rivka | Oh, for fuck's sake.

Entry tags:

drama,
psychology

Oh, for fuck's sake.

Ninety-nine percent of the time, when I'm offensive, (a) I know that I'm being offensive, (b) I'm doing it on purpose, and (c) I'm willing to acknowledge it. This may not be much of a virtue, but sometimes it's all I've got.

In another journal to which I shall not link, a commenter presented the opinion that "autism and ADD are 'massively overdiagnosed.' " When I asked if she had any evidence for this claim, she posted a long set of justifications involving lazy teachers, parents with no discipline skills, venal psychologists, and suggestive idiots who see symptom lists on the internet and become convinced that their child is autistic. Here's the money quote:

what is often diagnosed as autism is more likely a lack of parenting skills combined with a therapist's interest in creating a lucrative "treatment" plan - one that involves "specialists" "drugs" and "group therapy" - all of which line someone's pockets.

My response, I acknowledge, was not at all kind or temperate. I regretted, afterwards, not making the same points in slightly more temperate language. But I am not amused, today, to discover that she made a long self-pitying post in her own journal about how victimized she was by my horrible attack. Because she is never one to make a point offensively, herself. She's very gentle.

If the bit I quoted above is not unbelievably offensive to parents of autistic children and to mental health treatment providers, then I need a new definition for the word. Yes, when I fired back, I was harsh. But I'll be damned if I'm going to accept a version of events in which I am supposed to have fired the first shot.

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Well, my gut feeling is that she might be right on the point of ADHD being a 'fashionable' diagnosis, and I can't help but feel that it might be related to kids no longer being allowed - if not _expected_ - to run around and expend a lot of energy. When I was in primary school, if kids - especially boys - were to have difficulties sitting still and concentrating, it was often simply ignored - they had plenty of opportunity to run around and climb trees and play football and get into all kinds of scrapes in their breaks, and they were expected to grow out of it.
As far as I am aware, most of them did.
I am slightly cynical as to whether, almost thirty years later (ugh!) the same standards would be applied, or whether parents and teachers wouldn't actively seek a diagnosis and ways to 'fix' what is so obviously 'wrong' with the child - after all, the child doesn't want to sit quietly in front of the video as my neighbour's kids spend at least half their time.
There also seem to be links between very wired behaviour and sugar highs or certain food additives - and *that* would most certainly make it a modern problem. In such cases, my impulse would be to _first_ see whether the problem cannot be controlled with a better diet and more chances to blow off steam rather than with drugs, but that doesn't seem to be everybody's first point of call.
Which, as I realise, is tremendously unfair on those people who *do* try, and *are* the best parents they or anyone else can be under their circumstances.

As for autism, thankfully I lack direct experience with it. I do, however, own a horse whose behaviour became more understandable - and more controllable - once I started looking into autism (somebody wrote about their kid and I thought 'that sounds just like my horse'), so on that account I have every inch of sympathy for the parents; but again, I wonder how much can be achieved with behavioural therapy and what role drugs can - or should - play.

As I said, these are musings of a laywoman. I do not think that the parents should be blamed, but living next door to a set of bad parents (not ill-meaning, just totally unskilled, which breeds a lot of verbal violence) I wonder whether milder tendencies that another set of parents would have absorbed wouldn't come out full blast when combined with helplessness before even average behaviour.

You know, it bothers me quite a bit when people who are fully aware that these are topics they haven't studied, and are only musing based on first principles, feel comfortable implying that other people are drugging their kids unnecessarily. Can you explain to me why you think it's appropriate to do so?

As it happens, people have tried experimental educational settings for children diagnosed with ADHD, in which sitting still is not required and there are lots of chances for exercise. It makes school more pleasant, but it doesn't mitigate the disabling effects of the illness. It certainly doesn't result in increased school performance.

Furthermore, untreated ADHD is not benign. It's associated with high risk of school failure, drug and alcohol abuse, serious conduct problems including criminality, social rejection by one's peers, depression, and family conflicts. ADHD is not a problem that vanishes if people wink and say that "boys will be boys." Some kids do grow out of it, true; others experience lifelong failures at work and at home if they don't receive help.

Finally, do you have any idea about how commonly behavioral therapy vs. drugs are used to treat autism, or does it just sound good to you to imply that people use drugs too much?

Man. This is the last thing I expected to see on this thread.

feel comfortable implying that other people are drugging their kids unnecessarily. Can you explain to me why you think it's appropriate to do so?

I think there is a general tendency in society to look towards drugs as good solutions.

In many cases, they are. In many cases, they are the best solution. But there are probabably equally as many cases (headaches, colds) where popping pills is *not* the best, most efficient, or least problematical solution - yet there is a subtle pressure towards doing so.

I think looking towards a drug - like Ritalin - as the starting point of approaching a problem (confirmed by the article you quoted) is a bad philosophy, and I like to see it questioned. Which does not mean that I reject Ritalin as being inappropriate on principle, only that I want to be reassured that it is not used unquestioningly, just as I want to feel reassured that people do not use antidepressants (another disputed, often highly efficient, frequently necessary, but sometimes too easily prescribed class of drugs) as a first resort. (This, unfortunately, is first hand experience.)

