Dr Caroline Leaf – stop spreading ADHD stigma and ignorance

“Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.” ~ Martin Luther King Jnr.

Sincere ignorance … conscientious stupidity – I’m struggling to know which category to put Dr Leaf’s latest e-mail newsletter into.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist and self-titled mental health expert.  She is not a doctor.  She is not a psychologist.  She does not work for a university.  She hasn’t published any peer reviewed medical papers for two decades.  She is not accountable to any peak professional body.

Yet the Christian church gives her unfettered access to their pulpits despite the ignorance and stigma she enthusiastically promotes.

Take the “Mental Health News” e-mail that she posted today for example.  Dr Leaf seamlessly moves from one misrepresentation to another, weaving a narrative that unfairly undermines scientifically proven treatments for mental illness, eroding confidence and destroying hope.

She starts with the story of Michelle and Carter, although it wasn’t Michelle and Carter as her e-mail newsletter stated. It was Michelle Carter and Conrad Roy, something which Dr Leaf got right in her blog post dated 1 August 2017 (see the image at the bottom of the page), but then got wrong in her e-mail newsletter on 30 August 2017. Dr Leaf says that Michelle texted Conrad to kill himself, and he did. Michelle and Conrad were on “brain-disabling” (psychiatric) drugs. Therefore, psychiatric drugs killed Michelle and Conrad. In my opinion, that Dr Leaf would stoop so low as to use the suicide of a teenager to try and push her own ideological barrow says much about her character, but then I shouldn’t be surprised as she did the same thing when Carrie Fisher died earlier this year. It’s sick, and it’s low, and it’s something that Dr Leaf should apologise for.

It’s also incredibly disingenuous, drawing a conclusion from incomplete evidence. Dr Leaf has no experience with the case. Instead, the source of this information is Dr Peter Breggin, himself an outspoken and discredited critic of psychiatric medication with a penchant for cherry picking and bias. Dr Leaf has used the story of Michelle and Conrad based on the tainted recall of half a story. She has no idea what really contributed to Michelle and Conrad’s tragedy. Her statement, “Yet, as is often the case, there is a large and dreadful disparity between what actually happened and what we are told happened” is therefore sadly ironic.

Dr Leaf then moves on to ADHD and drugs. Dr Leaf treats the concepts of ADHD and its treatment with the same respect as she gave Michelle and Conrad. She makes statement after misleading statement which do nothing but demonstrate her myopic bias.

Let’s just take one sentence: “These drugs create, rather than cure, chemical imbalances in the brain, are difficult to come off and can have terrible side-effects that last for years, including suicide and homicide.”

ADHD is often misunderstood and almost always stigmatised.  ADHD is more than just being an active child who likes to play.  ADHD is a dysfunctional lack of control that’s abnormal compared to other children the same stage of development, is long standing and affects their entire lives.

ADHD is caused by an abnormal pattern of genes, the expression of which are triggered by environmental conditions in pregnancy and early childhood, resulting in slower maturation of the brain and an uncoordinated network of “connectomes”, which disrupts the attention and planning processes of the brain.

We know that children with ADHD have slower maturation of the grey matter [1] and structural changes in the frontal regions and deeper parts of the brain [2].  In more recent times, modern brain imaging techniques have been able to show differences in the way that the regions of the brain link together to form networks.

Think of the brain networks as a tug-o-war team.  When all the members of a tug-o-war team work in unison, they increase their collective strength, but if the different team members don’t co-ordinate their efforts properly, the strength is lost.  The same goes for the brain.  Modern neuroscientists have discovered that the function of the brain relies on physical networks within the brain, called “connectomes” and how these connectomes co-ordinate with each other.

In the ADHD brain, the connections between the different connectomes are immature [3].  These immature connections weaken the collective strength of the network, because they aren’t synchronously “pulling” together.

What’s better understood is that the neurotransmitter called dopamine is crucial to the ADHD disease process [4].  Medications such as Ritalin which enhance the dopamine signals in the brain significantly reduce the symptoms of ADHD [5].

