This is the interview with Dr. Frank Barnhill, about misdiagnosing ADHD, on Monday Night Radio. Monday Night Radio is an online (Internet-based) talk radio show where different experts are interviewed, and people around the world can listen via the Internet, and call in to talk with the expert, and ask them questions.
The Internet Patrol’s Anne P. Mitchell, Esq., is the host of Monday Night Radio.
This Monday Night Radio show with Dr. Barnhill was first aired on 10/25/10. In addition to reading the interview below, you can listen to the recorded show via iTunes – where you can also subscribe to the podcast of all of the recorded shows. Here is the iTunes link: http://www.MondayNightRadio.com/ref/MNR-iTunes.
Links to the guest’s website and book, if any, are at the end of the interview.
Anne: It’s time for Monday Night Radio. Monday night is your night to talk with the experts. Call us now to get into the queue at 866-Monday6. That’s 866-Monday6. Call us now, or e-mail your questions and comments to [email protected] Tweet them to us @mondayradio. Now, here’s your host, Anne P. Mitchell, esquire.
Anne: Good evening, everyone, and welcome to another episode of Monday Night Radio. I am very excited. Our Canadian listeners can now call our toll free Monday Night Hotline. That’s really exciting because we are always happy to help out and save everyone a little money. So, it’s really awesome that they can call. Actually, anyone anywhere in North America can now use the toll free number. That number is 866-Monday6. Now listeners anywhere else in the entire world can call our direct line. That number is 3478573122. Again, that’s 3478573122. So, we are now truly global with the ability to hear from our listeners anywhere in the world, very, very exciting. I also, speaking of calling in, want to remind you that we invite all of our listeners to call in and tell us what you think about anything at all at any time. You can call that same Monday Night Hotline 866-Monday6 any time day or night and leave us a message telling us what is on your mind. So, as an example we had someone call in who wanted to talk to us about the Juan Williams firing that happened last week. As you may recall, Mr. Williams an NPR correspondent was on Larry King and made some interesting comments about how he was nervous when he boarded an airplane and would see someone dressed in Muslim garb. That was very un-PC of him, and so NPR let him go. Here is what one of our listeners had to say.
Listener #1: Yes, I was commenting on this e-mail I received concerning the firing of Juan Williams. I don’t believe he should have been fired. People get nervous over a lot of different things. Just because he made that comment, I don’t see that as being so insensitive that he should have been fired. As for me, I see someone in different types of attire that would not make me nervous.
Anne: So, what do you think? Again, tell us what you think about anything. It doesn’t have to be about the Juan Williams firing which to you may be old news by now. But, what is on your mind? Let us know at 866-Monday6. But, do wait until after the show. Call in now to talk to this show’s expert. I am so pleased to be able to have this guest on our show. What many of you don’t know, in fact probably no one listening knows until I reveal it now, is that there was a time where I was diagnosed by proxy if you will as having ADD or as it is now known ADHD. That was because a family member of mine was diagnosed as having it. There is a very strong likelihood that if someone in your family, in your direct lineage, parent, child has it, there is a very good chance you have it as well. On the other hand there are many, many people who are diagnosed with having ADHD, ADD who don’t actually have it. In fact, as our guest is going to tell us there are many other conditions that can mimic ADHD. Countless children, adults as well, but especially the children, in our school system are diagnosed as having ADHD are medicated for ADHD, when in fact they don’t have ADHD at all. I think that is just a travesty. So, our guest who I am about to bring on is Dr. Frank Barnhill. He is a medical doctor. In fact, he has been practicing family medicine and ADHD behavioral medicine for almost 30 years. He has a new book out. I think it is new. I have to confess I’m not sure that it is new. He does have a book out. I have been reading it, and it is really wonderful. I will let him tell you about that. Without further ado, I would like to get Dr. Barnhill on the line. Dr. Barnhill, are you there?
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Dr. Barnhill: Yes, I am. Good evening, and thanks for having me.
Anne: Welcome to the show, Dr. Barnhill.
Dr. Barnhill: How are you?
Anne: I am so excited to have you on the show. I have to tell you the switch board is already lighting up, which is just wonderful. I am very well, thank you. How are you?
Dr. Barnhill: Well I had no idea that we were dealing with a previous victim of ADHD diagnosis.
Anne: I have to say I don’t think of myself as…
Dr. Barnhill: You know most people who are highly successful in life, especially gifted people, those in the what I call the technical industry and the entertainment industry have been misdiagnosed with ADHD in the past. A lot of their gifted traits were mistaken. Kids who are gifted and who end up holding prominent public positions usually are very curious. They have insatiable curiosity and they are often mislabeled as ADHD based on their impulsivity and their drive, their creative stamina as I put it. Maybe that happened with you.
