CHADD writes to Dr. Phil
I found this letter from the administrators of CHADD to Dr. Phil. Thought you all might be interested. I'll have to post it in sequential postings, as it is pretty long!
News from CHADD
Volume 4, Number 24
October 4, 2004
Dr. Phil On AD/HD: Major Blunders, Some Positives
Last week, on his new program "Family First," Dr. Phil McGraw (best
known as "Dr. Phil"), devoted an hour to the topic of AD/HD. CHADD
watched the program and responded to Dr. Phil with concern about many of
his non-scientific recommendations. CHADD also acknowledged when and
where Dr. Phil "got it right."
CHADD advocates treatment of AD/HD in children through a multimodal
approach and relies on the published science on multimodal treatment as
developed by the National Institute of Mental Health, American Academy
of Pediatrics, and the American Academy of Child and Adolescent
Psychiatry.
Below please find CHADD's analysis of the program and our letter to Dr.
Phil.
______________________________________
October 4, 2004
Dr. Phil McGraw
5482 Wilshire Boulevard #1902
Los Angeles, CA 90036
Dear Dr. Phil:
As the nation's leading advocacy organization serving children and
adults with attention-deficit/hyperactivity disorder-one that supports
evidence-based science in the treatment of mental disorders-CHADD
appreciates the full hour you devoted on your show to the topic of AD/HD
(September 28, 2004). However, while your program certainly helped raise
awareness of the disorder, we are concerned that the majority of your
recommendations were not scientifically grounded and may have confused
your viewers, perhaps even leading some down inappropriate paths in
search of solutions that are questionable, perhaps even harmful.
CHADD advocates treatment of AD/HD in children through a multimodal
approach that consists of (1) parent and child education about diagnosis
and treatment, (2) specific behavior management techniques, (3)
medication and (4) appropriate school programming and supports.
Treatment should always be tailored to the unique needs of each child
and family. CHADD relies on the published science on multimodal
treatment as developed by the National Institute of Mental Health,
American Academy of Pediatrics, and the American Academy of Child and
Adolescent Psychiatry.
TO YOUR CREDIT:
* You made very clear that AD/HD is a neurobehavioral disorder
characterized by differences in brain structure and function that affect
behavior, thoughts and emotions.
CHADD's Position: Multiple studies have been conducted to discover the
cause of the disorder. The exact causes of AD/HD remain elusive, but
research indicates that at least three separate yet interactive brain
regions have been associated with the condition. Research also clearly
indicates that AD/HD tends to run in families. More than 20 genetic
studies have shown evidence that the disorder is largely an inherited,
neurologically based condition. AD/HD is a complex trait, and complex
traits are typically the result of multiple interacting genes. Problems
in parenting or life situations may make AD/HD better or worse, but they
do not cause the disorder. [1]
* You stated that medication can be effective and in some instances
quite necessary.
CHADD's Position: For most children with AD/HD, medication is an
integral part of treatment. It is not used to control behavior.
Medication, which can only be prescribed by certain medical
professionals if needed, is used to improve the symptoms of AD/HD so
that the individual can function more effectively. Research shows that
children and adults who take medication for symptoms of AD/HD usually
attribute their successes to themselves, not to the medication. [1]
* You cautioned viewers to look at the presenting behaviors before
jumping to the conclusion that their child may have AD/HD. For example a
child may have depression, anxiety or another co-occurring condition.
CHADD's Position: As many as two thirds of children with AD/HD have at
least one other coexisting condition. [2] The constant motion and
fidgetiness, interrupting and blurting out, difficulty waiting in lines
or sitting in restaurants and need for constant reminders may overshadow
these other disorders. But just as untreated AD/HD can leave lasting
scars, so too can other untreated disorders cause unnecessary suffering
in individuals with AD/HD and their families. The most common disorders
to occur with AD/HD are (1) Disruptive Behavior Disorders, (2) Mood
Disorders, (3) Anxiety Disorders, (4) Tics and Tourette's Syndrome and
(5) Learning Disabilities. [3]
* You encouraged development of a consistent and structured environment
both at home and in school where a child with (or without) AD/HD can
thrive.
CHADD's Position: Behavior interventions are often a major component for
children who have AD/HD. Important strategies include being consistent,
using positive reinforcement, and teaching problem-solving,
communication and self-advocacy skills. [4]
* You acknowledged the challenges faced by teachers who are managing the
needs of 25, 30 or more children in their classroom and the importance
of strong parent-teacher collaboration.
