Skepticism about science and medicine

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Posts Tagged ‘ADHD treatment’

Pseudo-science of ADHD at FDA

Posted by Henry Bauer on 2019/05/27

Attention-deficit-hyperactivity-disorder, ADHD, is diagnosed on the basis of an entirely subjective scale which is also irrational,  for example in postulating different criteria at different ages (The banality of evil — Psychiatry and ADHD).

The diagnostic criteria for ADHD are purely behavioral, since no physical basis for ADHD has ever been established. Of course, ADHD is far from alone in that respect among the disorders catalogued in psychiatry’s “Bible”, the Diagnostic and Statistical Manual of Mental Disorders (DSM), now (since 2013) in its 5th edition (DSM-V or DSM-5).

Despite the lack of  any proven physical basis for mental disorders, psychiatry has experimented with such physical treatments as lobotomy and shock treatment (nowadays described as electroconvulsive therapy, ECT).

Psychiatry’s latest venture into treatment of ADHD Is the application of electrical stimuli based on what can only be described as guesswork about a possible physical basis for ADHD and further guesswork as to whether the stimuli could accomplish anything useful. “Guesswork” because this extraordinary intervention has been approved by the FDA on the basis of a ridiculously limited clinical trial (FDA permits marketing of first medical device for treatment of ADHD):
“62 children with moderate to severe ADHD were enrolled in the trial and used either the eTNS therapy each night or a placebo device at home for four weeks”.
The results were anything but spectacular, indeed not very convincing at all:
“the average ADHD-RS score in the active group decreased from 34.1 points at baseline to 23.4 points, versus a decrease from 33.7 to 27.5 points in the placebo group.”
Bearing in mind that these scores come from subjective assessments, one might conclude that the trial results might — at best — serve as a basis for continuing research.
Or perhaps one might conclude more cautiously, indeed more sensibly,  that further research might not be warranted since the treatment has undesirable side-effects:
“The most common side effects observed with eTNS use are: drowsiness, an increase in appetite, trouble sleeping, teeth clenching, headache and fatigue. No serious adverse events were associated with use of the device.”
Not all parents might agree, after all,  that it is of no serious concern that children have difficulty in sleeping and experience headache, fatigue, and teeth clenching, particularly as there is no guarantee of any benefits.

So far as the ADHD-RS is concerned, note how easily a total score could change by 10 points or more, when rating on a 0-3 scale such behavior as

1. Fails to give close attention to details or makes careless
mistakes in schoolwork.

or

2. Fidgets with hands or feet or squirms in seat

Ponder the full scale of 18 items, yielding scores between 0 and 54, so an average of 27:         ADHD-RS -IV


Words fail me. For an appropriate critique, see Michael Cornwall,
DA Approves Using Electricity All Night Long on Children’s Brains, 21 May 2019

 

 

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