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> Parenting, not pills
> A new study casts serious doubt on our all-too-common practice of dosing
> hyperactive kids with Ritalin. Dr. Lawrence Diller welcomes the news.
> Editor's note: Parents, kids and other readers are invited to query Dr.
> Lawrence Diller about behavioral issues related to young children. Dr.
> Diller can be reached at
> Dec. 12, 2002  |
> Dear Dr. Diller,
> I am the mother of a "spirited" 4-year-old boy whose behavior has become
> almost too difficult for me, or his preschool teachers, to handle.

[Fred A. Baughman Jr., MD:
Behavior to difficult for parents or teachers
to handle is not a medical diagnosis/disease, warranting or justifying
medical management of any time or parents or teachers declaring they are
perfect, their efforts optimal and complete, and that it is time to consider
medical or surgical intervention. Is the orientation of these parents,
teachers such that they believe such behavior to be a disease, ADHD perhaps,
the only reasonable response being medical, medication.]

> At
> school, I'm told, he is unable to sit still, stay focused or get along well
> with the other kids. He has been aggressive, and I'm not sure he's going to
> be allowed to stay. At home, he is active, in fact he bounces off the walls,
> but so far we haven't gone beyond basic attempts to control him.
> His teachers, and a couple of parents, have hinted that he might have ADHD
> and that we should look into medication. I am at wit's end, but I'm very,
> very reluctant to start giving him pills. My impression is that this is the
> accepted treatment, but I need to know: Is there an alternative that works?

[Fred A. Baughman Jr., MD:
The fact that it is "accepted" in a profession (psychiatry,
pediatrics, neurology, family practice) that has wholly sold out to the
psychopharmaceutical industry does not mean it is truly effective or even
safe. It is neither and it's use is based upon the contrived (by all of the
above) notion that these and other behaviors are brain diseases,
abnormalities when none of them are. They seek to have the naive
public/parents provide their child one-dimensional drugging, caring not at
all whether real world solutions are tried, things such as discipline,
family counseling, family and school accountability, a private or parochial
school education/rearing in place of our psychology-, psychiatry-laced,
drug-pushing public schools]

> -- Out of ideas
> The controversy over attention-deficit/hyperactivity disorder (ADHD) and its
> main treatment, Ritalin, refuses to go away. Parents struggling with their
> children's seemingly insurmountable behavioral issues -- at home and in the
> classroom -- still face a bewildering array of passionate, conflicting
> opinions about the diagnosis of ADHD and the safety and effectiveness of
> stimulant drugs like Ritalin in treating it.

[Fred A. Baughman Jr., MD:
There are two separate issues but Diller seeks to further
confuse and obfuscate speaking of "opinions about the diagnosis of ADHD and
the safety and effectiveness of stimulant drugs like Ritalin in treating
it." In all of medicine and surgery, diagnosis comes first and must be
proved before treatment can be rationally prescribed. Diller knows as well
as I that ADHD is not a disease, an abnormality within the child; he know
that no psychiatric diagnosis from within the DSM-IV or any DSM is an actual
disease. On March 7, 1998, speaking at the American Society of Adolescent
Psychiatry, Swanson confessed: (from the tape recording of the session):
"I would like to have an objective diagnosis for the disorder (ADHD). Right
now psychiatric diagnosis is completely subjective.We would like to have
biological tests-a dream of psychiatry for many years." ]

> This confusion reigns despite
> relative unanimity from mainstream medicine that ADHD is a brain disorder,
> and its best treatment is Ritalin or one of the newer, long-acting drugs
> like Adderall or Concerta.

[Fred A. Baughman Jr., MD:
Swanson, choosing to forget his 3/7/98 confession that their is
no such thing as a psychiatric/psychological brain
disorder/disease/abnormality, proclaims there is "relative unanimity from
mainstream medicine that ADHD is a brain disorder." He knows as well as I
that in medicine and science (if it is to be scientific) that their must be
a confirming physical abnormality (including chemical) without which there
is no abnormality/disease. He know that "unanimity," consensus, a show of
hands, as is the process at the DSM Committee of the American Psychiatric
Association, never validates the presence of disease in any organism, human
beings included. This brings us to the reason one is not justified in
jumping to conclusions about the treatment of ADHD or any other entity as
Swanson has done: "its (ADHD's) best treatment is Ritalin or one of the
newer, long-acting drugs like Adderall or Concerta." Where the presence of
physical abnormality/disease has not be established, no medical/medication
treatment is required or is justified. Swanson knows this, and knows that
his statements obfuscate, covering up the lack, throughout psychiatry (as he
confessed above) of any physical abnormalities/diseases calling for,
justifying, treatment with medications, especially not addictive, dangerous,
sometimes deadly medications. Further, Swanson knows that the report in the
October 9, 2002 Journal of the American Medical Association fails to prove
that ADHD is a bona fide disease, one that can be demonstrated, diagnosed,
proved to exist, individual by individual]

> Now, however, there is heartening news from a major study of toddlers with
> ADHD -- and the surprising outcome should please virtually everybody.
> This multi-site study headed by Laurence Greenhill of Columbia University
> involves several hundred children from ages 3 to 5 who have been thoroughly
> screened and diagnosed with ADHD. That, in itself, is a remarkable feat.

