Ten days ago an article appeared on Medscape that announced that a test had been approved by the FDA that would
“help diagnose ADHD...” The FDA approved it on the basis of a 275 subject study of children from ages 6 to 17. The diagnostic finding used to confirm the ADHD was the ratio of theta and beta brain waves in an electro-encephalogram that could be done in 15minutes. Evidently children labeled with ADHD are reported to have a different ratio than the general population.
You can find the research paper that the company released on the day of the approval by going to http://www.nebahealth.com/results.htm
The FDA and the company involved state that the use of this EEG measurement will make the single clinician more accurate to the tune of 88% versus 60 percent of the time. Now this accuracy is judged against what a multidisciplinary team of individuals would say about the patient. That means the test is 88% as accurate as several clinicians getting together and giving us their opinion. So, we still do not have an accurate test that can make the diagnosis most every time in everyone who has it. That is true because to this date no one has defined the pathology that is supposed to cause ADHD.
Now, the test itself may be valuable in that the company says it can reduce by 34% the number of individuals who are
wrongly diagnosed as having ADHD. If it does, that will be a blessing to those who have struggles but do not need the added burden of the side effects of the ADHD medications. But, there is one more benefit that could be derived from a test like this.
The test may be telling us that children who appear to have ADHD symptoms are different but not necessarily ill. And,
that difference may result in their having difficulty in fitting into routine classroom learning situations. The test cannot tell us that the difference we see in these children is a disease. As one mother told me, the most important decision she made in helping her son who struggled with hyperactivity was when she said, “My son is not broken, and I do not have to fix him.”
The best conclusion we may be able to draw from the study is that these children are different and they need a different approach to education. In my blog on 7/11/2013, I reviewed research that showed that children who take medication for ADHD do not appear to see much improvement in their grades. With both these studies in hand, what we ought to be doing is changing the education setting to one in which these children can learn. And, it will not likely be the traditional “25 student sit at your desk and quietly learn” classroom.
I am riding along with my son in law and grandson most of the way to Disneyworld. It has been an eventful journey with a blown head gasket, an unexpected night in the Hilton Garden Inn, and a long daytime drive for which we had not planned. There have been wrecks on the interstate, long waits in traffic and lots of opportunities to grumble. And, day one of our vacation isn't even over yet. I keep telling my dear wife Helen, who is in the other car with six small grandchildren that life is an adventure...:-)
It would be easy enough to start complaining. It requires little training and only a small amount of self worship to do it. But, I have been distracted down here in the south by the shear unadulterated graciousness of the people of Georgia. At midnight we were marooned with a broken Honda Odyssey standing in the parking lot of a closed Honda dealership weighing our options. Hotel number 1 was full, but the Hilton had 2 rooms. And, so we camped out for the short night waiting to drag the Honda to repair. In the morning the night manager graciously gave us passes for breakfast with a smile. The waiter served us with the same kind of grace. It was almost as if God was daring us to be grumpy.
At the Honda dealership, the technicians were kind and told us they would need an hour to diagnose the problem. We sat in the waiting room with several other customers who just seemed intent on being pleasant while they talked with us and others instead of sitting in stony silence acting like there was no one else in the room. It just seemed like
people were just friendlier. The Honda dealer had bad news, but he smiled and said “would you like to talk to Enterprise?” Within 15minutes there was a supersized SUV in the parking lot with a smiling rental agent in a
suit and tie and within the hour we were back on the road.
I travel a fair amount these days and I can tell you that there are considerable differences in the way people act around our nation. I will not impugn anyone's region, but I will say, I would rather be smiled at, talked to kindly, and
treated with the grace I received from those dear people in Georgia. I mentioned this to a friend who told me that it was all a veneer, and that just below their skin, these southerners were just as graceless as we are. I disagree, but even if it were true, I vote for the gracious veneer.
Good manners and kindness have been and will remain two of the things that separate us from savagery. I do not pretend to know the motives of the folks who were kind to us today, but I suspect it is mostly due to the fact that their mothers and grandmothers raised them well. And we need more of that kind of behavior. It could also be true that many of those kind people I met were simply acting on the truth of scripture. Paul told us to “Let all bitterness and wrath and anger and clamor and slander be put away from you, along with all malice. Be kind to one another, tender-hearted, forgiving each other, just as God in Christ also has forgiven you. (Eph 4:31-1 NAU) Yes, our nation needs more of this!