Anne: I have to tell you, Dr. Barnhill, I don’t know whether I was misdiagnosed or not diagnosed, because again it was one of those, “Oh, well your family member has it, so you must have it too.” I have to tell you that I have always thought of my style of attending and thinking as being a feature, not a bug. It was quite a shock to me to learn that not everyone can do 3 or 5 things at once and do them all successfully. I kind of think not being able to do that would be a hindrance.
Dr. Barnhill: I agree. A lot of experts will agree with you now, because we are going through this catharsis over misdiagnosis of ADHD. Suddenly everyone agrees we are misdiagnosing too many children. All the news stories lately espousing that 1.1 million were misdiagnosed and mislabeled as ADHD. Those are just eye opening. You see more and more content on the internet about gifted children now who have been mistaken for ADHD. There are so many kids that like you have an insatiable drive, are able to multi-task, are able to hyper focus, are able to create and do more in a shorter period that have been mislabeled. It is pitiful. I see more and more of these children in the office every week.
Anne: Dr. Barnhill, I have so many questions for you, and our callers have questions, but I would like to bring something up that has been just sticking in my craw ever since I researched it. My numbers are old and you I’m sure have better numbers and can speak to this more knowledgably certainly that I. We have a son; my son is 12.5 right now. We always knew that we were going to homeschool. In part it was because we always knew he was very bright as a boy. We knew he would get bored to tears very quickly in the traditional public school setting. We knew he would act up and he would get labeled. They would want to medicate him. We just knew that the odds of that were very great. As we were making these decisions, I did some research. At that time, this was several years ago, what I found absolutely horrified me. What I found was that at that time in the United States across all states in the public school system 17% of elementary school children had been diagnosed with ADHD and were medicated. Of those children, 80% of them were boys. Can you talk to that a little bit? I don’t know if you have more current numbers, but I was shocked and horrified.
Dr. Barnhill: Well, your numbers, of course date back a few years. Currently, it depends on which resource you use. We believe as few as 6 million and as many as 9.5 million children in the United States alone have been diagnosed as ADHD. Of those the Centers for Disease Control estimates currently at the end of 2009 that 70% are receiving medication for ADHD. That means between 6 and 7 million children are getting drugs every day for ADHD. It is unreal, the number of children that are being treated for ADHD with drugs.
Anne: In you expert opinion based on your practice and the research that you’ve done of that, oh my gosh I just have to say that is a disgusting, astonishing number, of those 9.5 million children labeled ADHD, 70% of whom are on medication in the United States, what percentage in your experience truly have ADHD? And need or would respond to medication?
Dr. Barnhill: Approximately 25% have been misdiagnosed as ADHD. In other words, 75% of that number probably were ADHD or have what I call incomplete ADHD symptoms, which means that they don’t have the disability associated with ADHD. Of those, probably half don’t need medication.
Dr. Barnhill: We have as many, one of the authors from North Carolina State that produced those numbers, about 1.1 million children being misdiagnosed last year, we had a discussion a couple of weeks ago. He agreed with me. The current number is more like 2.5 million children have been misdiagnosed in 2009 as ADHD. Of those, 70% of those unfortunately are on ADHD drugs that they really don’t need to be on. They are being treated for diseases that are not ADHD. I try to emphasize with parents that until you know what disease is actually causing your child’s behavior or misbehavior, you can’t really adequately treat it.
Dr. Barnhill: A lot of these children are evaluated in really quick office visits by doctors. Sometimes the moms tell me the office visits last as little as 15 to 20 minutes. The doctor basically gives a quick thorough workup that culminates in the child being tried on the medication. One of the fallacies that we have in the medical profession about ADHD is that if you start a child on ADHD medications and he or she gets better, her behavior gets better or his attention span gets better or his hyperactivity gets better, than that means it’s ADHD. Nothing could be further from the truth. Just because a child responds to ADHD medication doesn’t mean they are ADHD.