CHADD's Position: Teachers are frequently the first to recognize
learning, functioning, and behavioral problems in the school setting and
therefore should be able to advise parents of such observations. CHADD
believes that professionals should act within their professional scope
of practice, thus, school personnel should not recommend the use of
medication. Medication assessment and prescription is the role of the
physician. However, teachers should be able to recommend a comprehensive
and complete medical assessment by persons licensed to perform such
evaluations. Because students spend a significant portion of their day
in the classroom, the vital role teachers play in providing observations
to the diagnosing professionals cannot be underestimated. [5]
* You stated that a government agency should never dictate a particular
medication for a possible mental disorder.
CHADD's Position: CHADD agrees that no school should be allowed to
condition school attendance on whether or not a child is medicated.
CHADD does support the U. S. Senate-passed legislation that directs the
U.S. General Accounting Office (GAO) to conduct a study to document the
scope and seriousness of this possible national problem.
* You highlighted the role that children can and should play in managing
their disorder.
CHADD's Position: CHADD endorses the recommendations by resiliency
expert, Robert Brooks, Ph.D., that emphasize the importance of
developing resiliency in children by teaching decision-making and
problem-solving skills and reinforcing self-discipline. This includes
guiding children in solving problems by helping them to develop
solutions to problems, rather than getting angry at the situation.
Self-discipline is described as ownership, acceptance and adherence to
the given rules and understanding why they exist. [6]
* You suggested that if the parent is having difficulty, he or she might
want to explore whether the parent also might have undiagnosed AD/HD.
CHADD's Position: AD/HD has been recognized and treated in children for
almost a century, but the realization that AD/HD often persists into
adulthood has only come over the last few decades. The prevailing belief
among professionals for many years was that children and adolescents
would outgrow their symptoms of AD/HD by puberty, and certainly by
adulthood. However, contemporary research has shown that as many as 67
percent of children diagnosed with AD/HD will continue to have symptoms
of the disorder that significantly interfere with academic, vocational
or social functioning in their adult lives. [7,8]
Continued....
* Perhaps most important, you concluded with the recommendation that
parents should consult with a physician if they suspect their child or a
loved one may have AD/HD.
CHADD's Position: Although individuals with this disorder can be very
successful in life, without identification and proper treatment, AD/HD
may have serious consequences, including school failure, depression,
problems with relationships, conduct disorder, substance abuse and job
failure. Early identification and treatment are extremely important.
There are several types of professionals who can diagnose AD/HD,
including school psychologists, private psychologists, social workers,
nurse practitioners, neurologists, psychiatrists and other medical
doctors. Regardless of who does the evaluation, the use of the
Diagnostic and Statistic Manual IV criteria is necessary. A medical exam
by a physician is important and should include a thorough physical
examination, including hearing and vision tests, to rule out other
medical problems that may be causing symptoms similar to AD/HD. In rare
cases, persons with AD/HD also may have a thyroid dysfunction. Only
medical doctors can prescribe medication if it is needed [4]
HOWEVER, YOU ALSO GOT IT WRONG IN MANY KEY PLACES. CONSIDER A FEW OF
YOUR BLUNDERS:
* You used a sensational, misleading and unfair way to grab viewer
attention: "Pills as Parenting."
CHADD's Position: Attention-deficit/hyperactivity disorder frequently
makes headlines-often for good reasons, but more often than not for
sensational purposes. Considered as today's diagnosis du jour, AD/HD is
often depicted as something that simply doesn't exist. But for the
individuals and families dealing with the disorder, AD/HD is a difficult
reality. Why is there such controversy around AD/HD? In part, the
controversy reflects a societal reluctance to identify children as
having a mental disorder. In part, the controversy reflects our
ambivalent feelings about medication, particularly because our idealized
view of childhood does not include the use of "pills" to help a child
better manage his or her mood and behavior. And finally, the controversy
reflects our concerns-legitimate concerns-that medication might be
improperly prescribed. [9] Your headline plays upon people's fear, and
further perpetuates the stigma that too often accompanies a mental
disorder.
* You stated that a diet high in sugar or food additives could trigger
AD/HD.
CHADD's Position: Dietary interventions (as contrasted with dietary
supplements) are based on the concept of elimination, that one or more
foods are eliminated from one's diet. The most publicized of these diet
elimination approaches is the Feingold Diet. [10] This diet is based on
the theory that many children are sensitive to dietary salicylates and
artificially added colors, flavors and preservatives, and that
eliminating the offending substances from the diet could improve
learning and behavioral problems, including AD/HD. Despite a few
positive studies, most controlled studies do not support this
hypothesis. [11] At least eight controlled studies since 1982, the
latest being 1997, have found validity to elimination diets in only a
small subset of children "with sensitivity to foods." [11] While the
proportion of children with AD/HD who have food sensitivities has not
been empirically established, experts believe that the percentage is
small. [11,12,13] Parents who are concerned about diet sensitivity
should have their children examined by a medical doctor for food
allergies. Research has also shown that the simple elimination of sugar
or candy does not affect AD/HD symptoms, despite a few encouraging
reports. [11,14,15]
* You unfairly implied that the mother's parenting style (as opposed to
the father's) was the primary source of the problem.
