Martha Burge - The ADD myth : how to cultivate the unique gifts of intense personalities

First published in 2012 by Conari Press

Red Wheel/Weiser, LLC

With offices at:

665 Third Street, Suite 400

San Francisco, CA 94107

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Copyright 2012 by Martha Burge

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from Red Wheel/Weiser, LLC. Reviewers may quote brief passages.

ISBN: 978-1-57324-582-1

Library of Congress Cataloging-in-Publication Data

Burge, Martha.

The ADD myth : how to cultivate the unique gifts of intense personalities / Martha Burge.

p. cm.

ISBN 978-1-57324-582-1

1. Attention-deficit hyperactivity disorder. 2. Behavior disorders in children. I. Title. II. Title: Attention deficit disorder myth.

RJ506.H9B87 2012

618.92'8589dc23

2012010793

Cover by Jim Warner

Cover art by Christopher Oates/Shutterstock.com

Interior by Dutton & Sherman

10 9 8 7 6 5 4 3 2 1

Printed in the United States of America

MAL

The paper used in this publication meets the minimum requirements of the American National Standard for Information SciencesPermanence of Paper for Printed Library Materials Z39.48-1992 (R1997).

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This book is dedicated to my sons, Stephan and Adam, who have taught me a depth of love I never imagined. Raising them has been the greatest joy of my life. They showed me the beautiful spirit in intensity and inspired my life's work.

Martha Burge's book is a useful response to the recent epidemic of attention deficit disorder. When we published DSM-IV in 1994, the rate in children was just a bit more than 3 percent. Now, it has almost tripled to a remarkable 10 percent. The diagnosis of ADD has also exploded in adults, with rates jumping from under 2 percent to as much as 5 percent. And this diagnostic inflation is not just a local United States phenomenon; it is happening simultaneously in all the developed countries around the world.

Ms. Burge offers a strategy she hopes may help cure the epidemic of ADD. She warns us to stop medicalizing what is often basically normal behavior and to stop over-treating with unnecessary and potentially harmful medication. She offers an alternative approach for dealing with the myth of ADD that accepts and accommodates the human variability it represents, rather than pathologizing and treating as illness all hyperactivity, impulsivity, and distractability.

Let's first explore the causes of the ADD epidemicthis will help us understand how best to contain it. A small part of the growth in ADD rates was a predictable result of changes we made in its DSM-IV definition. Previous definitions required hyperactivity, impulsivity, and inattentiveness. We recognized that some people with ADD (particularly females) have clinically significant inattentiveness, but without the hyperactivity or impulsivity. Our field testing predicted that allowing for this in our DSM-IV definition would increase rates of ADD by about 15 percent.

But none of us working on DSM-IV imagined there would be a tripling of rates in so short a period of time. We weren't psychic and had no way of predicting the other two events that soon completely changed the ADD landscape. Shortly after DSM-IV was published, new and expensive on-patent ADHD drugs were approved for marketing by the Food and Drug Administration. The previous generic drugs were so cheap and unprofitable that drug companies didn't bother to push their sales. Now, with potential blockbusters in hand, they had powerful financial incentives to aggressively extend their market by promoting the diagnosis of ADD and encouraging its medication treatment.

And, almost simultaneously (for unrelated reasons), the FDA deregulated some of its control over drug company marketing. It gave Big Pharma permission to advertise its pills not only to doctors but also directly to consumers. Soon, the companies were mounting expensive and ubiquitous promotional campaigns in print media and on TV and the Internet. Total marketing budgets grew from an already hefty $791 million in 1999 to an astounding $4.8 billion in 2006. A small but significant fraction of this consisted of a highly successful marketing campaign to convince psychiatrists, pediatricians, family practitioners, parents, patients, and teachers that ADD was under-recognized and under-treated. ADD became a fashionable fad diagnosis and drug sales took offfrom $304 million in 1994; to $658 million in 1999; to $2.11 billion by 2003.

Ms. Burge correctly worries that the drug companies have succeeded in their campaign to re-label as mental disorder what is often just a normal variation in behavior. As a consequence, the use of ADD drugs has doubled, so that almost 5 percent of our children are now receiving a pill for it (with an even higher percentage among boys). Loose diagnosis and careless prescription bring questionable benefit but accrue considerable costs and risks. Although medication clearly helps in the short term, its long-term benefits are unclear. Often there are side effects (like insomnia and decreased appetite), and the long-term risks (especially for kids with their developing brains) are unknown. Inaccurate diagnosis may unleash stigma and cause a reduced sense of self-control. And then there is the serious problem of the secondary market for diverted stimulant drugs. Illegal stimulant use for recreation and performance enhancement already occurs in up to 10 percent of high schoolers and up to 35 percent of college students.

DSM-5, a new revision of the diagnostic system, is scheduled to appear in May, 2013. Unfortunately, it will markedly increase the current diagnostic inflation and open the floodgates to even greater overmedication. The DSM-5 redefinition of ADD further reduces diagnostic thresholds and makes it even easier for kids, and especially for adults, to be misdiagnosed and over-treated. I see absolutely no justification for this further expansion of an already bloated diagnosis. Unless there is a huge public outcry or government intervention, DSM-5 will blow up the ADD bubble even further.

Many people make the false assumption that the experts working on DSM-5 must be expanding the diagnosis of ADD because they are in bed with the drug companies and want to help them sell pills by expanding the market of potential customers. I strongly disagree. The DSM-5 experts have an intellectual, but not a financial, conflict of interest. They are making very bad decisions, but for pure motives. Experts tend to overvalue their pet diagnosis, worry about missed cases, underestimate the risks of over-diagnosis, and ignore that ADD is often diagnosed carelesslyespecially in primary care settings by rushed practitioners who are much less expert than they. DSM-5 will be a great boon to drug company sales and profitsbut that will be a side effect of DSM-5, not its intent.

Martha Burge cures the worrisome ADD epidemic by turning ADD instead into a myth. She correctly points out that symptoms of hyperactivity, impulsivity, and inattention are very common in the general populationreally no more than part of the Bell curve distribution of individual difference. ADD is not a clearly defined illness diagnosable with an objective, biological test. There is no bright line delineating where to draw the boundary between normality and disorder. Burge considers ADD to be a harmful myth that errs by seeing the glass half empty. She presents a contrasting halffull perspective that celebrates the emotional intensity and breadth of attention that is currently mislabeled ADD: With a greater range of attention we are never inattentive; we are always taking in more than others.