This week there have been unhappy mobs breaking windows, robbing stores, and beating innocent passersby. Before the weekend is over at least 10 people will have been shot on the south side of Chicago and several will die.
Somehow I think there is a connection here. Maybe the whole mess that we are facing today could be helped, not fixed, but helped if we all choose the veneer. Or it could even be better if we chose to live like the Bible says and
treat each with kindness, gentleness and love.
And, once again thank you to the kind people in Georgia!
When I was growing up in the sixties one of my favorite radio commentators was Paul Harvey. He just had a way of saying things that made real sense in a time when it seemed like everyone was rebelling against authority by burning their draft cards or their bras. It was the beginning of the era of sex, drugs and rock & roll and people seemed intent on living out the motto "if it feels good do it!" Well, there was a price then and there is still a price now to be paid for indulging ourselves. Harvey said it best, "Life has a way of overcharging a fella for overindulgence." Well, in the past
week science has produced the research to prove his point.
We generally assume today that cigarette smoking and heavy drinking must be bad for us. In an article published in the British Journal of Psychiatry titled "Combined impact of smoking and heavy alcohol use on cognitive decline in early old age..."[i]
, the authors Gareth Hagger-Johnson et.al
, have determined that our ability to think is savaged by the combination of heavy alcohol use and smoking. They measured the decline in the ability of adults to think over a 10 year period and the results were startling. People who smoked 20 cigarettes a day and drank the equivalent of 14 English pints (20ounces!) of beer per week saw their cognitive ability drop 36% faster when compared to people who did not smoke and who only drank moderately. That means the smoking/ heavy drinkers had lost considerably more of the thing we hold most dear as adults; the ability to think.
Dementia is no laughing matter in this country or in Britain. You only need to talk with a friend or relative who faces the struggle of what to do with loved ones who no longer have the capacity to care for themselves to understand the heartache it brings. So, why in the world would we want to do something to ourselves that could make this to worse?
Biblical counseling has something to say about this issue. Of course the problem is choosing habits that are self destructive. Drunkenness is defined in scripture as sin. Paul said “And do not get drunk with wine, for that is dissipation, but be filled with the Spirit, (Eph 5:18 NASB). It is hard to avoid the plain words to the Ephesians and to us. Paul admonished the Corinthians that they were (and we are) the temple of God and that they should take care not to destroy the temple. (1Corinthians 3:16:17) Clearly believers should avoid habits that are known to harm their bodies.
I have now lived through two generations. I grew up in a church where we did not drink alcohol, play cards, go to movies and if we lived north of the Ohio River we did not smoke. And, naively, I suppose we thought no one was indulging. I have watched over the past 40 years as churches have accommodated themselves to many of these habits. I would say it is just as naive now to assume that counselees who come to counseling with many kinds of
struggles are not drinking alcohol to excess, smoking, and using other legal and illegal drugs. The only way we can help them is to ask them as we gather the history how much they drink and how much they smoke.
Medical science is telling once again that smoking and drinking alcohol to excess is really bad not only for our health, but bad for our brains! And, it is our job to ask and then offer biblical encouragement to help those who are
struggling with alcohol and nicotine to quit, grow and change. [i] http://bjp.rcpsych.org/content/early/2013/06/21/bjp.bp.112.122960.abstract
British Journal of Psychiatry, “Combined Impact of smoking and heavy alcohol use on cognitive decline in early old age: Whitehall II prospective cohort study.” Gareth Hagger-Johnson et.al.
ADHD, Amphetamines, and School Performance
I have consistently taught that taking medicine is a Romans 14 issue of Christian Liberty. I have also taught students that the question should not be “is taking this medicine right or wrong?” The question should be does the medicine actually work and are the benefits worth the side effects. Well in the case of ADHD and amphetamines, we now have some research that helps answer the question.
ADHD is an educationally driven phenomenon. The primary rationale for using amphetamine derivative medications is that it will improve the mental focus of the child allowing them to receive instruction and learn. The medicines used are also supposed to reduce “hyperactive” behavior that disrupts classrooms. In theory it would make sense that if the child could sit still and pay attention without having to be constantly corralled by the teacher he or she might learn more.
Research made available by the National Bureau of Economic Research[i]
and commented on in the Wall Street
, would indicate otherwise. While teachers and parents may perceive their children are doing better a long term study would indicate that there is little to no educational benefit from treating boys and girls with medications such as amphetamine derivatives Ritalin and Adderall.