CHADD's Position: Parenting a child with attention-deficit/hyperactivity
disorder, or any disability, can be overwhelming at times. All parents
sometimes feel anger, fear, grief, frustration and fatigue while
struggling to help their child. However, parents needn't waste limited
emotional energy on self-blame. AD/HD is a hereditary disorder and is
not caused by poor parenting or a chaotic environment. How a child with
AD/HD will do in adulthood is best predicted by three things-(1) whether
his or her parents use effective parenting skills, (2) how he or she
gets along with other children, and (3) his or her success in school.
[16] Psychosocial treatments are effective in treating these important
domains. Second, behavioral treatments teach skills to parents and
teachers that help them deal with children with AD/HD. They also teach
skills to children with AD/HD that will help them overcome their
impairments. Learning these skills is especially important because AD/HD
is a chronic condition and these skills will be useful throughout the
children's lives [17,18]. Additional recommendations can be found at:
http://www.chadd.org/fs/fs2.htm. [19]
* You stated that medication (you called it drugs) is effective in only
50 percent of children and that efficacy diminishes as soon as a child
begins taking medication.
CHADD's Position: Approximately 70 to 80 percent [20] of children with
AD/HD respond positively to psychostimulant medications. Significant
academic improvement is shown by students who take these medications:
increased attention and concentration, compliance and effort on tasks,
amount and accuracy of schoolwork produced as well as decreased activity
levels, impulsivity, negative behaviors in social interactions, and
physical and verbal hostility. [21] There is no scientific evidence to
support a reduction in efficacy.
* You failed to mention, discuss or describe multimodal treatment-the
treatment approach endorsed and used by the National Institute of Mental
Health, the American Academy of Pediatrics and the American Academy of
Child and Adolescent Psychiatry.
CHADD's Position: Treating AD/HD in children often involves medical,
educational and behavioral interventions. This comprehensive approach to
treatment is called multimodal and consists of parent and child
education about diagnosis and treatment, specific behavior management
techniques, medication, and appropriate school programming and supports.
The severity and type of AD/HD may be factors in deciding which
components are necessary. Treatment should be tailored to the unique
needs of each child and family. Psychosocial treatment is a critical
part of treatment for attention-deficit/hyperactivity disorder in
children and adolescents. The scientific literature, the National
Institute of Mental Health and many professional organizations agree
that behaviorally oriented psychosocial treatments-also called behavior
therapy or behavior modification - and medication have a solid base of
scientific evidence demonstrating their effectiveness. Behavior
modification is the only nonmedical treatment for AD/HD with a large
scientific evidence base. [18]
* You stated that the ONLY way to diagnose AD/HD is with an EEG or a
Spectagram.
CHADD's Position: The science does not support this statement. There is
no single test to diagnose AD/HD. Consequently, a comprehensive
evaluation is necessary to establish a diagnosis, rule out other causes,
and determine the presence or absence of co-existing conditions. Such an
evaluation should include a clinical assessment of the individual's
academic, social and emotional functioning and developmental level. A
careful history should be taken from the parents, teachers and-when
appropriate- the child. Checklists for rating AD/HD symptoms and ruling
out other disabilities are often used by clinicians. [1]
* You also stated that neurofeedback (biofeedback) is an alternative to
medication.
CHADD's Position: Complementary interventions are not alternatives to
multimodal treatment, but have been found by some families to improve
the treatment of AD/HD symptoms or related symptoms. Recent research
suggests that the theory underlying EEG biofeedback treatment is
consistent with what is known about differences in brain activity
between individuals with and without AD/HD. [22,23,24] This treatment
has been used for over 25 years [25] and there are many parents who
report that it has been extremely helpful for their child. There have
also been several published studies of neurofeedback treatment that have
reported encouraging results. [26,27, 28, 29] It is important to
emphasize, however, that although several studies of neurofeedback have
yielded promising results, this treatment has not yet been tested in the
rigorous manner that is required to make a clear conclusion about its
effectiveness for AD/HD. [30] "The aforementioned studies can not be
considered to have produced persuasive scientific evidence concerning
the effectiveness of EEG biofeedback for ADHD." [25] Controlled
randomized trials are required before conclusions can be reached.For your consideration, I have included the link to our Web site(s)
where a wealth of information on AD/HD can be found:
/http://www.chadd.org> or /http://www.help4.adhd.org>. I also have
attached our fact sheet on assessing complementary and controversial
interventions and our document entitled AD/HD: Fact vs. Fiction.
