SCT — The new attention disorder

A friend alerted me to a recent NYT article about what promises to become the next pediatric psychiatric diagnosis du jour: sluggish cognitive tempo disorder.

Dr. Russell Barkley, a clinical psychologist on faculty of the Medical University of South Carolina, has hailed SCT as “the new attention disorder,” manifested in the inattentive child who tends to daydream in class, seemingly unable to quickly process academic tasks at hand. Strict criteria for diagnosis have not been formulated as yet; but rest assured, they won’t be long in coming. Researchers estimate that close to 2 million children might qualify for the diagnosis.

[Disclaimer: According to the NYT article, Dr. Barkley, a perennial proponent of ADHD, has gleaned over $118,000 in consultant fees from Big Pharma in a three-year stretch between 2009 and 2012.]

The next procedural step will be formulation of recommendations for pharmacologic treatment. The most likely classes of drugs already exist. All that will be necessary is to market the diagnosis to the medical community, disseminate the possibility to the public at large through the news media outlets, and educate practicing clinicians on “appropriate treatment.”

The upshot will be an exponential number of new prescriptions written for psychoactive pharmaceutical medications dispensed to one of the most vulnerable segments in our modern success-driven society, young children.

Along with the closely related ADHD diagnosis, the beauty of such a condition is its chronicity. Once established, such neurobiological diagnoses insure the continual flow of stimulant medication through the lucrative pharmaceutical pipeline — more Soma for the masses, as Aldous Huxley might have couched it.

I shudder when I think of the sheer numbers of young brains bathed daily in the latest pharmacopeia. Millions of children are now being treated with psychotropic medication at younger and younger ages.

And if they aren’t exposed to a panacea of pharmacologic substances, most (if not all) are being bombarded with electronic media in its various forms throughout their entire day.

I wonder what the human species will look like in the next several generations.

Perhaps our grandchildren will live in some sort of virtual reality from womb to tomb, their minds pharmacologically altered to ensure a sort of peaceful compliant existence.

Orwell and Huxley were ahead of their time, but not by much.

“Notes from a Healer” — Reining in the Rx

Despite a 7 percent decline in the number of overall prescriptions written for children under the age of 18 from 2002 to 2010, there was a 46 percent increase in the number of prescriptions specifically for ADHD medications for teenagers and children over the same period. When I read this disturbing statistic, Dylan came to mind.  more»

My latest installment of Notes from a Healer — Reining in the Rx — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

Prenatal treatment of ADD on the horizon

With anticipated widespread acceptance of revised diagnostic criteria in DSM-5, the bible of psychiatric diagnoses, researchers are now keen to examine the efficacy of treatment for prenatal attention deficit disorder (ADD-PN).

“We’ve already got the drugs. This will allow us to study the incidence and treatment of ADD in the womb (ADD-PN) using only the highest ethical standards in medical research,” said Dr. Erma Kidd, a psychopharmacologist on staff at Slamdunk Medical College and Hospital, one of the few remaining medical institutions in the country not underwritten by the pharmaceutical industry.

Researchers have known for decades that ADD (or ADHD, as it is sometimes called) carries a genetic predisposition. “We’ve been able to track this malady through generations of families. The trouble was that we had no good clinical criteria for prenatal diagnosis of the disease,” Dr. Kidd explained in a recent e-mail. “Publication of DSM-5 changes all of that. Now we can diagnose ADD-PN in the womb. And if we can diagnose it, treatment options are just around the corner.”

This late-breaking news comes on the heels of recent announcements that child psychiatrists, general practitioners, pediatricians and maintenance personnel working in their offices have been given the green light to treat preschoolers with powerful stimulant medications in an effort to improve quality of life—for them and for their parents.

Off the record, preliminary studies examining the efficacy of prenatal pharmacologic treatment for ADD-PN have been underway since last year. “It’s been exciting, but extremely tough on our research team,” Dr. Kidd wrote. “After devising modalities to administer methylphenidate-like drugs to a cohort of fetuses, we were forced to wait until the babies were born before we could adequately study their behavior and development.”

Nevertheless, preliminary data is promising. “Mothers who had methylphenidate infused into their amniotic fluid reported considerably less fetal movement during the third trimester of gestation,” Dr. Kidd said. “Indirectly, we infer that the drug was helping these fetuses to calm down, to become less impulsive and more focused in the womb.”

Subsequently, some of the subjects have been born; and the data so far is impressive. Developmentalists report that when compared with their peers, many infants in the research cohort seem to be able to rest comfortably in feeding chairs in front of daytime television game shows for longer periods of time. They also exhibit less interrupted sleep, and coo and babble only when prompted.

“Imagine, babies genetically destined to suffer from ADD throughout their lifetimes, who now at only 2 months of age show less impulsivity when vocalizing with their parents. They wait to be recognized before speaking; and even then, their remarks seem to be much more age appropriate.”

The future looks bright for these children. “No more food fights at the dinner table, no more negative behavior at bedtime,” Dr. Kidd added. “We’re working hard to make it a better world for parents, for all of us.”

Still, some clinicians exercise a word of caution. “When it comes to the grey matter of the human brain, nothing is black and white,” one researcher commented. “In these clinical trials, nothing is a slam-dunk.”

Apart from stock options which she has yet to exercise, Dr. Kidd has disclosed no contractual relationships with any of the major pharmaceutical companies who market methylphenidate in their product lines.

The way we practice now

According to current theory, people with ADHD have a relative deficiency of dopamine, an essential neurotransmitter in the brain.  Adequate levels of dopamine are necessary to induce incentive and motivation.  Stimulant medications boost dopamine levels and enhance the ability to stay focused on task.

But in our modern psychopharmacological approach to the treatment of ADHD we have all but forgotten the environment.  more»