'ADHD is biobabble'

October 5, 2005

Doctors are prescribing ADHD drugs to young people like never before. But one psychiatrist is dedicated to weaning children off the drugs which he describes as "highly addictive". Sami Timimi explains to Adam James why he believes ADHD is a "cultural construct" and the result of speculative "biobabble".

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Our hard-to-parent children are popping psychiatric pills like never before.

Last year UK psychiatrists and pediatricians wrote out 329,000 prescriptions for Ritalin and Concerta, the psycho-stimulant drugs to treat diagnoses such as attention-deficit-hyperactivity-disorder (ADHD). This is a massive 57 times more than they wrote out in 1994.

However, one child psychiatrist is bucking the trend. In fact Dr Sami Timimi is dedicated to weaning children off the drugs. For him, the medication is "highly addictive" and has chemical properties which are "virtually indistinguishable" from amphetamines like cocaine and speed.

Timimi, who works for Lincolnshire Partnership NHS Trust, is arguably the leading UK psychiatrist critical of the ADHD diagnosis.

His book, 'Naughty Boys; Anti-Social Behaviour, ADHD and the role of culture' is the first authoritative critique of the ADHD diagnosis - and related prescribing - by a UK psychiatrist.

His co-written chapter in a new book, Making and Breaking Children's Lives, is exclusively published today at psychminded

Quite simply Timimi does not believe ADHD is a valid medical diagnosis. Instead ADHD is a "cultural construct"; the result of speculative "biobabble".

Last year he wrote in a academic paper: "ADHD is a 'dumping ground' allowing all of us to avoid the messy business of understanding human relationships and institutions and their difficulties, and our common responsibility for nurturing and raising well behaved children."

How can society therefore justify prescribing potentially dangerous drugs to treat a pseudo diagnosis, asks Timimi? Moreover, Timimi says he has children referred to him who have been made worse by ADHD medication.

"ADHD fanatics have been overplaying the evidence of the effectiveness of Ritalin," he states. "The most recent metanalysis concluded that evidence that Ritalin was useful for more than four weeks has yet to be demonstrated."

"Most children do not want to be on medication. They get called names like 'druggie'. And they do not like the effects of the drug. They feel light-headed, dizzy or complain of being 'not me'

"They can use [the ADHD diagnosis] as an excuse to get away with things they do not want to do. They might say 'I am sorry I can not do it, I have got ADHD'."

Timimi certainly puts his money where his mouth is. Over the last two years he has weaned dozens of ADHD youngsters off stimulant medication.

He chooses, instead, to work with families - and schools - to discover what dynamics within the child's environment is resulting in their problematic behaviour.

"I try to enter into a dialogue and talk to parents about the fact that ADHD is a controversial diagnosis," he says. "It's about trying to understand their child from a parent's objective and not the doctor's."

Timimi examines what lies behind a child's problematic behaviour. It could be learning difficulties, a high sugar diet, domestic violence, extreme lack of exercise or poor discipline.

"I don't say people are bad parents, because for me bad parents are those who go out to intentionally damage their children," Timimi explains.

While England and Wales health bodies do not seem overly concerned by the escalation of ADHD drugs on children, the Scottish Executive is different.

In January it launched an inquiry into ADHD and Ritalin following its own tenfold increase in Ritalin prescribing over eight years.

Meanwhile in clinics all over the UK there's no end to the fierce upwards prescribing curve of ADHD drugs. Timimi is - at the moment - demonstratively exceptional.

* The Rise and Rise of ADHD, by Sami Timimi and Nick Radcliffe, in Making and Breaking Children's Lives, published by PCCS books (pdf)

* Making and Breaking Children's Lives, published by PCCS books

* Naughty Boys: Antisocial Behaviour, ADHD and the role of culture is published by Palgrave MacMillan.

See also:
Oct 5, 2005: Watch out for suicidal behaviour for children on ADHD drug, regulator warns - new clinical trial data shows increased risk of suicidal tendencies in children on Strattera
Jan 10, 2005: Inquiry into ADHD treatment in Scotland - following huge rise in Ritalin prescriptions
August 4, 2004: Clinical psychology publishes landmark critique of ADHD and use of psychiatric medication for children - "overzealous" mental health professionals prescribe "addictive and brain-disabling" drugs, argue clinicians

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If ADHD drugs are so addictive why do teenagers refuse them?

