Urging caution regarding a pharmaceutical cash cow will never be easy.

Contributing to the problem is how difficult it can be to live with children who have extensive ADHD symptoms. Their constant impulsivity and inability to appreciate consequences is enough to drive the finest of parents bonkers. (While I'm not the finest of parents, I have been a foster parent and am an adoptive parent, and can well appreciate the promise of a magic bullet--or any bullet that might help a child with ADHD to slow down just a bit, and to be able to listen and focus and think.)

I've also heard time and again that children with ADHD will go on to self-medicate with something illegal if we don't medicate them with something legal. I think this reasoning his horribly flawed, but it makes a certain amount of sense to desperate parents.

As for the effectiveness of drugs like Ritalin, while I've seen a much appreciated slowdown in the child's activity level, I've also seen a corresponding dulling which has been of concern. Also my awareness of the neurological immaturity of a child's brain and how it is still a neurological work in progress until early adulthood concerns me about the impact of drugs on it. However, my experience is anecdotal and observational rather than scientific, so it isn't of much value.

I do believe it is important that studies like those you mention be part of our decision-making process. I also think it never hurts to look carefully at the funding sources or funding trail (which can be much more subtle) of studies on drugs that promise to change unwanted behavior.

While I have faith in the integrity of the scientists at the big drug companies, I sometimes wonder if our desperate need as consumers--combined with the exuberance of the drug company marketing and sales teams and the demands of stock holders--always results in the best of outcomes.

Dr. Ghaemi, at the risk of your becoming a Tom Cruise protege, I think your voice of caution is an important one.

Paul Joannides, Psy.D.

As someone with ADD i question ADHD. Depression with ADD is what ADHD is and ADD gets the blame.ADD can go untreated and those with it still do fine. Depression on the other hand should never go untreated.I believe there is, to this very day, a very poor understanding of what just plain old ADD is. Sincerely,David

May I pose the supposition that many parents and physicians have become stymied by a faulty understand of how children "should" behave? Though no clinician, I am a parent and I have seen other parents readily label (and seek professional help labeling) their children ADHD. Occasionally it appears that as a culture we've developed an intolerance for the good old activity and carelessness that used to be the staples of childhood. To further illustrate our delusionment, rather than identifying better ways to promote productive energy and reinforce critical thinking skills, every child--regardless of their attentional capabilities--is forced into a rigid model of education that begs adult sensibilities out of even our youngest of pupils. (Think I'm kidding? My sister was a kindergarten teacher's aide last year and was shocked to discover that even kindergarteners are expected to be able to read sight words and write their names. On average, these are four and five year olds!) Remember when we were kids? When Ritalin wasn't so readily supplied and ADHD wasn't so readily applied, active kids were just active kids. Parents didn't run out for the magic bullet to kill the beast in us, they sent us outside to play. Begs the question, how serious are we when we say we just want our kids to be "normal" if the way we're "normalizing" them is through a trendy label and cool little pill? (And how much of this trend may be attributed to poor parenting?)

My son has very ADHD-like tendencies--almost complete inabillity to sit still, marked difficulty concentrating on tasks that do not interest him, poor task-completion skills, and trouble coherently speaking during high levels of excitement (he's also very excitable.) What this means for me is that I often have to repeat myself, I have to break up tasks into simple steps instead of complicated processes, and i have to drop what I'm doing, reading, watching on tv, and go outside to play Jedi Knights and Darth Vader with him when he asks. I remind him to calm down when he appears to become overwhelmed, I help him focus on diversional opportunities when he can't have something he wants, I reduce the amount of time we sit in one place or bring along something to keep his interest if we are out somewhere he can't run around and play. Is this hard? Sure. A bit inconvenient? Sometimes. So what? I'd rather my son not come to think there is something "wrong" with him just because he is who he is. Besides, isn't it a little misleading to unconsciously supply our children with the belief that if something is a little hard, there's a pill to make it easier? Don't we all suffer with personal deficits that make certain things a struggle--poor organization skills, poor time management skills, inability to commit, etc? Got a pill for that too?

In the early years depression can look like ADD but no one wants to say there child will become a depressive so they go with the more likable label. Mental illness is highly genetic also.-Sincerely -David

You really need to start reading the literature, Frank, and if you can't , then you really shouldn't be writing with pontificating authority here.

"Knock-out" rats with "hyperactivity" are NOT the same as rats with ADHD -- if such a creature could be found -- much less humans with ADHD.

Again, you mix, conflate, and confuse issues at a dizzying rate.

Moreover, you set up straw men that no one would disagree with, including most clinicians who treat ADHD (that other methods should be tried before medication). You do this just to gain credibility?

The AMP class isn't for everyone, especially in the IR formulations. But for some, it will be nothing short of life-changing, when prescribed responsibly. Shame on you (again) for creating confusion when you could be creating awareness.

Gina Pera, author
Is It You, Me, or Adult A.D.D.?
Http://www.ADHDRollerCoaster.com

Well, one minute, I'm reluctantly reading Frank Lawliss. The next I find myself at your blog, Nassir. I thought I was clicking on more of Lawliss's columns, but instead it bumped me to yours.

You can see my confusion, though, as you include almost as many misconceptions as Lawliss typically includes.

I suggest you read up on the literature and learn more about ADHD. Obviously, we have a problem with physicians who are sloppy and lazy prescribers (not that Big Insurance has helped in this matter). But you perform no service by simply reinforcing ignorance when you could be explaining protocols. Perhaps that is because you are unfamiliar with them? That's clear, from saying that when medication must be used that it be used short-term only. Where's your evidence that this is useful?