by Ron Weinstein, Ph.D.

In the last century, Americans tried living in an unregulated medical marketplace. In 1906, the tide began to turn as a response to abuses in the patent-medicine industry. The 1912 Sherley Amendment made false health-related advertising claims illegal and the 1962 Harris-Kefauver Amendment made submission of proof of efficacy a necessity for a medicinal to be marketed to the general public. Over the past few years, there has been a remarkable growth of a "healing" industry which has been referred to by names that include "alternative", "holistic", "Eastern" and "complementary" (group A). This group makes claims about products that "cure" or "eliminate or reduce the symptoms" of those unfortunate enough to have an attention deficit hyperactivity disorder (AD/HD). These products included nutritional supplements, vitamins, amino and fatty acids, and a whole slew of other compounds. This industry distinguishes itself from what might be referred to as "traditional" or "Western" (group B), whose method of "healing" consists of medication. Group "A" promotes itself as looking beyond the traditional dogma of healing, whereas group "B" remains skeptical and bases its treatment on conclusions reached from a careful analysis of research and what it considers fact, not fantasy. 

The topic of effective treatment of AD/HD, like that of sex, politics and religion, is fraught with strong emotions and personal opinions. Many of these opinions however, are based on misinformation and colored by an individual’s own personal difficulties. As a professional, I realize that it is futile to attempt to "change" another’s attitude. It’s my responsibility however, to educate my clients, and to also address, if possible, the reasons underlying their decision to use or not use medication. A treatment choice should not be based on faith, but on reason and knowledge. 

Two individuals whom I have had the great honor of knowing were Carl Sagan, the brilliant astronomer, and the neurologist Oliver Sacks, M.D. One of them (Sagan), was an open-minded explorer of the universe, who fine tuned my pre-existing intellectual skepticism and helped me to differentiate between "claims" and facts. The other, Dr. Oliver Sachs, who came to international prominence with the film Awakenings, was a role model to a young man whose natural inclination was to always challenge the status-quo. This ability to remain an intellectual skeptic while at the same time looking beyond the traditional dogma has proved particularly useful for me when evaluating treatment modalities for attention deficit hyperactive disorders. The fact that I was diagnosed with AD/HD in 1990 was also quite helpful. 

The diagnosis of AD/HD is not simple despite some claims to the contrary. Adding to the complexity and confusion is that AD/HD characteristics are normal human characteristics. AD/HD is much more complex than many other neuro-biological conditions. The interplay of neuro-biological, environmental, genetic and familial factors affects how the symptoms appear and is often disregarded when choosing whether to use medication or not. Therefore, it is essential to understand that AD/HD is a great deal more than the "holy triad" and is just not "not paying attention" or "bouncing off the walls"! 

It may appear to some, that professionals who question the use of nutritional supplements or other "alternative" products are unreasonable or "close-minded". However, while most of the "alternative" products produce no lasting benefits and may cause no direct harm, it is the resulting long-lasting indirect harm which concerns many of us. It’s what we don’t observe, which influences our future development. 

Those individuals who reject the use of medication as being dangerous and promote "alternatives", support their arguments by providing unsubstantiated and inaccurate information and research which is often flawed. Medication has been accused as "putting on a Band-Aid", creating dependency and not addressing the 

real problem, which is often stated inaccurately as a dietary deficiency or a problem with nutrient absorption. Although their arguments are insubstantial, their influence is wide-ranging. It has created confusion and promotes fear about the use of medication. The simplistic and naive assertions about AD/HD made by many "alternative" practitioners, reveals their ignorance. While some have attempted to quantify product research in this area, it usually falls far short of what would be considered valid and reliable. This is understandable given the great amount of variability within the AD/HD population. As such, I’m not saying that we must rely on research findings to decide the efficacy of a treatment, since I’m a firm believer in clinical studies and experience. 

Too many people use medication as a "magic pill" to cure all of their problems. Medication doesn’t help you make friends or do your homework. The medication only allows the individual with AD/HD to incorporate the tools needed to succeed. When no friends are forthcoming or the homework still doesn’t get done, the medication "doesn’t work". When a child becomes irritated, agitated or depressed in the afternoon, having taken only an early morning dose, the medication becomes the culprit. Medication itself is rarely the problem - it’s usually the dose, the timing, the monitoring and the expectations.

No one can deny that the "alternative" product market is a billion dollar industry. While some purveyors of "alternative" products are sincere in their approach, they are all profit-motivated and will change their product emphasis depending on the whims of the marketplace. "Alternative" promoters are reaching people emotionally. What sells is not the quality of their products, but the ability to influence their audience. They offer a solution for the "problems" they say are caused by medication. They state that their product is safe, gentle, and without side effects. If this is true, their "product" would be too weak to have any effect. Anything that is potent enough to relieve symptoms, will be potent enough to cause side effects. For example, when vitamins are consumed in excess of the body's physiological needs for example, they function as drugs rather than vitamins. We also know that individuals with AD/HD will often get excited by something new. This newness often creates a placebo effect that appears to relieve, for a short time, some of the AD/HD symptoms. 

The "alternative" marketplace for AD/HD products has created a safe and justifiable haven for individuals whose fears are not based in fact. M. Scott Peck in "The Road Less Traveled" defines love as "the willingness to extend yourself for someone else's growth". I’d like to compare this to the use or non-use of medication. While many parents are wont to admit (and many don't even realize it), that when they say "we are not using medication for the good of our child", what we really are dealing with are the fears of the parents. Of course they care about their child, but they don't want to have to worry or take a chance IF something happens because of their decision to use medication. Since they don't want to have to feel or deal with the pain, they turn to so-called "safe alternatives". In these cases, their fear overrides what we know will most likely result by not taking medication. 

The seriousness of this matter can not be ignored, knowing as we do the devastating long tem implications for those who remain untreated, inappropriately treated or undiagnosed. Anxiety, depression, anger, feelings of being overwhelmed, difficulties with written expression, short-term memory, note-taking, handwriting, automatic retrieval of basic facts, the mechanics of math and writing, and not knowing the "process" of how they got the right math answer, are all related to AD/HD. 

While everyone is running around looking for alternatives to medication, AD/HD children and adults who are not taking medication are losing ground on the path of becoming healthy and evolved individuals. Instead of throwing the baby out with the bath water, we need to face the reality of the situation, move forward and address the real problems. Instead of placing so much emphasis on medicating or not medicating, the problems can be resolved if individuals with AD/HD and the professionals who work with them concentrate on learning more about AD/HD and all its manifestations. 

Ron Weinstein is currently the Clinical Director of the A.D.D. & Family Support Centre located in Harrogate, UK. Since 1990, he was the director the A.D.D. Center of New England. He specializes in attention deficit and behavioral disorders. In addition to his private practice, he consults with school systems, state and federal agencies and is a frequent speaker at national and international conferences. He can be reached at e-mail DrRon@addcentre.co.uk or through his website at http://www.addcentre.co.uk/

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© 1999 Weinstein