Anne: You know, I have so much more to bring up with you, first let me say that the name of Dr. Barnhill’s book is “Mistaken for ADHD: How You Can Prevent Mislabeling Your Child as a Failure in Life in the Face of a Looming ADHD Misdiagnosis Crisis” but really all you need to do to plug in at Amazon, is plug in mistaken for ADHD. If you have a question or a comment or a story to share, please give us a call on our hotline at 866-Monday6. Again, that is 866-Monday6. You can all in from anywhere in North America on that line. If you are outside of North America, you can call us at 3478573122. Or, you can drop us a comment by e-mail at [email protected], or Tweet us @mondayradio. Now, before we go any further, Dr. Barnhill, we actually have someone on the line who says that she almost died from a misdiagnosis. So, let’s bring her on the line now, because that is right what we are talking about, if I can get her. Come on. Martha, are you there? Hi. Welcome to Monday Night Radio with Anne and Dr. Barnhill.
Caller #1: Hi. Thank you for having me. I am very lucky to be here.
Anne: It sounds like it. What is your story?
Caller #1: Well I was diagnosed with ADHD. I initially went to a psychiatrist. It was my junior year of college. I went to Emory University. It was a top 20 school. It was really when they just started diagnosing more ADHD. My father had been diagnosed earlier in the year with pancreatic cancer, and I started to have difficulty concentrating and remaining in the rigorous curriculum of my university. I went to a psychiatrist and she started to treat me. She was also a counselor. She began to treat me for depression, and then wanted to see if I was in fact ADHD. They diagnosed me as ADHD and the medication that they put me on, adderall wound up causing a hidden arrhythmia to present itself while I was running on a treadmill a year and a half later. I actually died and had to be defibrillated back to life. They think that the arrhythmia was triggered by the medication and the dosage that was administered.
Anne: That is quite a story. Dr. Barnhill, what do you make of that?
Dr. Barnhill: That is an accurate analysis of what can happen with that medication. In fact, approximately the FDA issued what we call a black box warning about the stimulants that are used to treat ADHD. This black box warning essentially said all ADHD stimulants can cause cardiac arrhythmias, can cause an irregular heartbeat, and can cause palpitations. This is especially true in people who have preexisting heart disease, whether it is a bad valve or an irregular heart beat in the past. There have been 5 documented deaths related to the use of ADHD stimulants and irregular heartbeat. Those have occurred mostly in teenagers. That is a very accurate story. It is almost classic for what happens when a person has a hypersensitivity reaction to the medications. It’s very interesting.
Caller #1: One thing that I had going on…What they found so unusual was really that by all other accounts, and I’m not sure, Dr., if this is something that you would be able to answer or if it is more for my cardiologist because they never really were able to provide any advice afterwards, and I have to say that I have had tons of support especially from the American Heart Association on dealing with the repercussions of something like this. They never really said…I had to actually have…They had to shock me back into a rhythm for my heart to go in that particular, it never would have pronounced itself without the medication. Does that make sense? It wasn’t arrhythmia that you could see normally. They had to do an EP study.
Dr. Barnhill: Right. The workup for that type of cardiac problem needs to include what is called mapping of the pathways, the electrical pathways inside the heart. That is a very specialized type of cardiology. Those doctors, I know in our area there are only 5 servicing probably 2 million people. That is a very, very specialized cardiology consultant. You may wish to find one of those.
Caller #1: I already had one that I had to see. But, continuing with the diagnosis to ask you so many years later. I’ve been really successful. I’m a publicist, so I do a lot of different things at once and have not had a problem with it without any kind of medication.
Anne: It sounds like they were fixing something that wasn’t a problem.
Caller #1: It really felt that way and I was wondering if you found in your experience in diagnosis of patients later say in their 20s. Do you ever see that where someone has something that is really traumatic in their life and they can’t concentrate that that diagnosis, if that’s common if depression and ADHD are ever confused?
Anne: We are going to let Dr. Barnhill answer that, and, Martha, I am going to thank you for the call very much. Dr., is that something that you see that people have some other stress that causes them to have a hard time focusing? That’s something that is very well known that a large stress as in this last callers case she had the situation with her father and then it looks like ADHD but gosh shouldn’t the medical community or the psychiatric community realize that when you have a big shock in your life that makes it difficult to focus? That’s not a great time to be looking at something as ADHD is it?
Dr. Barnhill: No it’s not. One of the things that we emphasize when I give lectures to doctors is first make sure that whatever you are going to utilize is not going to cause the person to use the edge that they have in life. We all have the ability to a certain extent to handle major changes in our life. Major stressors in our life, and if you overmedicate a person you take away their ability to deal with that stress. Unfortunately the stimulants used in ADHD do that. If a person truly is not ADHD and you place them on a stimulant what you are doing is slowing them down. You’re slowing their thought processing down. They are no longer able to handle the stress they were dealing with. I suspect that what happened here is situational depression, anxiety, handling the grief of a sick father, handling the loss of control, and suddenly being placed on medication for ADHD which slowed all of those skills down, all of those techniques for coping precipitated an event. Part of the event was the arrhythmia directly related to the medication. Of course once you are no longer on the medication you are able to better cope with all of the problems that are occurring.
