The So-Called ADHD “Epidemic”

“I think I got ADHD.” I can never say what I think when someone says this. I think, “get out of here you drug seeking idiot.”  The great majority of people who come into my office saying this are just that. Of course, I am not that blunt — at least not to their faces.  But the tragedy is that they WILL find somebody to dash off a prescription (for a price).

Sometimes drug-seekers know they really don’t have it.  Sometimes they are actually misled by those who make such diagnoses wholesale. I know of entire medical clinics who make a fortune by turning out ADHD diagnoses. There are clinical scales for Attention Deficit.  Tests for it. Every single test I have ever seen for ADHD has “false positives.”  It can say that you have this when you do not. This is not that hard.  I have seen some tests where I myself would have qualified for ADHD.  And I can tell you for sure, I absolutely do not have ADHD.

A woman came into my office, who certainly did not have it.  She was, however, very good at crying and begging me for a little amphetamine. “When I was on it, I did so much!  I got a lot accomplished; it was so good for me.” I think she was bipolar.  She looked manic, extremely emotional, even desperate. As far as I could figure she was not acutely withdrawing from any kind of drug, and she was not in any kind of life-threatening danger. I told her as gently as I could. “Everyone feels that way on amphetamines,”  I explained to her.  “What you just told me only means I have to get the whole story and make a diagnosis of my own and suggest some options for treatment. “No,” she said.  The tiny blonde pounded my desk. “I know what works and I want it and you won’t give it to me.  You’re wasting my time.”

I made completely sure she was not in any danger — not suicidal, and did not want to harm anyone else. “You may leave if you want,”  I said.  “You can answer my questions if you like.  If you don’t want to, you are free to leave. She was still ranting as she ran out. I have seen exactly three patients in my 35-or-so year medical career who actually fit the criteria for ADHD (Attention Deficit Disorder with Hyperactivity) as first described by Dr. Carpenter in a home for boys with discipline problems in 1925.  They were people who had a “paradoxical” response to stimulants — who could use a strong cup of coffee like a sleeping pill.

They would initially get sleepy with their stimulants. These three patients did get stimulants from me. I have seen patients who love their stimulants.  They are not my patients. Once I saw some at certain glamorous practices in Hollywood.  I do not work in such places, so nobody using stimulants for weight control or glamorousness is getting that from me.

The tough thing about being a psychiatrist is that you live where cultural norms intersect medical illnesses.  You have to be able to tell the difference between what culture has created and what biochemistry has created. I have seen plenty of people who tell me they have had insufficient attention to succeed in academics or in business. I have never seen anyone who had insufficient attention to play a complex video game. Stimulants are addictive.  They carry a risk of sudden death.  I can minimize it a little with appropriate annual cardiac exam per customer. It is shocking to me how little research there is on the effects of amphetamines on adults when they are taken long-term. Chronic amphetamine use can cause sudden death and can have poor effects on the liver.  Where this illness may exist, check out the alternatives. After all — In most cases, it is still one heart to a customer.

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