/http://www.chadd.org/fs/fs6.htm>
/http://www.chadd.org/factvsfiction.cfm>
Dr. Phil, you undoubtedly will continue receiving inquiries from
families concerned about AD/HD. When you do, please refer them to CHADD.
We have a toll free number (1-800-233-4080) where trained information
specialists can respond to specific inquiries.
You have a responsibility to tell your viewers the truth. Unfortunately,
you missed a key teaching opportunity. Next time, please do your
homework.
Respectfully submitted,
E. Clarke Ross, D.P.A.
Chief Executive Officer
CHADD I'm bumping this up, since someone asked about it & its too much to copy & paste.
Thanks for your post. I missed the show. Of course, my mother-in-law didn't. Now she's telling my child that she doesn't really need her meds and just needs to eat less sugar. She is constantly demeaning our efforts and thinks nothing is wrong with her grandaughter and is totally against meds.
My in-law spouts of at the mouth all the time, and has her own little temper tantrums (a little ADHD in her possibly?) with little regard that my 7-year old is a sponge who picks up everything. My in-law said something to the effect of "if you don't pick that up, I'm going to kill you." Needless to say, my child said "I'm going to kil you" to another child in school and was suspended for a day. My in-law laughed. &^%$.
This whole process or trying to get the right med and help with behavorial problems is hard enough without a grandma who believes everything Dr. Phil says.
I, unfortunately watched this particular episode and I was completely disgusted by his comments. I was angry about the "only way to diagnose ADHD is through an EEG comment" and I thought about writing a letter myself. Thankfully CHADD, being the wonderful organization that it is, did so with much more class than I would have. I may still write a letter but I still need some time to cool off...thanks for the post!
Lets not forgt that he was also promoting the book of his good friend, Dr. Frank Lawless who btw charges thousands just for a consultation
Ugh, Dr. Phil, that man drives me nuts. He is so self righteous and self fulfilling it is enough to make gag.
Good for CHADD for writing him back. I wonder if he will do a follow up.
As for the sugar/food additive thing, I have to disagree there. I do notice a difference in me and my daugher (who is 2) if I cut out the sugar and processed foods/additives etc in our diet, but it certainly doesn't "cure" my ADHD, nor do I think that ADHD is caused by diet. But I do think in overall lifestyle and health our Western/North American diet is contributing to certain ailments because of the lack of nutrition in what are now becoming our every day type foods.
And LJWH, my goodness, I hear you on the MIL front. Mine is an absolute freak show of a woman who also believes absolutely everything that she hears on TV and also doesn't believe that ADHD exists and that it is a nutritional deficiency/bad diet thing (this being said after she loads my 2 year old up on total garbage food that she thinks is "healthy").
Dr. Phil slants everything to suit his own opinion. I've seen him do it time and time again and it is pathetic how he keeps getting away with it when it is so insanely blatant.
Just cause science doesn't support it doesn't mean it's un true. There are treatments that have been sucessful that science doesn't support. A eeg can look at how much brain activity is there and where there is a problem area. Dr. Phil is an entertainer, much like Dr. Laura. He goes for the ratings and gets unusual authors who will stir the pot. I can't imagine taking him seriously. Sadly, many do take him, Nanny911, etc. to heart and that makes the general public think all over again, "It's BAD parenting." I never watch this man or any "instant fix" shows because they go against what I'd like to do---increase true awareness of disorders that actually do exist, and are not related to parenting.Hey! The Super Nanny taught me that time-outs should be one minute per year of age! 
[QUOTE=Luvmykids02]
Lets not forgt that he was also promoting the book of his good friend, Dr. Frank Lawless who btw charges thousands just for a consultation
[/QUOTE]
This is exactly what I have come to think of Dr. Phil. Just another entertainer looking to promote his friend's PRODUCT, not to help people.
Unfortunately, I got caught up in this hype when we were first looking to get a diagnosis for my SD. Luckily, it did not take us too long to find the right professionals to help us.
I never liked Dr Phill and still do not and agree he is only after the ratings. Why i missed the show because of work and because of what I already stated 1st sentence.stepmom2maddy wrote:
Unfortunately, I got caught up in this hype when we were first looking to get a diagnosis for my SD. Luckily, it did not take us too long to find the right professionals to help us.
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