Anne: So, ironically in that case they created more of a problem than had already existed. You are listening to Monday Night Radio. Our guest is Dr. Frank Barnhill. He has written a book called “Mistaken for ADHD” and we are talking among other things about misdiagnosis of ADHD. Dr. Barnhill, before I go on let me just tell everyone that they can call in and talk with you or ask you a question or tell you a story. Call 866-Monday6. That’s our toll free number from anywhere in North America, 866-Monday6. If you are outside of North America you can still call and talk with Dr. Barnhill at 3478573122. If you don’t want to call you can send us an e-mail and we will relay it to the good doctor at [email protected] Tweet us @mondayradio. Dr. Barnhill, one of the things that you say in your book, it’s towards the beginning and this goes back to my own research and decision to homeschool, etc. You say of the teaching styles in schools, simply telling children what to learn and then blaming them when they don’t understand something is how kids get labeled so easily. You go on to talk about learning styles. If I may, just a little quote from the book, you are talking about yourself as a child and your father kind of finally getting that you were a very hands-on learner, that you are really what we call a tactile learner. You said that you think your father finally realized that, “I needed to have my hands on things I was expected to learn. I needed not only to see them, but to feel them, to touch them and mentally absorb their substance.” You go on to say we now recognize those visual tactile skills as being essential to a child’s ability to learn and store the memory of what he or she has just learned, and yet that really is still not what goes on in many, many schools. So, what I would like to ask you to talk about that a little bit. I know we have some callers that want to talk about the learning style connection. I’d also like to start that off with a question. I myself, my style of learning and the way that I went through college and law school was by writing my notes. The very act of sitting in a lecture and committing to paper, the process of putting pencil to paper and moving my hand and writing those notes, I usually didn’t ever have to study from the notes again. That very act of committing what I needed to know to paper and writing notes is what really made it possible for me to retain what I needed to retain. I’m wondering if you think that that very act in and of it is one of those sorts of hands-on mechanisms.
Dr. Barnhill: That’s truly a hands-on mechanism. It’s one that I used in medical school. Most medical school students subscribe to what is called a transcription service, but I took long hand notes all the way through medical school and rarely had to look at them again. It’s called concrete ideation. In other words, you are making your memory permanent by taking an active part physically in storing the memory. It’s the same thing as a child in a classroom being handed a toy boat and then explained what a boat is and teach the child how to spell the word boat. The child’s memory becomes concrete based on touching the boat and simultaneously learning what a boat is and how to spell the word boat. The problem that we see in school children now is our society wants to place them in what I call the cookie cutter mold. It’s easier to teach 30 children in a classroom if all the kids advance at the same rate, are learning the same lesson, are able to sit still and pay attention, and develop the same social skills, and have the same testing skills. We have failed to recognize in most cases that each child has his or her own individual skill set. They all have a different capacity for learning. That includes different capacities for what they hear, see, feel, touch, scent, even smell, because a child learns based on the seven senses. Those senses allow the child to input, to take in information, then process the information, which basically means figure out what is going on, and then store that information for future use or immediate use. They decide what to do with the information after it is processed. Not every child can process information as rapidly as another, and they don’t certainly process it in the same manner. To give you an example, I had a child that we evaluated for ADHD several months ago based strictly on the teacher stating that every time the child took a test, he wanted to stand up by his desk and tap his foot. After he tapped his foot for 2 or 3 minutes he could sit down and answer 2 or 3 questions, and he would stand back up, tap his foot again for 2 or 3 minutes. This went on and on until she called the mom and said, “Your son is obviously ADHD. He’s disrupting the class when he takes exams. I can’t put up with this. You have got to do something immediately.” Of course he is 8 years old. We took a look at the child. He clearly wasn’t ADHD. He has a learning skill set that is different from every other child. After speaking with his teacher about it I explained that if she would allow him to take his exams standing all the time, he didn’t have to sit down after he tapped his foot, he could improve his grades dramatically. Of course that is what happened. He would stand at a higher desk and constantly tap his foot while he took his exam. She made arrangements for him to do that out of the visual field of the other children so it didn’t disrupt the class. His grades went up. We were able to keep him off of ADHD medications.
