Should I Medicate ‘Just in Case’?

During the past week a user of the ‘3 Steps ADD’ premium website made the following comment: “…many people who do not have that are diagnosed with it. True ADD’ers go through hell.” This statement neatly summarizes the two sides of the ADHD debate. It is very true that some people go to hell and back as they struggle to come to terms with the condition and its fallout. It is also true that many other people (a much larger group in my opinion) are wrongly diagnosed and therefore sent down a path of treatment is that they simply do not need. If you doubt this last statement you can simply take a look at the rate of ADHD diagnoses over the past few decades. You will see a graph that resembles the trajectory of a rocket taking off. Now ask yourself: Is this a true reflection of reality? Can it really be that a condition that was almost unknown a generation ago now affects (if you believe the statistics) almost 1 in 10 of young people, or are there some other factors at work here?
I sincerely believe that there are indeed other factors at work and I have written extensively about this in the past. I am convinced, in summary, that aggressive marketing by drug companies (who developed very lucrative drugs to throw at the problem) and a radically changed educational environment (where anything outside highly standardized behavioral ideals will be ruthlessly dealt with) combines to make an ADHD diagnosis almost inevitable wherever there is the slightest question about a child’s behavior. It has therefore become almost fashionable to label children as ADHD and to then proceed to drug them into submission.
Many parents are vaguely aware of this bias towards a positive diagnosis but feel ill-equipped to question and challenge it. Some also believe that it is better to err on the side of caution. This line of argumentation goes more or less like this: ‘While we cannot be sure if Johnny really has ADHD it can surely not be harmful in any way to get him on medication just in case?’ The three words ‘Just in Case‘ have, in fact, become one of the chief weapons in the arsenal of those who would like to pressure parents into accepting radical treatment options. The big question, however, is at what side ‘caution’ can really be found! I am totally convinced that the prudent, careful and responsible course of action would be to avoid a formal diagnosis for as long as possible and to only accede to it when all other possible causes and strategies for their alleviation have been eliminated. Why do I take this position? Allow me to explain:
ADHD Diagnoses can easily lead to labeling: I have often warned about the dangers of the labeling that so often accompanies ADD/ADHD diagnoses. The word ‘She has ADHD‘ can so easily be used to justify different treatment of a child. The most insidious form that this can take is the lowering of expectations. Many teachers simply will not push students whom they believe have ADD/ADHD to the edge of their capabilities because they are convinced that they are not capable to achieve anything more than basic classroom compliance. Is this really what you would want for your child? Would a cautionary approach not rather be to stay as far away from labels as possible?
Overzealous diagnosis harms those who really have the condition: I think that part of the frustration of the commenter mentioned above is the fact that in the stampede to diagnose as many people as possible with the condition the true sufferers are forgotten. ADD/ADHD is a highly complex condition and a lot of research is required to get to the best possible ways of detection and treatment. It is, however, sadly the case that research agendas are being confused by the fact that (if the drug companies are to be believed) just about every Tommy, Dickie and Harry has the condition. This widening of the research pool makes focused research on the condition very difficult and it is getting more difficult with every irresponsible diagnosis.
Many ‘treatments’ are highly dangerous: If the standard treatment options for ADD/ADHD were essentially benign the ‘just in case’/’err on the side of caution’ approach would have made perfect sense. The fact is, however, that the vast majority of ADD/ADHD diagnoses lead to treatment with one of ‘Big Pharma’s‘ flagship ADD/ADHD products. To be blunt: These products are extremely dangerous and have been associated with addiction, self-harm, aggression, long-term passivity and even suicide. Why on earth would anyone want to walk down this kind of road – ‘Just in case’!?
Old maps often contained the warning: “Here be dragons”. The message was simple – Don’t go there! I am convinced that most ADD/ADHD diagnoses are made with undue haste and a lack of rigor and should therefore carry the same kind of warning. The ‘3 Steps‘ and the other resources that I have developed will help you to avoid this dangerous road.