By Katie Scarvey
kscarvey@salisburypost.com
Dr. Bose Ravenel considers himself a rebel with a cause. A High Point pediatrician, Ravenel has positioned himself as one of an increasing number of voices concerned about the huge number of children diagnosed with attention deficit hyperactivity disorder who are treated with psychotropic medication.
With parenting expert John Rosemond, Ravenel has written a book questioning the ADHD establishment: “The Diseasing of America’s Children: Exposing the ADHD Fiasco and Empowering Parents to Take Back Control.”
Ravenel doesn’t dispute that the behaviors associated with ADHD ó inattention, impulsivity, hyperactivity ó exist, he says.
In fact, he says, “phenomenologically, it’s vastly under-diagnosed,” since huge numbers of children today are exhibiting the behaviors that have been labeled ADHD.
The Centers for Disease Control and Prevention report that 7.4 percent of children nationwide, ages 3-17, have been diagnosed with ADHD ó or 4.7 million children. According to CDC data from 2003, 2.5 million youths 4-17 are currently receiving medication as treatment for the disorder.
And Ravenel feels this is a travesty.
“ADHD is nothing more than being human,” Ravenel says. He adds that when he filled out a questionnaire that seeks to identify adult ADHD, his answers suggested that he has the disorder.
An ongoing medical debate is whether the set of symptoms that comprise ADHD are caused by something organic ó the oft-cited “chemical imbalance,” as some believe ó or whether they are caused by environmental factors. A third option is that ADHD results from a combination of organic and environmental causes.
Ravenel readily admits that his position on ADHD has changed radically over the years. When he was a clinical associate professor of pediatrics at UNC Chapel Hill, it never occurred to him to question the establishment wisdom, he says.
In 1988, he left academia and went back to private practice in High Point. In a typical week, he says, he’d see 12-15 children who came in because of ADHD symptoms.
After filling out a questionnaire designed to identify those with ADHD, perhaps 90 percent would be diagnosed with the disorder.
Back then, his High Point practice consisted of only two doctors. After his original partner retired, Ravenel inherited many of his ADHD patients, which were almost exclusively medication-managed, he says.
At that point, Ravenel had not yet questioned the use of medications such as Ritalin and Adderall to treat ADHD.
At some point, however, he felt compelled to do some research and look at the evidence. He read at least 100 books, he says, representing both sides of the debate.
His conclusion?
There’s a lot of bad science out there when it comes to ADHD. He now considers himself a “reformed, repentant” former member of the ADHD establishment.
Ravenel is quick to provide examples of what he means by bad science. One study that was put out “with much fanfare,” Ravenel says, supposedly proved that the brains of ADHD children are smaller than those of other children.
The study, however, Ravenel says, doesn’t account for the fact that the children in the ADHD group were on average two years younger than children in the control group ó which would account for their brains being smaller.
Ravenel points out that typically,
ADHD researchers have careers that have been heavily funded by pharmaceutical companies, which have much to gain from the medicalizing of ADHD.
Ravenel is skeptical of claims that the ADHD brain is inherently different from the normal brain.
“No ADHD genes have been discovered,” he writes. “No ADHD gene transmission theories have been proven, no ADHD biochemical imbalance has been quantified, and no specific ADHD brain condition has been identified.”
Ravenel instead uses a behavioral model to explain ADHD.
ADHD behavior, he believes, not is not a result of some inherent condition in the brain but of various lifestyle factors, many of which have to do with how children are parented.
In his own practice, Ravenel no longer prescribes any medication for ADHD, choosing to give parents advice on how to modify the conditions in their children’s life to treat the disorder naturally.
The parents who seek him out are typically looking for non-medical ways to treat ADHD.
Ravenel recommends:
– Restricting exposure to electronic media to no more than 30 minutes a day during the week. That includes television and video games.
There are some studies that tend to support Ravenel’s contention that electronic media can have a negative effect on children. A 2004 study found that each hour of TV between the ages of 1 and 4 increases by nearly 10 percent the risk of serious attention problems at age 7.
– Offering children a healthy diet, restricting processed foods, sugar and additives.
– Making sure children get plenty of exercise.
– Using traditional, “common-sensical” childrearing principles that focus more on children developing self-control rather than self-esteem ó which Ravenel believes will be a natural outgrowth of successful self-control.
Most doctors, he says, simply aren’t aware that there are ways to deal with ADHD without resorting to potentially dangerous medication.
His partners in High Point still prescribe medication for ADHD, although “they’re obviously aware of what I’ve written,” he says.
“They don’t feel they’re equipped to do what I’m doing,” he says.
Ravenel realizes that not all parents will be motivated enough to consistently put his advice into practice over the long haul.
Out of every 10 parents he talks to, he says that perhaps five will come back and be thrilled at the dramatic changes they’ve seen in their children.
The rest, he speculates, get discouraged and don’t return.
That’s a problem, according to Dr. Wayne Koontz and Dr. Christopher Magryta at Salisbury Pediatric Associates.
Koontz and Magryta don’t disagree with much of what Ravenel is saying and like Ravenel, prefer to recommend changes in diet and lifestyle to treat ADHD if possible. But, Koontz says, while medication is not the first option, it should be an option for those children who need it.
Koontz has had years of experience treating ADHD and can tell plenty of stories about children who were struggling in school who had their academic lives turned around by judicious doses of medication.
He’s also convinced that untreated ADHD can have many negative consequences, including a higher risk for incarceration and illegal drug use.
Both Koontz and Magryta say that they have had ADHD from childhood.
Neither has ever used medication ó both say that they found ways to cope without it ó but they nonetheless believe that medication is appropriate for children who do not find successful ways to cope without it.
Koontz emphasizes that he is always looking for ways to get children off medication.
While Ravenel is concerned about the side effects and the potential long-term effects of the regular use of psychotropic medication in children, Koontz says that drugs like Ritalin have been used for many years, and that there has been “no long-term fallout.”
Magryta agrees with Ravenel about treating ADHD without drugs when possible but believes that the use of medication “is absolutely beneficial in appropriate cases.”
“We believe that ADHD can be improved through a conscious effort to improve diet, increase exercise, decrease video watching of all types and structured parenting,” Magryta says. “Medicine should be a small part of the solution for the population that needs it.”