder.
107; 2001:974-978 (Supplement).
7. Carey WB. NIH Consensus Conference on ADHD (transcript). November 16-18,
1998. Bethesda, MD.


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