Anne: That is such a perfect example. What it brings to mind for me is when are we going to stop labeling children who have different learning styles at all? Because, there are probably as many learning styles in a given classroom as there are children. Let’s go to Christine on the line. She is calling from San Diego, and she very much wanted to talk about learning styles and ADD. First just let me remind our other listeners that you too can call in to talk with Dr. Barnhill. The number to call in is 866-Monday6. If you are outside of North America call us at 3478573122. Christine, are you there?
Caller #2: I am here.
Anne: Thank you for waiting so very patiently.
Caller #2: My pleasure. I’ve been enjoying listening. I’m so glad that you are talking about this. This is such an important subject. I see it everyday, how the kids suffer in the schools from this very, very thing that you are talking about. I wanted to ask Dr. Barnhill, did you ever do any research into the connection between food allergies and ADHD and ADD?
Dr. Barnhill: Yes. While researching for mistaken ADHD went through all the current literature associated with food dyes, specific food allergies and excessive intake of sugar, sugar byproducts, and artificial sweeteners. Pretty much covered the entire gambit; the problem that I found in the research is that there really are no good research studies that support any specific food, artificial sweetener, or chemical, or whatever for causation of ADHD symptoms. That’s not to say that it doesn’t occur. What I tell parents about food and other chemicals, especially preservatives, red dye, yellow dye, all of the dyes is every child’s metabolism is different. If your child becomes hyper, inattentive, impulsive, can’t focus, unruly, develops a behavior problem and you notice this when he or she eats a specific food or is exposed to a specific food’s coloring, a dye or a chemical, then your child may just be reacting to that chemical. You should withhold that chemical or that food from their diet. As far back as 27 years ago, I had a little boy in the practice, 6 years old, and every time that child had candy that had red dye #5 in it or any type of soft drink, any type of food that was red, orange, pink he became terrible. His behavior was horrible. We basically put him on a red dye free diet for 3 months. His behavior improved. Now, would I be willing to say that that child developed ADHD as a result of red dye #5? No. What I would say is red dye #5 caused that child to have a behavior disorder that looked a lot like ADHD. We probably “cured” the child’s ADHD by restricting his red dye intake.
Caller #2: Yes. I would bet money that a lot of teachers see these behaviors and just turn right around and tell the parents the kids are ADD. I’ve actually seen a report done by a school psychologist that said in the report that the child showed all of the symptoms of it and they weren’t going to do anything for the child until the parents took him to the doctor and got him on drugs. That to me goes totally against the whole point of the IEP, which is to support the child in learning at the school. It’s appalling to me what is going on in the schools. I am so glad you are talking about this.
Anne: Christine, may I ask you a question? What is your relationship to this? Do you work in the school system, or are you a concerned parent?
Caller #2: I’ve been a professional tutor working with learning disabled kids for 20 years. I think in that time I’ve actually only seen 2 kids that I would say were actually ADHD. They were unmistakably crazy. Although, judging by what they ate, I would say that there food had a lot to do with it. All I ever saw them eating was sugar. But, most of the time, what I see is I get a kid who is a kinesthetic learner, who needs actually needs to physically move around in order to be able to process the information. The teachers are screaming at the parents to drug them, and a lot of parents thankfully won’t. Or, they at least will seek someone who knows something about it and say, “What do you think?” It’s pretty easy to tell if someone is kinesthetic or ADHD. Here’s what I always ask them, “If you are playing a video game, how long can you sit there and play a video game?” They’ll say, “Oh hours. I focus on it.” Doesn’t that kind of go against the definition of what ADD is supposed to be, which is a lack of being able to focus? So, I always say we are probably dealing with a kinesthetic learner. Then I approach them in the tutoring sessions that way, and all of the sudden they start learning.
Anne: Well that’s wonderful that they have you.
Caller #2: Yeah.
