Read an Excerpt
The Hyperactivity Hoax
By Sydney Walker III St. Martin's Press
Copyright © 1998 Sydney Walker III, M.D.
All rights reserved.
ISBN: 978-1-250-09742-2
CHAPTER 1
Symptoms in Search of a Diagnosis
Why did they give him Ritalin for diabetes?
Mother of a hyperactive child later diagnosed with subclinical diabetes after years of drug treatment
It's one of the biggest frauds ever perpetrated on the educational system, on parents, on their children. Every medical person involved should be held accountable for it ethically.
Dr. Michael Valentine, school psychologist, on the labeling of millions of children as hyperactive1
Has your child been labeled hyperactive? If so, you're not alone. According to doctors, there's an epidemic of hyperactivity in America today. Three to 5 percent of all U.S. schoolchildren, and more than 10 percent of elementary school-age boys, currently take Ritalin or other drugs for hyper behavior, attention deficits, and impulsiveness.
These children are labeled hyperactive by family practitioners, neurologists, and psychiatrists. Some of them are initially "diagnosed" by teachers, school counselors, or nurses. There's only one problem with this scenario: Hyperactivity is not a disease. It's a hoax perpetrated by doctors who have no idea what's really wrong with these children.
* * *
Are you skeptical? If so, I'm not surprised. The medical community has elevated attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) to the status of diagnoses, and most people believe that these are real diseases. They aren't — and doctors who label children ADD or ADHD don't have a clue as to what's really ailing them.
Why? Because hyperactivity and attention deficits are merely symptoms.
What's the difference between a symptom and a diagnosis? Here's an example. Let's say you come down with a chronic cough. Should your doctor say, "You have a coughing disorder," and prescribe cough drops — without worrying about whether you have lung cancer, strep throat, or tuberculosis? Or if you develop a swollen leg, should your doctor diagnose it as "a lump," and give you an aspirin, without determining whether that lump is a tumor, an insect bite, or gangrene?
Of course not. Yet this is how doctors "diagnose" hyperactivity. Is your child overly active? Does he run around too much? Does she fidget in class? Then your child is one of two million hyperactive children and needs to take amphetamine-like drugs — possibly for life. Likewise, if your child makes careless mistakes, doesn't seem to listen, doesn't finish schoolwork, loses things, and is easily distracted and forgetful, then he or she has attention deficit disorder and also needs drugs. Yet just as hyperactivity is merely a symptom, so are attention problems. The unanswered question, obviously, is, "What is causing your child to be hyperactive?" Or, "What is causing your child to have attention problems?"
It's a critical question. Children with early-stage brain tumors can develop symptoms of hyperactivity or poor attention. So can lead- or pesticide-poisoned children. So can children with early-onset diabetes, heart disease, worms, viral or bacterial infections, malnutrition, head injuries, genetic disorders, allergies, mercury or manganese exposure, petit mal seizures, and hundreds — yes, hundreds — of other minor, major, or even life-threatening medical problems. Yet all of these children are labeled hyperactive or ADD.
Furthermore, hundreds of thousands of perfectly normal children are labeled hyperactive or attention disordered, even though there's nothing at all wrong with them. These children are lumped in with the truly ill children I mentioned above, and all are medicated willy-nilly with potent and potentially dangerous drugs.
In short, huge numbers of healthy children are being drugged for no reason — and huge numbers of sick children are taking Ritalin to cover up the symptoms of undiagnosed and untreated medical problems. The latter is particularly tragic in light of the fact that most truly hyperactive and attention-disordered children have treatable or even curable medical conditions. The subtle behavioral changes that underlie these conditions require equally subtle diagnostic techniques, not a checklist and a pill.
Of course, most doctors do acknowledge that "a few" cases of hyperactivity and attention disorder are caused by diagnosable medical disorders. In the course of the fifteen-minute evaluation most hyperactive or attention-disordered children receive, doctors generally do a cursory check for some of these causes — hearing and vision problems, for instance. But because they believe that hyperactivity itself is a diagnosis, few doctors rule out all of the medical problems that can cause a child to be hyper or inattentive.
Labeling a child hyperactive or ADD, without finding out the underlying causes of the hyperactivity, can have many consequences — almost all of them bad.
Warren: Hyper or Sick?
I met Warren when he was eight. A previous doctor who labeled Warren hyperactive had started him on Ritalin, and his parents came to me for a second opinion.