So Ritalin and other drugs like it actually balance the neurotransmitters in the brain.  Dr Leaf’s argument that they “create … chemical imbalances in the brain” is as misleading as trying to argue that diabetic treatments are creating an “insulin imbalance”.

“These drugs … are difficult to come off” is also misleading.  Once the brain eventually matures as it does in most children with ADHD, the drug is simply weaned.  Dr Leaf doesn’t seem to understand that some children with ADHD will grow into adults with ADHD who will still need medication.  This isn’t because the drugs are hard to come off, they are simply treating an ongoing condition.

“These drugs … can have terrible side-effects that last for years, including suicide and homicide.”  Actually, the effects of Ritalin last less than a day because the drug is rapidly metabolised, and ‘homicide’ is not listed anywhere in the official product information.  Suicide has been reported in patients taking the Ritalin although the official product information notes that, “Adverse events reported since market introduction in patients taking methylphenidate include suicide, suicide attempt and suicidal ideation. No causal relationship between methylphenidate and these events has been established.”  Even so, medications like Ritalin are not meant to be given to people who have severe depression, anorexia, psychotic symptoms or suicidal tendency, just in case Ritalin might worsen these conditions.

Indeed, a Cochrane Review as recently as November 2015 said, “The evidence in this review of RCTs suggests that methylphenidate does not increase the risk of serious (life threatening) harms when used for periods of up to six months. However, taking methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.” [6]

So “these drugs” don’t have side effects for years, don’t make people homicidal, don’t make people addicted and don’t unbalance their brain chemicals.  It’s amazing how much profound mistruth Dr Leaf was able to pack into one littlesentence.

Then Dr Leaf goes on to attack the concept of ADHD itself – “Unfortunately, there is little scientific evidence for these labels … the very idea of ADHD, which includes vague operational definitions such as ‘often fidgets with hands or feet or squirms in seat,’ is subjective and defined by what society currently deems as ‘normal’ or ‘abnormal’”.

Denying the existence of ADHD is an old trick used by medication critics and the ignoranti for decades, but it’s like denying the existence of rain so you don’t have to buy an umbrella.  Dr Leaf’s assertion that the diagnosis of ADHD includes ‘vague operational definitions’ is just a strawman, because ADHD diagnosis is rigorous and relies on more than just a single characteristic like fidgeting.  I have listed the diagnostic criteria for ADHD at the end of this post, or you can look it up here: http://www.cdc.gov/ncbddd/adhd/diagnosis.html

In all of Dr Leaf’s railing against medications for ADHD, she fails to cite the evidence that shows that medications for ADHD improves the lives of those with ADHD [6], more than restrictive diets or cognitive retraining or neurofeedback [7].

Dr Leaf may like to think of herself as an expert, but her claims on ADHD and it’s treatment do not hold up under scrutiny.  She may think she’s acting benevolently but the promotion of her Dunning-Kruger style ignorance erodes the enormous hope that medications like Ritalin give to people who, without it, are held back by the mental and physical chaos that ADHD causes.

Dr Leaf, please, stop spreading the ADHD stigma and ignorance.  We already have to put up with enough suffering from the disease itself and the social stigma without you adding to it.

References

[1]       Shaw P, Lerch J, Greenstein D, et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Archives of general psychiatry 2006 May;63(5):540-9.
[2]       Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.
[3]       Cao M, Shu N, Cao Q, Wang Y, He Y. Imaging functional and structural brain connectomics in attention-deficit/hyperactivity disorder. Mol Neurobiol 2014 Dec;50(3):1111-23.
[4]       Wu J, Xiao H, Sun H, Zou L, Zhu LQ. Role of dopamine receptors in ADHD: a systematic meta-analysis. Mol Neurobiol 2012 Jun;45(3):605-20.
[5]       Reichow B, Volkmar FR, Bloch MH. Systematic review and meta-analysis of pharmacological treatment of the symptoms of attention-deficit/hyperactivity disorder in children with pervasive developmental disorders. Journal of autism and developmental disorders 2013 Oct;43(10):2435-41.
[6]       Storebo OJ, Ramstad E, Krogh HB, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews 2015 Nov 25;11:CD009885.
[7]       Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American journal of psychiatry 2013 Mar 1;170(3):275-89.

