By Dr. Yaakov Ophir
“As glasses help people focus their eyes to see,” medical experts from the American Academy of Pediatrics rule, “medications help children with ADHD focus their thoughts better and ignore distractions.” In their view, as well as in the view of multiple other expert consortiums, the most appropriate way to treat the “lifelong impairing condition” of Attention Deficit Hyperactivity Disorder (ADHD) is by taking stimulant medications on a daily basis.
Although stimulants, as suggested by their name, are frequently abused for stimulating (potentially addictive) sensations of high energy, euphoria, and potency, they are often compared to harmless medical aids, such as eyeglasses or walking crutches. Numerous studies, we are told, support their efficacy and safety, and evidence-based medicine dictates that these substances will be administered to children with ADHD as the first-line treatment.
There is only one, huge problem. ADHD is currently the most common childhood disorder in Western-oriented countries. Its ever-increasing rates are now skyrocketing. The documented prevalence of ADHD is not about 3 percent, as it used to be when the disorder was first introduced in 1980. In 2014, a survey by the US Centers for Disease Control and Prevention (CDC) revealed that over 20 percent of 12-year-old boys were diagnosed with this “lifelong condition.”
In 2020, thousands of real-life medical records from Israel suggested that over 20 percent of all children and young adults (5-20 years) received a formal diagnosis of ADHD. This means that hundreds of millions of children around the world are eligible for this diagnosis and that most of them (about 80 percent), including very young, preschool children, will be prescribed with its treatment-of-choice, as if regular use of stimulants is indeed comparable to eyeglasses.
Stimulant brands for ADHD, such as Ritalin, Concerta, Adderall, or Vyvanse rank at the top of the best-selling lists of medications for children. Indeed, the American dream may play a significant role in the proliferation of such cognitive enhancers in the US, but the rush for the magic pills crosses national borders. In fact, the ‘semi-final’ countries that are currently ‘winning’ the Ritalin Olympics, according to the International Narcotics Control Board, are: Iceland, Israel, Canada, and Holland.
But what if the scientific consensus is wrong? What if the medications for ADHD are not as effective and as safe as we are told? After all, stimulant medications are powerful psychoactive substances, which are prohibited to use without medical prescriptions, under federal drug laws. Like all, which affect the central nervous system, stimulant medications are designed to penetrate the blood-brain barrier – the specialized tissue and blood vessels that normally prevent harmful substances from reaching the brain. In this way, stimulant medications are essentially impacting the biochemical processes of our brain – that miraculous organ that makes us who we are.
In my new book ADHD is Not an Illness and Ritalin is Not a Cure: A Comprehensive Rebuttal of the (alleged) Scientific Consensus, I do my best to answer these disturbing questions. The first part of the book offers a step-by-step refutation of the notion that ADHD meets the required criteria for a neuropsychiatric condition. In fact, a close reading of the available science suggests that the vast majority of the diagnoses simply reflects common and pretty normative childhood behaviors that underwent unjustified medicalization. The second part of the book uncovers the massive evidence that exists against the efficacy and safety of the treatment-of-choice for ADHD.
Hundreds of studies, published in well-recognized, mainstream academic journals tell a totally different story than the one told by the American Academy of Pediatrics. Stimulant medications are nothing like eyeglasses. Of course, it is impossible to summarize an entire book here, but I do wish to outline three principal failures in the common comparison between stimulant medications and eyeglasses – or any other daily used, harmless medical aids for that matter, such as walking crutches.
- Even without considering the specific criticism about the validity of ADHD, the very comparison between organic/bodily conditions, which are typically measured through objective tools, to amorphic psychiatric labels that rely exclusively on subjective assessments of behaviors, is inappropriate and misleading. The ‘brain deficit’ and the ‘chemical imbalance’ that have been associated with ADHD are unproven myths. Stimulants do not ‘fix’ biochemical imbalances and they can easily be used also by non-ADHD individuals to enhance cognitive performance (even though these individuals are not assumed to have this alleged ‘brain deficit’).
- As opposed to visual impairments that restrict the individual’s everyday functioning, regardless of school demands, the primary impairment in ADHD is manifested in school settings. Eyeglasses and walking crutches are needed outside of school premises as well, even during weekends and holidays. ADHD, in contrast, seems to be a ‘seasonal disease’ (despite endless efforts to exaggerate and extend its negative outcomes to non-school-related settings). When schools are closed, its daily medical management is often no longer needed. This simple real-life fact is even acknowledged, to some extent, in the official Ritalin leaflet, which states that: “During the course of treatment for ADHD, the doctor may tell you to stop taking Ritalin for certain periods of time (e.g., every weekend or school vacations) to see if it is still necessary to take it.” Incidentally, these ‘treatment breaks,’ according to the leaflet, “also help prevent a slow-down in growth that sometimes occurs when children take this medicine for a long time” – a noteworthy point that brings us to the third, and most important error in the comparison between stimulant medications and other daily, physical/medical aids, such as eyeglasses.
- The benign examples used by proponents of the medications, such as eyeglasses or walking crutches are not regulated by the Dangerous Drugs Ordinance. Typically, these medical aids do not cause serious physiological and emotional adverse reactions. If stimulant drugs are as safe as experts say, like “Tylenol and aspirin,” why do we insist that they will be medically prescribed by licensed physicians? This question has philosophical and societal implications. After all, if the medications are safe and helpful to various populations (i.e., not only to people with ADHD), what is the moral justification to prohibit their usage among non-diagnosed individuals? This is unjustified discrimination. Moreover, why are we condemning (non-diagnosed) students who use these medications to improve their grades? If regular use of Ritalin and alike is so safe, why not place them on the pharmacies’ shelves, next to the non-prescription pain relievers, moisturizers, and chocolate energy bars?
The last rhetorical questions illustrate how far the eyeglasses metaphor is from the clinical reality and the scientific evidence regarding ADHD and stimulant medications. ADHD medications are not fundamentally different from other psychoactive drugs that cross the blood-brain barrier. At first usage, they may trigger intense sensations of potency or euphoria, but when used for prolonged periods, their desired effects subside, and their unwanted negative effects start to emerge. The brain recognizes these psychoactive substances as neurotoxins and activates a compensatory mechanism in an attempt to fight the harmful invaders. It is this activation of the compensatory mechanism, not the ADHD, that might cause the biochemical imbalance in the brain.
I realize that these last sentences may sound provocative. I therefore encourage readers not to ‘trust’ this short article blindly, but to dive with me into the deep (and sometimes dirty) water of the scientific literature. Despite the academic orientation of my book, I made sure to make the science available to most readers through plain language, illustrative stories, and real-life examples. And even if you disagree with some of its content, I am positive that, by the end of the reading, you will ask yourself, like I did: How is it possible that such critical information about ADHD and stimulant medications is being hidden from us? Does it really make sense to compare these drugs to eyeglasses? Are we medicating millions of ADHD children without proper scientific justification?
- Dr. Yaakov Ophir is a research associate at the Natural Language Processing lab of the Technion – Israel Institute of Technology and a licensed clinical psychologist with a specific expertise in child therapy, parent training, and family interventions. He received his PhD from the Hebrew University of Jerusalem and gained extensive experience in complex empirical research and scientific criticism. Dr. Ophir published over than 20 peer-reviewed scientific articles (in English) alongside multiple, less formal ‘popular science’ writings and radio/television interviews (mostly in Hebrew).
This article was first published at The Brownstone Institute. It is used with Creative Commons permission.