The basis for the research was a long term study in Quebec that looked at the outcomes of a pharmacy insurance program on the prescribing of stimulant medication and the effect of the medicine on the children who took it. Several things were noted in the study that run counter to current wisdom in the arena of ADHD. Instead of seeing an improvement in outcomes among the children treated, the children seemed to struggle in several areas.
Instead of having improved learning, there was “short term deterioration in academic outcomes among both boys and girls.” Boys were more likely to drop out of school and girls were more likely to be diagnosed with a mental disorder such as anxiety or depression. One of the conclusions that the study arrived at was that perhaps the medication was becoming a “substitute for cognitive and behavioral interventions that might be necessary for the child to learn.” In an odd turn, they concluded perhaps the reduction of hyperactive behavior resulted in the child getting less attention of the kind that might help learning.
Research is a great thing. This study was done by economists who probably were wondering if the cost of the medication in dollars was really gaining the benefit hoped for. I think it tells us that there is no good substitute for educating a child in the way that he or she can learn. (My interpretation of Proverbs 22:6) I think it also tells us that in the significant majority of boys and girls there is very little benefit to the medication if measured in educational terms.
Certainly not enough to make it worth the considerable side effect problems. [i]
“Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD?”, Currie et.al.,
Working Paper 19105 http://www.nber.org/papers/w19105
, National Bureau of Economic Research. It will cost
you $5 do download the paper in pdf format. Quotes in the blog come from pages 23-25. [ii] http://online.wsj.com/article/SB10001424127887323368704578593660384362292.html?mod=wsj_valetbottom_email
The paper is quoted heavily in the Wall Street Journal “ADHD Drugs Don’t
Boost Kids Grades,” by Shirley Wang. July 8, 2013.
Marijuana and Schizophrenia: How much warning do we need?
I do not intend to ride hobby horses in this blog but there are some subjects that demand attention now and then. The current rising interest in the use of marijuana among those who identify themselves as Christian is one of
them. This past week Dr Samuel Wilkinson, a physician in the department of Psychiatry at the Yale School medicine, wrote an editorial in the Wall Street Journal titled “Pot Smoking And the Schizophrenia Connection.”[i]
In it he states that “medical research shows a clear link between marijuana use and mental illness.” He also said that “it is becoming
clearer that the claim that marijuana is medically harmless is false.”
Wilkinson sited a number of studies in the article beginning with a 2004 study that concluded that marijuana use could be a “causal” agent in schizophrenia. He also quoted a 2007 study that said the risk of developing a psychotic illness such as schizophrenia was increased by 200% in heavy users. Wilkinson also noted that schizophrenia is a terrible burden to those who suffer it with lifelong disability. One third of the homeless in the U.S are thought to be
Knowing these things, I have a really hard time understanding why any believer would think it was a good idea to smoke marijuana. I have been told by some that if the laws of our nation change and marijuana becomes legal to grow and use, then Christians should be able to smoke pot. They invoke the Romans 14 doctrine of Christian liberty and dare anyone to be judgmental.
I think it becomes a simple question of whether or not Christians should knowingly put something in their bodies that can cause them serious harm and is known to be addicting. Paul tells us in his letter to Corinth, “Or do you not know that your body is the temple of the Holy Spirit who is
in you, whom you have from God, and you are not your own? For you were bought at a price; therefore glorify God in your body and in your spirit, which are God's.” (1Co 6:19-20 NKJ)
Our primary purpose in life is not recreation and certainly not recreational drug use particularly when that drug has great potential for harm. In a nation that has decided to make every kind of immoral activity legal, perhaps we should
remember that Paul also said, “All things are lawful for me, but all things are not helpful. All things are lawful for me, but I will not be brought under the power of any.” (1Co 6:12 NKJ) [i]
Wall Street Journal
Editorial, July 1, 2013.
I’ve always said you can protect yourself in life from many things, except grandchildren and viruses. This week I have
been blessed by both with a common cold and for a couple of days I resorted to taking cold pills. Last night I found myself wide awake watching a Star Trek movie I’ve seen several times at 2am. Of course along with the movies come the unavoidable commercials. One that received multiple plays was a bankruptcy attorney who was offering
“infotapes” on how to legally escape paying debts.