ADHD is not a problem that vanishes if people wink and say that "boys will be boys." Some kids do grow out of it, true; others experience lifelong failures at work and at home if they don't receive help.

Wondering whether there is an overdiagnosis of a certain illness/disorder/problem does not mean denying that it exists or that it is a real problem. Bad diagnostic methods that results in diagnosing people who don't suffer from something will, in the long run, probably prove as damaging as bad diagnostic methods that mean people who are suffering are not diagnosed. In the latter case, the effect is obvious and harming the people directly, in the former, it can mean that nobody takes the diagnosis - and the real sufferers - seriously, because they've come across too many people suffering with colds who "had the flu".

I tried to give you another perspective of why someone might arrive at the conclusions you referred to initially. Wondering what role non-drug treatments can play in the treatment for autism is a far cry from implying that drugs are used too much; attacking me for expressing an interest in the topic was not what _I_ expected.

What explanation would you offer for the sharp increases in diagnosis of ADHD and the corresponding prescriptions? Can you not at least acknowledge that they give the _appearance_ of a 'fashionable' diagnosis?

If sufferers are diagnosed by the virtue of having symptoms like 'having difficulty in playing quietly' and 'talking excessively' - are you *surprised* that people question where the line of diagnosis is drawn? Who decides how much 'playing quietly' is normal, and how quiet children should play? And don't you think that this line will be drawn differently in different societies?

the Feingold hypothesis that ADHD can be cured by a diet avoiding sugar and food additives was conclusively disproved more than twenty years ago

I am not aware that the concept has a name attached to it; but I know several parents who insist that they can see marked differences in their children's behaviour directly related to their diets; I know a couple of adults who will attest the same about themselves, so I think it's at least worth looking at. I know that I have difficulty concentrating if I skip breakfast and load myself with quick carbs...

There were two brothers.

One was called "computer" because he was thought to be the smarter one.

He was put on Ritalin. It helped. They took him off of it... hyperactivity is a trendy diagnosis. His parents were having marital problems. That was the only reason he was acting inappropriately.

The other... he just suffered. He didn't know how to deal with the racing thoughts, the overwhelming emotions, and hypersensitity to things.

Twenty odd years later, the other discovered that being half-asleep all the time, being unable to fight though a fog, being unable to bear the pain of being alive, that wasn't *normal*... and eventually discovered he had ADHD.

The other one, the brighter star, had already started killing himself with drugs and alcohol. He died last year. He was still finding a way to deal with his own pain, still trying to understand.

I understand that you hear all the stories, and you might think it's worth worrying about, and you also might think that Rivka is (or I am) being unduly harsh on those who don't understand.

But it can be a matter of life and death, literally.

And sometimes, sometimes you have the time, the strength, and the wisdom to be calm and find comfortable ways to counter the arguments and explain things in a way that gets people to understand.

And sometimes... sometimes you don't.

And it can be hurtful to people when they get snapped at angrily because they didn't understand. I get that. I'd rather (as would Rivka) gently change their minds, because a gently changed mind is more likely to stay changed.

But it's not always possible. People can't say "on" all the time, ready to let the pain and anger and frustration drain away, so that they can gently help another person to understand. So, sometimes the pain and frustration leaks out, and sometimes it's fair, and sometimes it's not, but life's like that, sometimes.

Yeah, I understand that people have misconceptions that can caus a great deal of suffering. I know that they're not evil or malicious for having those misconceptions. But *damn*, it still hurts.

Why shouldn't drugs be used for colds or headaches? I usually weather colds pretty well, but I do suffer from disabling migraines. As a matter of fact, it's widely recommended to take painkillers fairly early on in a migraine episode because it's a lot more difficult to defeat pain when it's well established. My direct experience alas confirm this.

I am not aware that the concept has a name attached to it; but I know several parents who insist that they can see marked differences in their children's behaviour directly related to their diets; I know a couple of adults who will attest the same about themselves, so I think it's at least worth looking at. I know that I have difficulty concentrating if I skip breakfast and load myself with quick carbs...

First, I know that I get grumpy if I don't have enough protein. That's not ADHD, it's well within "normal" human variation. That people do better with healthy food doesn't mean that improving one's diet will cure ADHD, or any other disease.

Second, it is very hard to sort out random chance and the placebo effect. This is especially true in cases where the evaluation of whether a treatment helps is the same person who has decided to try the treatment, and is administering it, rather than either an outside observer or the patient. I don't know how much variation there is in symptoms from day to day, or week to week, with hyperactivity or ADD. With conditions that do have such variation, almost anything can appear to be a "cure". Hence the belief among some people with multiple sclerosis that removing mercury fillings from their teeth is a cure, or at least a significant treatment: relapses and remissions are part of the normal course of MS, and it's not at all unlikely that a given person will have a remission right after trying any random treatment. Post hoc does not mean propter hoc.

Oh, and also: the Feingold hypothesis that ADHD can be cured by a diet avoiding sugar and food additives was conclusively disproved more than twenty years ago.

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