Warren was a normal, sturdy boy. He looked healthy except for his pallor, which contrasted strikingly with his mother's rosy complexion. His medical reports offered few clues about the roots of his impulsiveness, restlessness, and inattention. He'd had some breathing problems, episodes of partial hearing loss during ear infections, and a heart murmur — all conditions considered benign by previous doctors — but his records contained no significant red flags.
According to Warren's mother, he was cranky and sniffly as a baby, but his symptoms cleared up as he aged. However, shortly after a move to a new house, Warren changed for the worse.
"I can't remember that he ever balked at going to school," his mother told me. "He brought home good report cards. He never had any trouble with his teachers. Now he's in trouble all the time."
I asked her what was happening at school.
"He's in squabbles and scrapes with kids who used to be his good friends. He pesters his teacher. And he isn't learning anything in school. He's even backsliding. His handwriting and his spelling were better last year than they are now."
Warren's teacher was the first to bring up the word "hyperactivity." Warren wasn't destructive, she told his mother, but he constantly disrupted the class. If he wasn't raising his hand dozens of times an hour to ask an endless stream of questions, he was bouncing out of his chair to sharpen pencils, get a drink, or just wander around. He forgot his homework assignments. He ground his teeth while doing class work. He squirmed. He had trouble doing math problems he'd mastered days earlier.
"She told us to take him to a specialist in hyperactivity," Warren's mother said. They did, and the doctor prescribed Ritalin. Warren's parents worried about the drug's possible side effects, but the doctor convinced them that Ritalin would solve their son's academic and behavioral problems.
"We thought, well, if it would do any good ... but it didn't."
No surprise. After an extensive three-day workup, I was able to diagnose Warren's real problem. By day two, I'd unearthed several clues. First, Warren was color-blind. Second, his electroencephalogram (EEG) showed abnormal but nonspecific brain wave patterns. A test called an electronystagmography (ENG) also produced abnormal results. These test results, taken together, told me that something serious was wrong with Warren's brain, but they didn't tell me what the problem was.
The next day, I discovered the answer: A carbon monoxide assay revealed a blood saturation of this deadly gas at the dangerous 20 percent level. Carbon monoxide was displacing the oxygen in Warren's bloodstream, drastically reducing the supply of oxygen to his brain. His fidgeting, falling academic performance, and purposeless hyper behavior were all symptoms of low-level carbon monoxide poisoning.
Warren's parents immediately called the gas company and had their heating system overhauled. They also started driving Warren to school, rather than having him ride for several hours a week on an old school bus with a faulty exhaust system.
Repeat studies three weeks later showed that Warren's carbon monoxide level had dropped to 3 percent. Already, his teachers and his parents were seeing dramatic changes in his behavior. Within six months, Warren's EEG was normal, and his color blindness — not hereditary in his case but due to toxic exposure — was resolved.
It took three days of evaluation, and many studies, for me to identify Warren's problem and rule out the hundreds of other conditions that could have caused his symptoms. Was it worth it? Warren's parents certainly thought so. His previous doctor's "diagnosis" may have been faster, but it was wrong — and Ritalin certainly wasn't a cure for carbon monoxide poisoning.
Symptoms in Search of a Diagnosis
Do all hyperactive children suffer from carbon monoxide poisoning? Of course not. As I've noted, hundreds of different disorders can cause the symptoms that doctors call hyperactivity or attention deficit disorder. Some are common, some are rare, and some happen only once in a blue moon. These disorders have different causes, different prognoses, and different treatments. And that's exactly my point.
If a hundred different disorders can cause fidgeting, academic problems, overactivity, sleep problems, and attention disorders, then how can doctors pretend to treat all hyperactive or attention-disordered children with a single drug? The approach is even more illogical when you consider that this drug, Ritalin, merely masks symptoms without addressing what's causing them.
An even more dangerous trend is letting elementary school teachers "diagnose" hyperactivity and ADD, a frighteningly common practice these days. Here's how it works. A teacher, frazzled by Johnny's disruptive behavior, calls Johnny's parents to a meeting. Flanked by a school psychologist or principal, the teacher advises the parents that Johnny needs to be taking Ritalin. The parents take Johnny to a doctor, who in essence rubber-stamps the teacher's "diagnosis," often without even conducting a physical examination.
I understand that teachers can be tremendously burdened by impulsive, overactive, disruptive students. Teaching these children can be a nerve-racking and frustrating experience. In effect, many of these children are completely unteachable, and Ritalin does restrain some of them to the point that they can sit and learn. But allowing teachers to "diagnose" hyperactivity and doctors simply to rubber-stamp the teachers' recommendations to put children on Ritalin is an extraordinarily risky situation.