ADHD Diagnostic Criteria

The current criteria that must be matched to qualify for a diagnosis of ADHD is:

(1) Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
* Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
* Often has trouble holding attention on tasks or play activities.
* Often does not seem to listen when spoken to directly.
* Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
* Often has trouble organizing tasks and activities.
* Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
* Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
* Is often easily distracted
* Is often forgetful in daily activities.

(2) Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
* Often fidgets with or taps hands or feet, or squirms in seat.
* Often leaves seat in situations when remaining seated is expected.
* Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
* Often unable to play or take part in leisure activities quietly.
* Is often “on the go” acting as if “driven by a motor”.
* Often talks excessively.
* Often blurts out an answer before a question has been completed.
* Often has trouble waiting his/her turn.
* Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
– Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
– Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
– There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
– The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
– The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
(http://www.cdc.gov/ncbddd/adhd/diagnosis.html)

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5 thoughts on “Dr Caroline Leaf – stop spreading ADHD stigma and ignorance

  1. I received the email myself this morning and I had to contain my anger at what she has said. I actually received another email from her later on, which was similar and spoke of the young lady who told her boyfriend to kill himself so he did. Then went on to say they were both on mind damaging drugs etc etc. The sad thing is there seems no way to stop her. I believe she causes more damage to people’s well-being than the very drugs she so hates.. This woman makes my blood boil. All the while she lives the high life in her big homes and private jets all at the expense of the vulnerable people who spend money on her worthless publications and events.. Can you tell I’m angry?! Matt

  2. I would like to point out that our current approach to ADHD (and other behavioral disorders), at least here in the US (I can’t speak to Australia), is heavily drug-biased, and unnecessarily so (and I believe this to be the underlying belief of Dr. Leaf).

    I believe your position could use some flavoring and understanding just as much as Leaf’s could (as you have demonstrated above).

    Based on Dr. William Walsh’s work (read “Nutrient Power: Heal Your Biochemistry, Heal Your Brain”), we know the following:
    – Two thirds of children diagnosed with ADHD simply have an elevated copper/zinc ratio in the blood.
    – Of those with the predominantly inattentive subtype of ADHD, more than half are deficient in folic acid, vitamin b12, zinc and choline, and develop better focus after supplements of these nutrients. Further, another cause of inattention can be extreme boredom, especially in children of very high intelligence, and these children need to be intellectually challenged.
    – Those with the predominantly impulsive and hyperactive subtype of ADHD, have a chemical signature of metal metabolism disorder involving copper overload and zinc deficiency. This metal imbalance causes low dopamine and elevated norepinephrine and adrenalin activity. Ritalin, Adderal, and other stimulant medications can effectively elevate dopamine activity and improve behavior and academic results. However, nutrient therapy to balance copper and zinc levels can often achieve the same result without the unpleasant side effects. (It is interesting to note that Ritalin and cocaine share the same mechanism of action — dopamine reuptake inhibition by impairing the action of DAT transport proteins).
    – Of those within the combined hyperactive/impulse and inattentivity subtype (the largest subtype of ADHD), 68% exhibit a seriously elevated Cu/Zn ratio in blood and tissues, and normalization of these trace metals can greatly reduce hyperactivity and improve attention span. Others in this classification may have a methylation disorder, toxic overload, pyrrole disorder, or other imbalance, and blood and urine testing is necessary for accurate diagnosis.

    The point? Nutrient/diet management should be the first line of treatment. Drugs should be reserved for “worst case scenario” cases.

    Conspiracies aside, I believe we have legitimate cause to call in to question the efficacy of the typical treatment those diagnosed with ADHD (myself being formerly diagnosed) receive. (I personally also believe the efficacy of the criteria for diagnosis should be called into question, with specific criticism towards the subjectivity of what is an “acceptable” activity level).

