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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Prescribing dangerous drugs for a made up disease

Honestly, I don’t know if I can go on much longer.

I feel like every time I approach the wild waters of social media, I find myself drowning in a sea of shameless ignorance.  It’s like a post-modern intellectual zombie apocalypse where brainless morons roam cyberspace, relishing the opportunity to infect the minds of the innocent and gullible with their delusions of expertise.

As I’m sitting here writing, the little angel on my right shoulder is trying to get my attention.  “Everyone’s entitled to their own opinion,” she whispers softly.

Except it’s hard to hear when the little devil on my other shoulder is digging his pitch-fork in my brain and twisting it to make a point.  “But their opinion is crap,” he angrily retorts.

Tonight, the subject of my inner voice’s great debate was the Facebook headline, “ADHD: Drugs to treat disorder could create heart problems for children, researchers say.  Children under 18 who had ADHD and were prescribed methylphenidate were more likely to get an irregular heartbeat in the first two months, researchers said.”

Screen Shot 2016-06-07 at 9.49.38 PM

The little paragraph on Facebook didn’t mention any important facts, like what the article was that they quoted, or that the actual number of events linked with drug were miniscule.

That didn’t stop some clearly stupid people from publically venting their rancid opinions all over social media.

There were the usual paranoid delusions claiming that ADHD is over-diagnosed so that the American Psychiatric Association could get more funding from pharmaceutical companies.  Or that Ritalin has never been properly tested, and that children on Ritalin have been human experiments for the last 30 years.

Then there were all of the old chestnuts too, like ADHD is because of poor parenting or poor diet, or teachers with sub-par intelligence who aren’t challenging their pupils enough.  And who needs Ritalin anyway when all you have to do is stop feeding them artificial flavours and colours, high fructose corn syrup, GMO’s and fast foods.  Better yet, treat them with cannabis.

There were also some brazen displays of intellectual impotence within the heady mix of stupidity, like the people who suggested that children shouldn’t be given ANY drugs unless they’ve got diseases like cancer.  ‘Cause, clearly, paracetamol and penicillin are just as toxic as Ritalin.

Then there was the cherry on top:

“The doctor who came up with ‘ADHD’ and ‘ADD’ confessed on his deathbed that they were made-up diseases.”

Really??  Oh, come on, that’s both pathetic and grossly insulting.  ADHD is a real disease.  It’s been proven by real scientists and real doctors working in real labs and real hospitals.  Yet in the post-modern mind-bubble, an unverified viral meme on social media carries more weight than decades of scientific enquiry by some of the worlds smartest people.

For those of us who aren’t intellectual zombies, there was no death-bed confession about ADHD’s concoction.  According to a fact-check by Snopes.com, the doctor who ‘made up’ ADHD never said ADHD wasn’t real, but only that he thought the biological cause of ADHD was over-estimated.

Those who clearly knew nothing about ADHD or its treatment decided to further perpetuate their ignorance by embellishing and catastrophizing the “heart problems” that the Facebook headline alluded to.  Except that if they had bothered to review the article Facebook was referring to, they would have seen that there really wasn’t anything going on.

According to the article “Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study” [1], the only significant heart issue with Ritalin is a condition broadly classified as ‘arrhythmia’, which is medical speak for an irregular heart beat.  However, the peak risk for arrhythmia in the study was in children with congenital heart defects in the first few days of treatment.  For this, the relative risk was 3.49.  That means that a child with an already dodgy heart will have a three and a half times greater risk of an irregular heart rhythm than a child with a normal heart who’s not on Ritalin.  This sounds terrible, but “lies, damn lies and statistics” – in reality, the overall number of children who will actually get an arrhythmia because of Ritalin is still incredibly low because the total number of children who get arrhythmias is incredibly low.  Mathematically speaking, 3.49 x diddly-squat is still diddly-squat.

Besides, all of this is old news.  The current study was simply trying to use a larger source of data to get better statistics on case-reports of the possible effects of Ritalin.  But in the product information of methylphenidate, heart problems are clearly listed as a possible complication.  Because of this, and to ensure that Ritalin isn’t thrown around like candy, only medical specialists like paediatricians and child psychiatrists can start a child on medications like Ritalin.

So the reaction to the new study is nothing more than a storm in a tea-cup, but it clearly demonstrates the stigma and ignorance towards ADHD that, I’m ashamed to say, still exists in our modern, progressive society.

Is it any wonder then that parents actively avoid getting an assessment for their struggling children, or do everything they can to avoid Ritalin even when they have a clear-cut diagnosis of ADHD?  ADHD causes enough suffering by itself, but the baseless and incoherent ranting of the uninformed masses adds stifling layers of unnecessary stigma and misery to those who deserve our support, not misleading advice or irrational judgement.

References

[1]        Shin JY, Roughead EE, Park BJ, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ 2016;353:i2550.