To illustrate just how misguided this practice is, consider the following two scenarios.
Case I: James
At six years old, James is driving his adoptive parents crazy. He wets the bed. He bounces off the walls at home and at school. He's confrontational and destructive and has wild tantrums when he's crossed.
James also exhibits pica — that is, he eats nonfoods such as dirt and paste. He grinds his teeth. He's been placed in a special education class because he can't attend or behave well enough to keep up with other students. His teacher recommends Ritalin.
James is a classic case of hyperactivity. But Ritalin and counseling won't treat the medical conditions my evaluation reveals.
First, tests reveal toxic lead levels that are crippling James's brain cells. In addition, he suffers from fetal alcohol syndrome (FAS), a tragic consequence of prenatal alcohol exposure. Children with mild cases of FAS often show no obvious physical signs, and in James's case, there is only one subtle physical clue — abnormal epicanthal folds over his eyes. The real clue comes from his family history: James's biological mother had a long history of both drug and alcohol abuse.
James needs immediate treatment to lower his toxic lead levels, and his family needs to determine the source of the lead he's ingesting and remove it. James also needs a different special education class, with teachers knowledgeable about FAS children's disabilities.
Case 2: Debby
Debby, age five when I see her, is tiny and delicate. Her mother, however, describes her as a "mean little kid" who has temper tantrums and screaming fits. As a baby, she cried continuously, slept very little, did not nap, and banged her head on her crib. Now in school, she's run away from kindergarten twice. Her teacher despairs over her out-of-control behavior and recommends medication. Debby's first doctor agrees.
Fortunately, Debby's mother demands a second opinion. My examination leads me to call for a cardiac consultation, which uncovers a defective blood vessel between Debby's heart and lungs, preventing a normal flow of oxygenated blood to the brain. Surgery corrects this serious and potentially fatal condition. Almost immediately, Debby's behavior improves, her tantrums stop, and her teachers begin praising her academic achievement.
* * *
Now ask yourself: Did Debby's teacher and James's teacher make correct diagnoses when they suggested that these children were hyperactive and needed Ritalin?
The answer obviously is no. Ritalin treatment wouldn't have corrected the lead poisoning that was continuing to damage James's already malfunctioning brain. And Ritalin would merely have masked symptoms of a disorder that could eventually have killed Debby.
The Problem That Doesn't Just Go Away
Once a teacher or doctor identifies a child as hyperactive or attention disordered, the next step is almost a forgone conclusion: a quickie medical evaluation and a prescription for Ritalin or similar drugs. When these drugs do work, they work in the extremely limited and temporary sense that children taking them tend to be calmer, more focused, and easier to live with, at least in the short term. But, as I explain later, these drugs are far from benign, and their benefits are questionable.
The real tragedy, however, is that masking children's symptoms merely allows their underlying disorders to continue and, in many cases, to become worse. Contrary to popular belief, hyperactive children don't simply outgrow their symptoms. Instead, many grow into troubled teens and adults.
About half of all children labeled hyperactive do well in adulthood. Many of them originally suffered from time-limited physical disorders in childhood (developmental seizures, for instance); when the disorders cleared up, so did their hyperactivity. Others were never hyper in the first place but merely normal, active children (see Chapter 8). The outlook for the other 50 percent of children labeled hyperactive, however, is grim.
Salvatore Mannuzza and colleagues, studying adults labeled hyperactive in childhood, found that they were far more likely than control subjects to hold low-paying jobs and to be high school dropouts, and that a large minority of them regularly committed irresponsible and violent acts. Eric Taylor and colleagues found that hyperactivity — even in children who showed no early evidence of serious behavioral problems — was a risk factor for problems in late adolescence, frequently leading to violence, other antisocial behaviors, social problems, and school failure. And H. R. Huessy and colleagues, following eighty-four hyperactive children for up to a decade, found that their rate of institutionalization for delinquency was twenty times that of the general population. Numerous studies also show that children labeled as having both hyperactivity and conduct disorder — a fancy psychiatric term for stealing, lying, and acting out — are at extremely high risk of drug abuse, teenage pregnancy, and criminality in adolescence and adulthood.
(Continues...)
Excerpted from The Hyperactivity Hoax by Sydney Walker III. Copyright © 1998 Sydney Walker III, M.D.. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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