    I gracefully admonish you to not be swift to dismissal of points solely based on the source (i.e. Caroline Leaf). If you put your personal battle aside, both of you may have points you both could learn from and come to a greater, more holistic understanding of the problems you both are attempting to tackle.

    With grace and a sincere heart,
    – M

    • Hi Matthew,

      Thank you for your gracious and sincere comment.

      Respectfully I disagree with you. There is no dietary treatment with any evidence of benefit for ADHD with the exception of supplementation with polyunsaturated fatty acids (omega-3 and omega-6 fatty acids) but the effect is tiny (Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American journal of psychiatry 2013 Mar 1;170(3):275-89).

      Dr William Walsh may say that there is a link with copper/zinc ratios and ADHD, but he also believes in Pyrrole Disorder, which was scientifically debunked 40 years ago (see http://www.drbillsukala.com.au/nutrition/pyroluria-disease-myth/ if you would like more information). And anyone that is so wedded to pseudoscience, in my opinion, should not be taken seriously.

      Having said that, if you would like to provide any references from the published peer-reviewed medical literature for abnormal copper and zinc ratios in ADHD, be my guest. I’m always happy to hear of any new, scientifically valid, information.

      I understand the concern surrounding the diagnostic criteria for ADHD, but the ADHD criteria aren’t just describing kids that are active or boisterous. The criteria require multiple factors to be met and across more than one domain. You can’t just be disobedient at home and fine at school (or vice versa) and be formally diagnosed with ADHD. ADHD might be incorrectly diagnosed in some children but by the same token, it also might be incorrectly not diagnosed in others. Most children with ADHD will grow out of it and just need more space and time to burn off their energy, but that does not negate the fact that most children will need some form of treatment and, at this stage in medical science, the most reliable treatment is medication. Stimulant medication needs to be used appropriately, like any drug for any condition in any person.

      Respectfully, my ‘battle’ with Dr Leaf is not personal, it is professional. I have not met her in person (her choice) and I hold nothing personal against her. I intensely dislike people being mislead by fake science, not just Caroline Leaf’s fake science but all fake science. My stand against Dr Leaf continues mainly because there are many other organisations which have debunked the myriads of other fake science out there, but Dr Leaf has largely flown under the radar of conventional sceptics, so until Dr Leaf relinquishes her ministry of fake science either by the church leaders finally holding her to account, or she repents, I will continue to hold her ministry up to the hard light of real science.

      That includes her abominable claims surrounding ADHD which are based on her fallacious assumptions about the power of the mind and her bias against biological psychiatry. On the subject of ADHD, there is no ‘holistic’ compromise because Dr Leaf is wholly misguided.

      Thanks for your contribution. I understand where you’re coming from, and I appreciate the spirit of your comment, even if I disagree. All the best to you.

      • Hi
        I don’t have much to say just that eating in a way to improve my brain chemistry and gut health has without a doubt improved my mental health in respect to ADHD and High Anxiety and depression. Along with exercise, CBT, behavioral therapy, faith and prayer and good friends, i am much better off ssri’s than on them. I decided to give the diet that takes you into ketosis ago – what a differance in such a short time, it inspired me to really take ownership of my mental health by what i put in my mouth. Dr Leaf greatly encouraged me that i could renew my mind by my thought life.
        Blessings
        Kerry

      • Hi Kerry. Thanks for your input. I’m glad exercise, CBT, behavioral therapy, faith and prayer and good friends have been highly beneficial for you. Not everyone needs SSRI’s. I’m intrigued why you would give Dr Leaf any credit as exercise, CBT, behavioral therapy, faith and prayer and good friends have nothing to do with your thought life? It sounds like you have improved your mental health through taking committed action, not by changing ‘toxic’ thoughts which is Dr Leaf’s fundamental belief.

        Anyway, good luck to you, all the best.

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