Let boys be non-stigmatised boys

Boys will be boys ...

“When I was a boy …”

Many a stirring yarn has been started with those exact words, as aging men relive their childhood adventures with sentimental grandiosity increasingly taking over from detail as each passing year blends in with the blur of distant memories.

Ps Greg Gibson wrote an article that caught my attention as it floated across my Facebook feed last night.  Gibson is a pastor in Knoxville, Tennessee.  His “when I was a boy” story recalled his happy times as an energetic child, a serene innocence punctuated by two years of Ritalin-induced misery.

His point: “I think we should let boys be boys, and non-medicated ones at that. Therefore, parents, if at all possible, don’t medicate your boys.”

I think I understand what he’s trying to say, that it’s ok to be an energetic child and to see the extra energy as a strength to harness, not a weakness to control.

That would be fine, except that in trying to normalise energetic behaviour, he also winds up demonising Ritalin.  It may not have been his intention, but whenever someone respected in the community says something negative about stimulant medication or ADHD, it reinforces the oppressive stigma attached to those who suffer from it.

Ps Gibson’s fundamental assumption, that normal but energetic children are being misdiagnosed as ADHD and therefore unnecessarily medicated, happens far less often than the opposite – children with ADHD are misdiagnosed as energetic children that just need to be taught how to control themselves.

Personally, I don’t know of any parent who ever wanted to medicate their child with Ritalin.  If anything, it’s the opposite, because if your child’s on Ritalin, then you must be a lazy parent, or given them too much sugar, or too much screen time, or not hugged them enough as babies, or didn’t practice vaginal seeding, or whatever other form of parent-guilt is being perpetrated by the media at the time. Parents will do everything they can in their power to avoid using Ritalin, because of a culture that blames and shames.

Unfortunately, this means that children who could be helped by Ritalin or other stimulant medication are left behind, because ADHD isn’t the mislabeling of normal energetic children who just need better structure, or better posture, or who learn differently.  ADHD is a real disability, a dysfunctional lack of planning and control that’s abnormal compared to other children, affecting their entire lives.

For example, these children find it hard to play with other kids because they can’t follow basic social rules like the rules of games, or waiting their turn.  These children find school difficult, because they can’t concentrate for long enough to focus on completing a multi-step task, or have a long enough attention span to make new memories for words or facts.

One of my patients, a little boy about seven years old, was brought in by his mother because a chiropractor wanted me to arrange a blood test on his behalf.  When I asked why, the mother said the little boy had dyslexia which the chiropractor was ‘treating’ (actually, this chiropractor was blaming a disease that didn’t exist, and wanted me to arrange a test that was resigned to the pages of history, but that’s another story).  When I talked to the mother about the child’s symptoms, it was pretty obvious that he had ADHD, amongst other things.  After seeing a developmental paediatrician to confirm the diagnosis, and taking Ritalin for just one week, his reading improved three whole reading levels, and after a month, he had not only caught up, but had passed a number of his class-mates.

This is a real life example of how ADHD can hold children back, and how stimulant medication can help.  While there are always exceptions to the rule, stimulant medications help more often than they hinder.  They’re sometimes the difference between a child meeting his full learning potential, or being unnecessarily held back, languishing at the bottom of his class as his peers go further ahead in leaps and bounds.

Our culture needs to move on.  We need to stop our social prejudices making life more difficult than it already is for children and their families who battle with ADHD.  We need to see that medications for ADHD can be the difference between a life of learning and a life unfairly held back.

Let’s change the tune.  Rather than saying, “Let boys be non-medicated boys”, how about we say, “Let boys be non-stigmatised boys.”  It’s only through the break-down of the stigma surrounding ADHD and stimulant medications, that all boys (and girls) can truly meet their full potential, whether they have ADHD or are just a bit more energetic.

If you want more information on ADHD and its treatments, this is a good place to start: http://www.rch.org.au/kidsinfo/fact_sheets/ADHD_an_overview/

If you are concerned that you or your child might have ADHD, talk to your local GP or paediatrician.

Ritalin may not help children with ADHD?

A few days ago, the media had a frenzy over a new study about the use of Ritalin (methylphenidate – a stimulant medication) for Attention Deficit Hyperactivity Disorder (ADHD) (http://goo.gl/Ht9GKF).

ADHD is always good for a headline grab because it is so polarizing. It’s like the new HIV – everyone’s got an opinion on ADHD, and most of them are facile or just plain ignorant. That doesn’t stop the armchair experts from sharing their opinions, and this new Cochrane review into the studies of Ritalin for ADHD just gives them another chance to vent their fatuous spleens.

Like a couple of the comments posted at the end of The Australian article. One suggested that ADHD was a disease invented so they could find another drug to treat it, and suggested that mobile phone games were the problem. Another thought he was rather humorous when he trotted out the tired old chestnut that it’s all the parents fault: “ADHD has been nicnamed {sic} ‘Absent Dad At Home’ syndrome!”  Sorry, but no one’s laughing. 