Anne: Christine, thank you so very much for the call. I just want to commend to you and the listeners out there. You brought this to mind, I don’t know if you are familiar with the TED talks, but there is one in particular, and you can find it on the TED website, which is ted.com. If you search for Ken Robinson, Sir Ken Robinson has a wonderful talk about this very thing. He talks about a child that he saw that was being told that she had some sort of, I don’t know if they were diagnosing it as ADHD, but she was just this problem child because she would just dance around all of the time. It’s just a wonderful story. So, I would commend that to you. Dr. Barnhill, I would like to talk a bit before we run out of time about those so called zebras. The diseases that kind of can hide in the grass looking like ADHD, but are in fact other diseases and I’m sure these lead to many of the misdiagnoses. Let me just remind everyone to call in at 866-Monday6. That’s 866-Monday6 if you are in North America. If you are outside of North America, give us a call at 3478573122. You can e-mail your questions and comments to [email protected] Or, tweet us @mondayradio. So, Dr. Barnhill, the one thing before this which just goes to again the schools and what Christine was saying. You have a line in your book where you say as more children in the school district are diagnosed with ADHD more and more federal funds are allocated for the education of those children. That’s a pretty straightforward, common sense thing to say, but also it is pretty damning. Because, you have to imagine that the teachers who are trying to deal with these children who have these different learning styles are well aware that if they can get a diagnosis they can get more funding. It could be altruistic. They’re thinking, “Ok, well more funding means we can help these kids.” But, that is a little bit like the tail wagging the dog, don’t you think?
Dr. Barnhill: Oh, that’s true. Unfortunately, there have been a lot of research programs both in Australia and in Canada to deal with this. In fact, the Australian Royal Medicine Society issued a statement a little over a year ago that America was experiencing an epidemic of ADHD diagnosis based on funding for federal programs through the school system. Australia would like to avoid doing the same. There have been a couple of articles in the Canadian medical literature to the same effect in the last 6 months. While what you say is true, it is sort of a double edged sword. If you need more funds for IEPs and for teachers, then you have to diagnose more ADHD and more learning disability and more behavioral problems. If you need to improve what you already have, then of course you’ve got to get more money from somewhere. It creates a conundrum. It creates a problem, such that children actually may be driven toward the diagnosis of ADHD based on perceived need.
Anne: Now, let’s talk about what might be assuming there is anything wrong with these children, and again I certainly don’t consider a learning style to be anything other than just that, a learning style and not something wrong. You have in your book 10 different possible precipitants if you will that could lead to symptoms that appear to be ADHD. These are to be as I understand the underlying things that can present to cause someone to be misdiagnosed as ADHD. Some of them are diseases. Some of them are environmental factors. Some of them are social and behavioral issues. So, would you be willing to just sort of go down that list of ten and speak a little tiny bit about each one?
Dr. Barnhill: Sure. Let’s cover the list based on the type of disease. One of my favorites is thyroid disease. I see this a lot, especially in little girls. Little girls come in misdiagnosed as ADHD inattentive type. They can’t pay attention. They daydream in class. They end up having low thyroid hormones. The thyroids just quit working. Once their thyroid hormone is replaced through supplements, their ADHD symptoms just go away. Their inattentiveness is gone. You can have hyperthyroidism, which is too much thyroid hormone. You see this in little boys. Usually they are very impulsive. They are wound up. They can’t sit still. Their thyroid is in overdrive. So, they end up being hyper of course. Once you take care of their thyroid problem, they slow down and they go back more towards what you would consider the activity of a normal child. You have problems such as lead poisoning, which is very obvious in the United States that was primarily eating paint at one time, now unfortunately it is primarily from children living near landfills and toxic spills that were covered up. The lead leaches through the ground into their play area. We still see some lead poisoning in children who live in the older homes that were renovated and the paint had been stripped off, but the dust containing the lead had not been cleaned out of the carpet or the floor or the wood joints in the floor. They inhale the dust and they become lead toxic. Children who have low iron levels, anemia, meaning low blood, they are very tired. They are inattentive. They fall asleep at their desk. The teacher thinks they have the inattentive type of ADHD because they can’t focus. If you spend 4 dollars a month on iron supplements for these children, they get better really rapidly as their hemoglobin goes up. Then, you have the new diseases as we call them, called pre-diabetes. These are conditions where children are not quite diabetic but they are one step away from being diabetic and they suffer surges in their blood sugar. It is sort of like the young lady was talking earlier when she called in about kids who had learning disabilities and they were on sugar all the time. Well, sugar loaded children a lot of times are pre-diabetic. They will eat a lot of sugar. Their blood sugar, blood glucose will go very high. They become hyperactive as a result. It’s hard to get them to focus and to study. 3 or 4 hours later when they haven’t consumed any sugar, their blood sugar drops back down into the normal range, and guess what? Their behavior improves. Pre-diabetes is a cause of mistaken ADHD. Diabetes of course can be a cause because of the same reasons, blood sugar fluctuating. You can have a multitude of problems that involve the adrenal glands. Those are the glands that sit on top of the kidneys and supply adrenaline, the chemical that gives us that rush when we need to respond to danger and frustration. Children who have adrenal dysfunction are hyper. They are wound up. They are hard to contain. Once their adrenal problems are treated, then their hyperactivity goes away and they are able to focus. We see a lot of children who have a lot of what we call disordered sleep. It’s one of my favorites. A little boy named Benji, ten years old. The child came in on 3 ADHD medications. Mom had the classic history. I know everyone has heard this. You’ve got to do something. I can’t take it anymore. He keeps bringing home bad report cards. He’s failing. His teacher told me if he doesn’t get better, if things don’t get better he is going to fail this year and it is already January. Well, Benji wasn’t ADHD. Benji stood 4 foot 9 inches tall and weighed 222 pounds.