Comment from: Trish Fowlie, community paediatrician, South West Kent Primary Care Trust
Date: October 20, 2006

If methylphenidate was so addictive, why do we commonly find oppositional teenagers refuse to take it, often with drastic effects.

I have worked as a psychiatrist, but I never managed to improve the quality of my patients' lives in any way close to prescribing methylphenidate for ADHD.

I agree we didn't need to recognise ADHD in the past, since most kids were half starved, half ill, and over-worked. If they had an impulsive accident down some mine or up some chimney, there was no health and safety to care all that much. Impulsive crime could easily be dealt with by hanging or deportation. No bother, no ADHD, no methylphenidate. Is that really what you want?

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Here's why methylphenidate is addictive...

Comment from: Barry Turner lecturer in forensic and biomedical sciences, University of Lincoln
Date: August 27, 2007

To answer Trish Fowlie's question, methylphenidate is addictive because of its pharmacodynamics. All psychostimulants if taken habitually cause an adapative change in the dopamine and noradrenaline function. This is because this drug causes an increase in the release of these neurotransmitters. Incidentally. before anyone thinks this is evidence for a pre-existing dopamine or noradrenaline imbalance. this happens in everyone that takes these drugs, not just those labelled with ADHD.

As for why do oppositional teenagers refusal to take it. Well that is their right and it is a fundamental breach of ethics to force treatment onto a non-consenting patient. Why do we find heroin addicts who want to kick the habit refusing heroin? It is the norm for addicts to want to quit because they don't like the side effects or ever-present danger to health and well being that drug addiction causes.

Trish Fowlie uses dramatic language in suggesting drastic effect. It is strange that these are not illustrated by examples. She says: " I have worked as a psychiatrist, but I never managed to improve the quality of my patients' lives in any way close to prescribing methylphenidate for ADHD." This is difficult to follow as there is no actual measure quoted for quality of life. What needs to be understood is that children do not voluntarily present with ADHD. They are taken to the doctors usually because someone else is complaining of their own 'quality of life'. It might be an idea before inflicting methylphenidate onto children, some of whom are incapable of metabolising it, that THEY are asked to comment on their 'quality of life'

Trish Fowlie says: "I agree we didn't need to recognise ADHD in the past, since most kids were half starved, half ill, and over-worked. If they had an impulsive accident down some mine or up some chimney, there was no health and safety to care all that much. Impulsive crime could easily be dealt with by hanging or deportation. No bother, no ADHD, no methylphenidate. Is that really what you want?"

When I was at school there were no half-starved children in my class and I did not see many sweeps' boys or child miners plodding their way to work. I am not aware of any of my generation being hanged for sheep stealing or transported for life. Neither were we aware of any such thing as ADHD. We had disruptive children, even delinquent ones, but we and our parents and teachers thought that was humanity in all its shapes and forms. I am immeasurably grateful to have been brought up in an era when there was still reason in medicine and before it was totally highjacked by big pharma.

Methylphenidate releases 5-hydroxytryptamine (5-HT, serotonin) and dopamine which eventually causes degeneration in neurones containing serotonin. This is real brain damage, damage to the actual brain tissue. This damage is irreversible and 'chemical balancers' will not repair the destroyed brain tissue or make it function normally again.

If the pro-drug lobby actually believe in chemical imbalances they should understand that serotonin function deficiency is associated with depression. Great marketing idea though, if the children treated with methylphenidate do go on to be depressives then they can still provide a market for even more psych drugs.

Unfortunately, it is likley that this iatrogenically-induced clinical depression will not respond to the current ragbag of SSRI snakeoil therapies. We should be finding out real soon as the first generation of methylphenidate victims are just about maturing into the next generation of depressives. What we should expect to see is that these people presenting with depression will go straight onto the atypicals and anti-psychotics to subdue them rather than even purport to treat.

I think the moral of the story is that 'chemical imbalances' pose a real risk of serious mental illness especially where they are induced iatrogenically by faulty medical treatment.

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Meds can be lesser of two evils

From: Tracy Pankhurst, parent of ADHD child, UK
Date: January 16, 2009

I have read many articles criticising the use of stimulant medication in ADHD; most were over-simplifications of the problem and, I believe, show a lack of understanding.

ADHD is not just about naughty boys acting out. ADHD also occurs without hyperactivity, in adults and in girl children. How many predominantly inattentive ADHD children quietly day dream at the back of our classrooms and under achieve?