I wondered for a moment why you would want to reach an audience at 2am until it dawned on me that people who are struggling financially are likely to worry about it. And, people who worry sometimes complain that they cannot sleep. That all seems straight forward, but this week I saw an article published in “The Journal of Neuroscience,” that examined the connection between sleeplessness and worry. The results were interesting and indicated that worry and sleep problems could be a two way street. It may be just as likely that people who fail to get good restorative sleep will be worriers as it is that worriers cannot sleep.[i]
The study looked at functional Magnetic Resonance Imaging brain scans in subjects who were sleep deprived and who were simply worriers. The results indicated that the same places in the brain, the amygdala and insula, would light up in those who were sleep deprived in the same way as those who struggled with anxiety. It also seemed in the study that people who were prone to worry were we more likely to respond with brain scan changing worry when they had not slept well.
Through the years that I have practiced medicine and have been involved in Biblical counseling, I have noticed that many of those who struggle with anxiety also have lives that are simply oversubscribed. Many of us wish there were 8 days in the week or 30 hours in a day because we have a lot we want or need to do. Most of us just try to cram 8
days into 7 or 30 hours into 24. And, the thing that suffers most often is how much we sleep.
One of the first things I want to know in a counselee who is struggling with worry or a sad depressed mood is how much they are sleeping. If they are sleeping less than 8 hours a night and are enforcing that with an alarm clock, I will assign 8 hours of sleep a night. If they cannot sleep that long even if they allow enough time for it, I will send them to see a physician to sort out the cause.
If it seems appropriate, I will tell the struggler that most of us don’t sleep enough because we do not allow enough time for it. And, until they change their schedule to allow for at least 8 hours, I may not be able to tell them what is causing their worry or their sadness. The good news is that in my experience, people who are sleep deprived and feel bad generally feel better in a few days.
Sometimes strugglers will tell me that they are just too busy to devote 8 hours to sleeping. I tell them what a wise pastor once told me when I was in just that kind of situation. He reminded me of what Jesus said in Matthew 11:28-30. “Come unto me all you who labor and are heavy laden, and I will give you rest…for my yoke my easy and my burden is light.” My pastor friend said that if I was struggling with a heavy burden of a work load, it wasn’t the one that Jesus gave me. And, he was right.
Along with a visit to their physician for a physical and lab work, 8 hours of sleep may be one of the more important
homework assignments we can give those who worry. [i] http://www.jneurosci.org/content/33/26/10607.abstract Tired and Apprehensive: Anxiety Amplifies the Impact of Sleep Loss on Aversive Brain Anticipation. Andrea N.
Goldstein1, et. Al.
The Journal of Neuroscience, 26 June 2013,
Iron Deficiency and Biblical Counseling?
He who gives an answer before he hears, It is folly and shame to him. (Pro 18:13 NASB)
In teaching biblical counseling and in medicine, it is good to emphasize the importance of getting as much factual information as we can before we decide what the diagnosis is and what to do about it. So the writer of Proverbs tells
to listen long before we answer.
In biblical counseling we are often faced with counselees who are labeled with DSM5 diagnoses including bipolar disorder, depressive disorder, ADHD, and anxiety disorder. We have been encouraged for years to believe that
these disorders were due to chemical imbalances in the brain tied to the levels of serotonin, norepinephrine and dopamine. But, an article published June 4 in BMC: Psychiatry, states that a common health problem in children may be connected to a greater risk of being diagnosed with bipolar disorder, depression, anxiety, ADHD and autism.[i]
The study conducted in Taiwan looked at the risk of being diagnosed with these disorders in 2957 children and adolescents with a diagnosis of iron deficiency compared to 11,828 healthy control subjects. The results indicated that children who are iron deficient have a significant increase of 2 to 5 times the risk of being identified with one of the disorders as children with normal iron levels. The article speculates on a connection between iron levels and neurotransmitters.
This is very important to all of us who counsel strugglers with these labels. Of all the homework assignments that I might give in the first hour of counseling, seeing a physician for a complete exam with appropriate lab work may be one of the most important. We really do not want to be counseling someone for any of these disorders who really has iron deficiency or some other medical disorder. The only way to know for certain is for the counselee to see a doctor.
The best part of it is that when we do send someone to the doctor and a correctible physical problem is found, the patient may well recover without another counseling session. And, that should make us all smile. [i] http://www.biomedcentral.com/1471-244X/13/161 Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study Mu-Hong Chen1
, Tung-Ping Su1
, Ying-Sheue Chen1
, Ju-Wei Hsu1
, Kai-Lin Huang1
, Wen-Han Chang1
and Ya-Mei Bai1
* BMC Psychiatry