Anne: Oh, my god.
Dr. Barnhill: He was only 10 years old. Benji had obstructive sleep apnea. He was not breathing well at night. His oxygen level was dropping very low. You know when you don’t sleep well at night, and you come close to waking up as many as 20 and 30 times an hour, then you are so tired the next day you can’t concentrate. You can’t focus. We cured Benji. He lost 65 pounds in one year using a combination of diet medication and exercise. Within 6 months of the second year his sleep apnea had improved to the point that he didn’t need therapy. Of course he had no ADHD symptoms at that point either, just a simple cure with weight loss and taking care of his breathing problem. Isn’t that awesome? The human body is so adaptable. This change in weight made a difference.
Anne: That’s pretty amazing. We have another caller on the line with a question. Is this a good time? I know you have some other things that can lead to these symptoms. We’ve only got about 10 minutes left and I do want to get to this caller. So, can you remember what you haven’t told us about yet?
Dr. Barnhill: Oh, yeah.
Anne: That’d be great. Again, listeners you can call in at 866-Monday6. Now let’s go to Gabe in Chicago. Gabe, are you there?
Caller #3: Yeah, I’m here.
Anne: You have been so patient, Gabe. Thank you so much. Do you have a question for Dr. Barnhill?
Caller #3: Yeah I do. You’ve been talking a lot about how ADHD drugs are overprescribed. I was just wondering what you think is kind of behind that. Do you think it might have something to do with fee for service payment system that we have? A lot of practices and hospitals in this country, because I know that has been related to a lot of people to healthcare overutilization in other areas. What other factors do you think might be causing too many prescriptions of ADHD drugs?
Dr. Barnhill: Oh, wow. Good question. Difficult answer.
Anne: Excuse me just a minute. Gabe, do you have your speaker on?
Caller #3: Yeah, I do.
Anne: Could you mute it please?
Caller #3: Yeah, hold on one second.
Anne: Thank you. Alright, sorry about that, go ahead, Dr. Barnhill.
Dr. Barnhill: Great. That’s a really good question. It requires a multi-pronged answer though. There are several things that drive the use of ADHD medications. Number 1 is pharmaceutical companies have done a really, really great job of educating doctors and the general public about the use of ADHD medications. Number 2 it is very easy to start a child on ADHD medication. Those stimulants are easy to write. Parents come in. They are about to pull their last gray hair out because their child’s behavior is terrible. They are failing in school. They want to do something. They want a quick fix. They want the fix to be today. Actually, they want it yesterday, but they will settle for today. They want the medicine started, because they know the kid next door is on it. There’s a kid down the street on it. They’ve heard how once the medicine was started the child’s grades went up. The behavior got better, so they want the fix. They want it then. That drives the use of ADHD medications. It is a quick fix. It’s trite. What parents want is they want their child to live a normal life. They want their family to live a normal life. They want their life back. Their life has been taken away. Nothing is normal when you live with a child that has been labeled as ADHD. That child and the family suffer discrimination. They suffer bias. I’ve had one family in the last 3 years that ended up in divorce because their child was misdiagnosed as ADHD.
Caller #3: Oh, wow.
Dr. Barnhill: So, those are the things. It’s tough, really tough.
Caller #3: So, you think it’s more of a desire on the parents’ part to kind of want a quick fix or like a magic bullet for their kids’ problems. So, it’s sort of like a wider societal issue that is driving this. Is that right?