I agree that, in an ideal world, we wouldn't have to consider medicating our children. Given enough support in school, and a learning environment which makes the best use of the childs attention, minimises peer bullying and teacher frustration and protects the child's self esteem I wouldn’t.

Unfortunately this kind of schooling would be prohibitively expensive to provide. Medication is often considered the lesser evil by worried parents...it’s never an easy decision to take. However 30-50% of those with ADHD (adults and children) do not respond to stimulant medication [Prim Care Companion J Clin Psychiatry. 2006; 8(4): 224–233.]

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From: Sally Roberts, teacher/parent, UK
Date: November 29, 2010

I agree with Sami Timimi and let me explain why. My son is nearly 20 and was diagnosed with ADHD when he was 5. He was placed on Ritalin and later Concerta and was on meds until he was 17.

I was like any other parent trying to find what was wrong, but at the age of 10 and high amounts of Concerta, the complaints were still coming in, my son's behaviour was worsening, he was about to be excluded from his special school, he did not sleep and I was going insane!

I had to find something else and this began a slow road to truly understanding ADHD. I began with diet, removing foods that exasperated his behaviour, I had to relearn my parenting skills, what had worked with my other child was not going to work with my son and especially now his self esteem was low. I had to get inside the head of my ADHD son. I researched and studied until I believe I found what i needed to help him and give him a good quality of life, without drugs. It was not easy but I believe I did it. I am now a teacher of kids with challenging behaviour and have a good success rate in my opinion. I learn more every day and one thing i am sure is that the diagnosis for ADHD is incorrect and needs to be reassessed.

I came in contact with Dr Tamimi when I was weaning my son off his medication as I could not find a doctor to help us. They just wanted to give us more.

Dr Tamimi could not help us as we were out of his area but I have followed his work and still agree with what I am reading.

I am not saying that a child with a different diet, different lifestyle, upbringing, etc would not have challenging behaviours, or learning and social difficulties but I do know for sure that they would not be as exasperated as they are, and the severe behaviours we see in today's society would not be around. We are trying to find an easy way out, when most of the problem lies in today's lifestyles and foods.

21st century lifestyle is the major contributor to the ADHD. I had to learn, this information was not available to me but then who is listening when you try to explain?

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Parents should look at emotional responsibility

From: Christine P, CAMHS worker, parent
Date: February 8, 2012

I have read with interest the previous posts, which are so very relevant to my own and my son's story.

He was diagnosed with ADD when he was 6 and started on Ritilin when he was 8.

He really found it difficult to concentrate and focus, he was not really naughty as such but got into a lot of trouble as he was so disorganised.

I was constantly trying to find answers which led me to different treatments for example neuro feedback and trying out different diets, none of these seemed to work that well, although we only managed half of the neuro feedback course, so the verdict was still out on that one.

His problems led me on a journey into studying psychology, social sciences and then on to social work ending up with a Masters degree and working in CAMHs.

Every day I struggle with the questions around diagnoses of ADHD and ASD and in my heart of hearts agree with what Dr. Sami says, which is difficult as most of my work team particularly those from a medical background think the opposite and when I have expressed my views there is a look of disbelief.

With regards to my son, he has taken medication for some time but tended not to take it at weekends or holidays and now he is at university probably dosent take it at all and seems to be getting on ok.

This may be because he is studying marketing which really suits his personality and creativity. The medication did help him focus which in turn built up his self esteem, he was better liked and had more friends because his impulsiveness was reduced.

So in one way it helped but having read the above comments regarding potential depression - it-s worrying.

My son was 6/7 weeks premature and had a difficult birth, I was stressed it was an IVF pregnancy and his whole early infanthood was difficult, my parenting skills were probably dubious, as my own parenting from my mother was somewhat lacking emotionally.

I've had therapy for over 4 years now and am coming to terms with my past, I have been on a spiritual path and used meditation and Buddhist principles to guide my life and feel a lot better for it.

I deal with a lot of parents that just see their children as a problem and want a diagnosis, however I really feel that they need to look at their parenting and how they were parented and try to increase their capacity for emotional responsibility for themselves and their children, this sounds judgemental but its not supposed to be, as you can imagine not many parents like this approach.

I am not trying to blame parents but just really trying to help them recognise that the emotional wellbeing of their family and their child is the responsibility of parents/family/school/community and nation.

It is difficult to come to terms with this approach because we do tend to live in emotionally illiterate and narcissistic times. Thanks for reading - hope it makes some sense

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