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Research Article

Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder

  • Gene-Jack Wang mail,

    gjwang@bnl.gov

    Affiliations: Department of Radiology, Stony Brook University, Stony Brook, New York, United States of America, Bioscience Department, Brookhaven National Laboratory, Upton, New York, United States of America, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, United States of America

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  • Nora D. Volkow,

    Affiliations: National Institute on Drug Abuse, Bethesda, Maryland, United States of America, Neuroimaging Lab, National Institute on Alcohol Abuse and Alcoholism Intramural Research Program, Upton, New York, United States of America

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  • Timothy Wigal,

    Affiliation: Department of Pediatrics, University of California Irvine, Irvine, California, United States of America

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  • Scott H. Kollins,

    Affiliation: Department of Psychiatry, Duke University, Durham, North Carolina, United States of America

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  • Jeffrey H. Newcorn,

    Affiliation: Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, United States of America

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  • Frank Telang,

    Affiliation: Neuroimaging Lab, National Institute on Alcohol Abuse and Alcoholism Intramural Research Program, Upton, New York, United States of America

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  • Jean Logan,

    Affiliation: Bioscience Department, Brookhaven National Laboratory, Upton, New York, United States of America

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  • Millard Jayne,

    Affiliation: Neuroimaging Lab, National Institute on Alcohol Abuse and Alcoholism Intramural Research Program, Upton, New York, United States of America

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  • Christopher T. Wong,

    Affiliation: Neuroimaging Lab, National Institute on Alcohol Abuse and Alcoholism Intramural Research Program, Upton, New York, United States of America

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  • Hao Han,

    Affiliation: Department of Mathematics and Applied Sciences, Stony Brook University, Stony Brook, New York, United States of America

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  • Joanna S. Fowler,

    Affiliations: Bioscience Department, Brookhaven National Laboratory, Upton, New York, United States of America, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, United States of America

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  • Wei Zhu,

    Affiliation: Department of Mathematics and Applied Sciences, Stony Brook University, Stony Brook, New York, United States of America

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  • James M. Swanson

    Affiliation: Department of Pediatrics, University of California Irvine, Irvine, California, United States of America

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  • Published: May 15, 2013
  • DOI: 10.1371/journal.pone.0063023

Reader Comments (3)

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Is ADHD a proven, demonstrable disorder/disease/physical abnormality of the brain or body?

Posted by fabjrmd1 on 21 Jun 2013 at 19:11 GMT

FRED A. BAUGHMAN, JR. M.D.
NEUROLOGY AND CHILD NEUROLOGY (Board Certified)
FELLOW, AMERICAN ACADEMY OF NEUROLOGY
fredbaughmanmd@cox.net
1303 HIDDEN MOUNTAIN DRIVE
EL CAJON, CA 92019
619-440-8236
06/21/13

RE: PLoS One. 2013 May 15;8(5):e63023. doi: 10.1371/journal.pone.0063023. Print 2013.
Long-term stimulant treatment affects brain dopamine transporter level in patients with attention deficit hyperactive disorder.
Wang GJ, Volkow ND, Wigal T, Kollins SH, Newcorn JH, Telang F, Logan J, Jayne M, Wong CT, Han H, Fowler JS, Zhu W, Swanson JM.

Wang, et al, state: “Attention deficit/hyperactivity disorder (ADHD) is considered to be the most prevalent psychiatric disorder of childhood and it’s increasingly being recognized in adults too.” They go on to say: “Deficits in dopamine (DA) neurotransmission have been associated with the disorder” but fail to mention that no proof exists of a physical abnormality (gross, microscopic or chemical) proving it is a disorder/disease/abnormal phenotype or providing a test by which it can be demonstrated as such [1]. It appears that the disorder/disease status of ADHD is no different at this time than it was at the end of the November 16-18, 1998, NIH, ADHD Consensus Conference when panel chair, Dr. David Kupfer, concluded (November 18, 1998):

“The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. However, we do not have an independent, valid test for ADHD, and there is no data to indicate that ADHD is due to a brain malfunction. Further research to establish the validity of the disorder continues to be a problem."

Recently, I aided a Canadian father (BV) in drafting a letter to Health Canada, the Canadian counterpart of the US FDA, asking whether or not ADHD was an actual disease having “a gross, microscopic or chemical abnormality” allowing for objective diagnosis. The answer he received from Supriya Sharma, MD, MPH, FRCPC, Director General. Therapeutic Products Directorate, Holland Cross, Tower “B,” 6th floor, 1600 Scott Street, Address Locator # 3106B, Ottawa, Ontario, K1A OK9, dated Nov 20, 2008, read:

“Dear Mr. V, Thank you for your letter of October 24, 2008, addressed to the Minister of Health, enquiring about the status of ADHD (Attention Deficit/Hyperactivity Disorder) as a disease. I am responding on the Minister’s behalf. For mental/psychiatric disorders in general, including depression, anxiety, schizophrenia and ADHD, there are no confirmatory gross, microscopic or chemical abnormalities that have been validated for objective physical diagnosis. Rather, diagnoses of possible mental conditions are described strictly in terms of patterns of symptoms that tend to cluster together; the symptoms can be observed by the clinician or reported by the patient or family members.”

On March 12, 2009, Donald Dobbs, Consumer Safety Officer, Division of Drug Information, Office of Training and Communications, Center for Drug Evaluation and Research wrote to me stating:

“This is in response to your letter dated December 19, 2008, requesting the reference/citation from the scientific/medical literature that the five psychiatric disorders listed in your letter are actual diseases. Your letter was forwarded to the Center for Drug Evaluation and Research (CDER) for a response. I consulted with the FDA new drug review division responsible for approving psychiatric drug products and they concurred with the response you enclosed from Health Canada. Psychiatric disorders (as Health Canada refers) are diagnosed based on a patient's presentation of symptoms that the larger psychiatric community has come to accept as real and responsive to treatment. We have nothing more to add to Health Canada's response.”

Surely Wang, et al, have considered ADHD to be a diagnosable disorder/disease for they committed their adult ADHD “patient” group to 12 months of “treatment” with methylphenidate (MPH) that they could not otherwise have justified. Methylphenidate is a Schedule II controlled substance, meaning that it presents a high likelihood for abuse because of its addictive potential. How did Wang et al describe ADHD in the informed consent documents presented to their adult ADHD patients?

There can be no presumption that ADHD or any psychiatric diagnosis is an actual disorder/disease having a confirmatory gross, microscopic or chemical abnormality that can be demonstrated for objective diagnosis.

Bibliography

1. There Is No Such Thing as a Psychiatric Disorder/Disease/Chemical Imbalance. Fred Baughman: PloS Medicine Volume 3, Issue 7, July 2006


No competing interests declared.