Dr. Barnhill: It’s not just the parents. I blame everybody equally. I know doctors who want the quick fix for the child too. When I’ve given many courses on ADHD, and doctors would say, “Look I’ve got this kid in the office a few weeks ago who was clearly ADHD. He was into all of my cabinets. He turned over the trash cans. I couldn’t get a word in edgewise. I felt so sorry for the woman. I just thought I’m going to put this kid on something today, because this kid is driving her nuts and I can see how he’s driving her nuts.” My argument there is that that doctor is responding just like the school teacher and just like the parent. As we discussed earlier, everyone needs to take a step back and slow down and go, ok this may really not be ADHD. This could be something else. If we don’t know what it is and we try to treat it, we may really harm this child. We may cause physical harm, sort of like the lady with the adderall and the cardiac arrhythmia. We may cause emotional harm. We may cause this child to fail academically. We may affect this child’s ability to socialize with friends. We may affect this child’s ability to grow into an adult who is capable of keeping a job and falling in love and getting married and having children. So, we need to slow down a little. We need to take a couple of steps back. Look at the child’s behavior. It’s sort of like the child we were talking about earlier who could only take exams effectively while he was standing at the desk tapping his foot. I don’t see anything wrong with that. I think that we should accommodate children. Kinesthetic learners for example have to touch things or have some type of over-stimulation, some type of sensory stimulation in order to learn accurately and adequately. We should accommodate those. The rest of the kids in the class would probably get a kick out of everyone passing a toy around to learn how to spell the word associated with the toy.
Anne: Gabe, thank you so much for the call. That was a really interesting question. One thing I wanted to throw out there, Dr., and you can bear me out here is also the detail people who visit you doctors. They give you pre-printed prescription pads. They make it so easy for you to reach for that pad, write the patient’s name on it, check off a dosage, and there you have it. I blame not the detail people, but I kind of blame the pharmaceutical companies a little bit. We are in one of the only countries if not the only country in the world where you can turn on the television and be told by the pharmaceutical company to go tell your doctor to give you the purple pill. I blame them a little bit. Dr., we have only 4 minutes left. So, I know we are not going to get to all of those other things that can be masked as ADHD. People are just going to have to go to Amazon. Do it now, and get Dr. Barnhill’s book. It is called “Mistaken for ADHD”. Some of the things that he wasn’t able to get to that may look like ADHD are diseases of the pancreas, neurological problems, and mild autism spectrum disorders. We mentioned food and drug ingestion, although not in this particular part of the show, social and behavioral issues. Dr., you have just a couple of minutes left, and I’m sure it’s not enough time to cover this, but if you could just talk for a moment to this. You have a couple of chapters about diagnosing ADHD the wrong way and diagnosing it the right way. Can you just very quickly elaborate on what the wrong way is for people out there so if they run into it they will know to run the other way?
Dr. Barnhill: That’s one of my pet peeves, and yes I’d love to talk about it. In “Mistaken for ADHD”, the chapter that deals with diagnosing ADHD the wrong way is targeted specifically at parents. Parents need to become strong advocates in their child’s healthcare. If you walk into a doctor’s office, asking for your child to be evaluated for ADHD and that doctor gives you an ADHD diagnosis: Number 1 without talking to the child; Number 2 without doing any type of blood work; and Number 3 in less than 3 office visits. You are in trouble. You cannot accurately diagnose it without those elements. There is no way.
Anne: Those are great rules of thumb. So, number 1 they should talk to the child. Number 2 they should do blood work. Number 3 they should have had at least 3 office visits before medicating your child for ADHD. Dr., we have one last question from the chat room. I’m going to just throw it out there really quickly. Hopefully it can be a fairly simple answer, because I definitely want to get to this. She asks, “Our neuropsychologist claims that ADHD is on the same spectrum as autism. Do you agree with that, Dr.?”
Dr. Barnhill: Hmm. That is a good question too. Both are probably neurodevelopmental disorders. That is true. With neurodevelopmental disorders you have processing input deficiencies. In other words sensory processing does not occur accurately. With all of the new research in ADHD indicating that it is neurodevelopmental and genetic, there is a high probability they are in the same spectrum. That spectrum probably includes Asperger’s syndrome where it is almost a joke in the medical field now. Asperger’s syndrome is going to be the next ADHD epidemic. That’s where we are headed.
Anne: Dr., thank you so much for joining us. This has been so interesting, so enlightening. Dr. Frank Barnhill, his book is “Mistaken for ADHD”. You can get it on Amazon. I highly recommend that you do. It is a very interesting read. Dr. Barnhill, will you come back?
Dr. Barnhill: Oh, I’d be more than glad to come back. Anyone who did not get an opportunity to ask their question, if you will go to my website, adhdbehavior.com you can e-mail me any time you want to and ask a question. You can follow our current threads on my blog mistakenforADHD.com. You can e-mail me from the blog too. I’ll be more than happy to answer questions. I’d love to come back. Just ask me.
Anne: Thank you, Dr. Thank you so much.