[Fred A. Baughman Jr., MD:
Referring to this, the Preschool ADHD Treatment Study, I
wrote, in the journal
SCIENCE, January 26, 2001
, that the main flaw, as
throughout all psychiatry, especially child psychiatry, is that ADHD has
never been validated as a disease/physical abnormality; the children said to
have it are normal, and, there is no justification for giving normal 3-5
year olds or normal children of any age, drugs such as this or any

> The
> government-funded project was the result of a national brouhaha that erupted
> two years ago when an article in the Journal of the American Medical
> Association (JAMA) revealed that the number of Ritalin prescriptions for
> toddlers as young as 2 for alleged ADHD were soaring.
> ADHD in 2-year-olds? The news was astonishing, and raised many more
> questions than it answered. Just how much activity, distractibility and
> impulsivity distinguishes a "disorder" from some variation of normal in the
> 5-and-under set? And should Ritalin be the treatment of choice for this very
> young age group? The public's reaction to the JAMA article was vigorous and
> skeptical. Political cartoons featured babies in cribs staring up at mobiles
> dangling pills instead of cute bunnies.
> This new study's primary purpose was to determine the effectiveness and
> safety of stimulants in very young children.

[Fred A. Baughman Jr., MD:
this study was
never justified in the first place. The University of Caifornia at Irvine
and Los Angeles were both participants in this, the PATS. I wrote the
District Attorneys of both Orange Co. and LA Co. charging, as was and is the
fact of the matter that entirely normal children were illegally being given
Schedule II, Controlled substances, under the guise that ADHD was a brain
disease. An information (disinformational) sheet used at UCLA (at least),
published by the NIMH (an agency of the federal government) stated,
fraudulently that children with ADHD have a chemical abnormality of the

> But extra thoughtfulness and
> care went into the design of this study -- a reaction not just to public
> anxieties about pills, but to worries about the ADHD diagnosis and efficacy
> of treatment without medication.
> Unlike most drug studies, which are financed by the pharmaceutical industry,
> this study required all families in the trial to participate in a behavioral
> intervention component before their children could receive Ritalin or a
> placebo.

[Fred A. Baughman Jr., MD:
but did not require them to have a disease before
implying to one and all, as here, that they had a

> Greenhill explained that researchers felt both morally and
> medically obligated to offer support and strategies for therapy to parents
> before trying out medication on their very difficult children. Indeed, no
> one knew for certain just how well the behavioral interventions would work.
> Amazingly, no one had looked until now.
> And a funny thing happened once they finally did look. Results are
> preliminary and the percentage could still change somewhat, but nearly half
> the families are opting out of the study after the three-month behavioral
> intervention because they are satisfied with the changes in their kids.

[Fred A. Baughman Jr., MD:
Because parents, lead, falsely, to believe their children
have a brain disease and might need medication are "satisfied" with the
study results, does nothing to verify that their children have an actual
disease, or in any way justify such medication in these children--never
proven to be anything but normal.]

> Suddenly, a pleased but chagrined Greenhill doesn't have enough children to
> participate in the medication arm of the study to satisfy statistical
> certainties. It is likely that more money will be needed to recruit
> additional children and pay their families to complete the research.
> The fact that brief, focused, short-term parent education and support work
> (teaching the parents the need for immediacy of rewards and consequences --
> "less talk, more action") should please everyone, except, perhaps, the drug
> companies. What Greenhill's group discovered is that, at the end of
> behavioral intervention, the children didn't change as much as their
> parents' attitudes. The parents came out of the therapy feeling much more in
> control of their kids, and as a result, they wanted to see how things would
> go without trying medication.
> Whether these children continue to demonstrate ADHD behavior as they grow is
> important. Up until now, most researchers say that ADHD is biological and
> basically fixed at birth (or even conception) and that parenting doesn't
> make much difference.

[Fred A. Baughman Jr., MD:
Again, whether or not "most
researchers say that ADHD is biological and basically fixed at birth (or
even conception) and that parenting doesn't make much difference," is beside
the point in matters of medical diagnosis. Consensus and a show of hands
has nothing to do with it, only whether or not their is a demonstrable,
demonstrated/diagnosed/proved physical (chemical included)

> I, along with many other doctors on the front lines,
> have found otherwise -- especially if interventions in the family are made
> before age 6.
> I'm not saying that Ritalin doesn't work at this age, though I will say that
> it doesn't work as well and has more side effects than with older kids. But
> even if Ritalin works, it is not a moral equivalent to helping parents
> parent better. And it still is unclear, despite thousands of studies on
> Ritalin, whether the drug makes a difference in the long term. For myself,
> I'd bet on the effectiveness of healthy parent and family relationships over
> a drug anytime.
> So where does this leave the parents of ADHD toddlers or even those of older
> kids who are struggling at home or at school? Try to find someone who works
> with families and knows children well but meets primarily with the parents
> and school personnel. Unfortunately, finding that someone won't be easy for
> most families. Access, availability, and costs for therapy are more daunting
> than offering a pill. But news of these parenting successes should spur us
> to provide these families with the kind of help that works, and the support
> they apparently prefer.

[Fred A. Baughman Jr., MD:
Diller is clearly a fence-sitter,
acknowledging that in the PATS study many parents are opting for renewed
efforts at parenting, deciding against drugging their normal (we have
established they have no disease and are normal) children; while at the same
time stating that Ritalin and other Schedule II stimulants are the proven,
first-line, treatment in children over six with ADHD. He knows none,
regardless of age have a bona fide disease and that their is no truth to the
"show of hands" claim from within the bought-and-paid-for establishment that
ADHD is a brain disorder, by which they mean brain disease, brain

> About the writer
> Dr. Lawrence H. Diller practices behavioral pediatrics in Walnut Creek,
> Calif. He is the author of "Running on Ritalin: A Physician Reflects on
> Children, Society, and Performance in a Pill."

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