We need to take a step back from the uneducated and unwarranted opinion of the self-titled experts, and look at what the study actually said. To do that, lets have a look at what the study was, what it looked at, and what the results were. We’ll then compare the results with some of the other options available for treating ADHD, so we can make an informed decision about how to best manage ADHD.

First, what study are we talking about? The study in question is a Cochrane Review lead by Storebo, titled “Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)” [1]. (You can read the official press release here: http://www.cochrane.org/news/researchers-urge-caution-prescribing-commonly-used-drug-treat-adhd or the abstract here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009885.pub2/abstract)

Cochrane reviews are scientific works that pool the best research on a particular topic and combine it into a mega-study, to get the best results available for a particular topic. First, all the papers written about the topic in question are found. The poorest quality studies are discarded, leaving studies that are suitable quality and are fairly uniform in how they did their research, so that the results from each study can be combined into one uniform result.

This process of meta-analysis increases the statistical power of the results enormously. The Cochrane Collaboration has been at the forefront of meta-analysis and has developed specific rules about the quality of evidence it accepts for its reviews, making a Cochrane review as trustworthy as medical research can be.

So what did the meta-analysis of methylphenidate for children with ADHD actually show? In short,

  • A strong improvement in the Teacher-Rated Symptoms score,
  • A strong improvement in the Teacher-Rated Behaviour score,
  • Small-to-moderate improvement in the ADHD rating scale,
  • Small increase in minor side effects such as poorer sleep and appetite, and
  • No increase in serious harm from methylphenidate.

So … that sounds pretty positive overall. Why the big hullabaloo? Why are these experts supposedly urging caution?

The concerns the researchers had was with the quality of the studies. Overall, the research that’s been done thus far has been deemed low quality by Cochrane’s standards. So they were cautious about suggesting that the results were reliable given the quality of the studies they had to work with. And that’s fair enough. Better quality studies are required to confirm the findings of the current Cochrane review, and this should be done as a matter of priority.

Unfortunately, the reviewer’s cautious approach to the research has been misinterpreted as a concern about the drug itself.

There are two important points here: 1. Accepting the limitations of the quality of the research it’s based on, the review still found a moderate effect of methylphenidate, and 2. Other “treatments” for ADHD have been proven in separate meta-analyses to be wholly ineffective.

There’s a little bit of statistical interpretation required here, but the Standardised Mean Difference (SMD, or sometimes called Cohens d) for the Teacher-Rated Symptoms score and Teacher-Rated Behaviour score was -0.77 and -0.87 respectively. The negative value here doesn’t mean that it’s bad; it’s just the arbitrary direction the reviewers chose to show improvement favouring Ritalin. Then there’s the SMD itself. The SMD takes into account the variability of the results overall, using a specific formula to take that into account.

The SMD used here doesn’t equate to the other value the reviewers used for the side effect statistics, which they expressed as a relative risk. So you can’t look at the numbers given and directly equate the power of the improvements with the chance of side effects of the medication.

However, it’s been said that an SMD of 0.2 is a small effect size, 0.5 is moderate, and 0.8 is large [2], so the effect of Ritalin given by the study was actually a strong effect. In comparison, the relative risk of minor adverse effects given by the review was 1.29, or a 29% increased risk, which is relatively small.

Then there’s the important consideration of the effects of other treatments for ADHD. The effect of Ritalin maybe backed by low quality evidence, but there’s no evidence of any effect for the other so-called ‘treatments’ for ADHD. As per the review by Sonuga-Barke (2013), there is a tiny amount of evidence for supplementation with omega-3 and 6 fatty acids, but none for:

  1. Elimination diets (including those for ‘antigenic’ foods, specific provoking foods, general elimination diets and ‘oligoantigenic’ diets)
  2. Food colouring (including certified food colours, Fein-gold diets and tartarazine)
  3. Cognitive training (including working memory specific, and attention specific training)
  4. Neurofeedback, and
  5. Behavioural intervention [3]

So no matter how inane or facile the arm-chair experts may be, there is no evidence that Ritalin for ADHD is harmful. There is a small risk of minor effects such as reduced appetite and sleep, but there is evidence (albeit low quality evidence) that it has a strong positive effect. In comparison, there’s no evidence of improvement from any other treatment that’s been adequately studied.

No drug is perfect, and that includes Ritalin. But it’s certainly not the devil in pill form either. It’s time to stop demonizing it, and ignorantly criticizing those children and their families who need it.

References

[1]       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.
[2]       Faraone SV. Interpreting estimates of treatment effects: implications for managed care. P & T : a peer-reviewed journal for formulary management 2008 Dec;33(12):700-11.
[3]       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.