Last week, I posted on the proliferation of unregulated, untested chemicals throughout the environment. The catalyst for that post was the release of the annual report from the President’s Cancer Panel, which warned that many of these chemicals were likely to blame for rising cancer rates in the US. The Washington Post wrote:
The current system places the burden on the government to prove that a chemical is unsafe before it can removed from the market. The standards are so high, the government has been unable to ban chemicals such as asbestos, a widely recognized carcinogen that is prohibited in many other countries.
About 80,000 chemicals are in commercial use in the United States, but federal regulators have assessed only about 200 for safety.
The report from the President’s Cancer panel also focused on the potential impact of this chemical burden on children:
Children are particularly vulnerable because they are smaller and are developing faster than adults, the panel found. The report noted unexplained rising rates of some cancers in children, and it referred to recent studies that have found industrial chemicals in umbilical-cord blood, which supplies nutrients to fetuses. “To a disturbing extent, babies are born ‘pre-polluted,’ ” the panel wrote.
Health officials lack critical knowledge about the health impact of chemicals on fetuses and children, the report said.
Now a new study published in Pediatrics, the journal of the American Academy of Pediatrics, links pesticide use with the rise in ADHD disorders among children. The study’s authors examined data on over 1,100 children, and determined that elevated levels of pesticide metabolites in the urine was associated with a diagnosis of ADHD. In fact, children with levels higher than the median of the most commonly detected metabolite (known as dimethyl thiophosphate), were twice as likely to be diagnosed as ADHD compared with children that had undetectable levels of the metabolite. The elevated risk factor remained even after controlling for confounding variables like gender, age, race/ethnicity, poverty/income ratio and others.
The pesticides studied belong to a class of compounds known as organophosphates. Time explains:
[Study author Maryse] Bouchard’s analysis is the first to home in on organophosphate pesticides as a potential contributor to ADHD in young children. But the author stresses that her study uncovers only an association, not a direct causal link between pesticide exposure and the developmental condition. There is evidence, however, that the mechanism of the link may be worth studying further: organophosphates are known to cause damage to the nerve connections in the brain — that’s how they kill agricultural pests, after all. The chemical works by disrupting a specific neurotransmitter, acetylcholinesterase, a defect that has been implicated in children diagnosed with ADHD. In animal models, exposure to the pesticides has resulted in hyperactivity and cognitive deficits as well.
Wikipedia explains that organophosphates are a known and potent toxin to humans:
Many organophosphates are potent nerve agents, functioning by inhibiting the action of acetylcholinesterase (AChE) in nerve cells. They are one of the most common causes of poisoning worldwide, and are frequently intentionally used in suicides in agricultural areas. Their toxicity is not limited to the acute phase, however, and chronic effects have long been noted. Neurotransmitters such as acetylcholine (which is affected by organophosphate pesticides) are profoundly important in the brain’s development, and many OPs have neurotoxic effects on developing organisms, even from low levels of exposure.
So why hasn’t the EPA or some similar body regulated these dangerous pesticides out of existence? The key is in part of the Washington Post quotation from above, indicating that “about 80,000 chemicals are in commercial use in the United States, but federal regulators have assessed only about 200 for safety.” Wikipedia elaborates on organophosphates specifically:
The U.S. Food Quality Protection Act (FQPA), passed in 1996, designated the United States Environmental Protection Agency (EPA) to conduct a 10 year review process of the health and environmental effects of all pesticides, beginning with the Organophosphates. The process has taken longer than expected, but was recently concluded and eliminated or modified thousands of uses.
Many non-governmental and research groups, as well as the EPA’s Office of Inspector General, have published concerns that the review did not take into account possible neurotoxic effects on developing fetuses and children, an area of developing research. A group of leading EPA scientists sent a letter to the chief administrator, Stephen Johnson, decrying the lack of developmental neurotoxicity data in the review process. New studies have shown toxicity to developing organisms during certain “critical periods” at doses much lower than those previously suspected to cause harm.
So, a 10-year review that began 14 years ago eliminates thousands of uses, and the government’s own scientists are saying the overdue review still did not go far enough. How confident can we be in the results of the review?
In doing research for this post, I learned some amazing things. For example, a great deal of the research on organophosphates was done by the Nazis. Although the research was initially aimed as using the compounds as insecticides, it turns out that since they are so highly toxic to humans they are ideal candidates for wartime munitions. The lethal fruits of this research include Tabun, Sarin, and VX gases, all of which are now classified as weapons of mass destruction by the U.N. You might remember Sarin gas from the news a few years ago– it was used in the terrorist attack on the Tokyo subway in 1995 which killed 13 people and sickened thousands more.
Another thing I learned when researching this post was that contemporary journalism is in a sorry state. I guess I knew that already, but each fresh instance of poor journalism drives the point home anew. A Reuter’s article I found contained the following paragraph:
Garry Hamlin of Dow AgroSciences, which manufactures an organophosphate known as chlorpyrifos, said he had not had time to read the report closely. But, he added, “the results reported in the paper don’t establish any association specific to our product chlorpyrifos.”
So I guess he scanned this report just to make sure it didn’t name his company’s chemical specifically. When it didn’t call them out by name, I’m sure he breathed a sigh of relief– the shareholders sure wouldn’t like a report like that. Wikipedia’s article on organophosphates notes that a study that did name chlorpyrifos was published in the same journal (Pediatrics) in 2007, which concluded that “children exposed to higher… chlorpyrifos levels were also significantly more likely to experience Psychomotor Development Index and Mental Development Index delays, attention problems, attention-deficit/hyperactivity disorder problems, and pervasive developmental disorder problems at 3 years of age.” I’m still not sure why Reuter’s didn’t find the earlier study significant enough to include in their story, it sure seems relevant to me. I mean, if you’re going to write a story about the link between pesticides and ADHD, then quote a pesticide manufacturer who says “not our chemical!” maybe you should verify that. In any case, Garry Hamlin of Dow AgroSciences should have reminded the reporter of the earlier study, but it must have slipped his mind. It’s too bad that Reuters journalists haven’t figured out to use Google yet, isn’t it?
It turns out that chlorpyrifos was so toxic that it was banned for residential use in 2001, but is still widely used on common crops like corn, wheat, and soy. These crops are also among the most common feedstocks for processed foods. Chlorpyrifos is “one of the most widely used organophosphate insecticides”, according to the EPA.
And how is ADHD treated? One of the primary ways is through medication. The National Institutes of Health has this list of medications available to treat ADHD:
| Trade Name | Generic Name | Approved Age |
|---|---|---|
| Adderall | amphetamine | 3 and older |
| Adderall XR | amphetamine (extended release) | 6 and older |
| Concerta | methylphenidate (long acting) | 6 and older |
| Daytrana | methylphenidate patch | 6 and older |
| Desoxyn | methamphetamine hydrochloride | 6 and older |
| Dexedrine | dextroamphetamine | 3 and older |
| Dextrostat | dextroamphetamine | 3 and older |
| Focalin | dexmethylphenidate | 6 and older |
| Focalin XR | dexmethylphenidate (extended release) | 6 and older |
| Metadate ER | methylphenidate (extended release) | 6 and older |
| Metadate CD | methylphenidate (extended release) | 6 and older |
| Methylin | methylphenidate (oral solution and chewable tablets) | 6 and older |
| Ritalin | methylphenidate | 6 and older |
| Ritalin SR | methylphenidate (extended release) | 6 and older |
| Ritalin LA | methylphenidate (long acting) | 6 and older |
| Strattera | atomoxetine | 6 and older |
| Vyvanse | lisdexamfetamine dimesylate | 6 and older |
Quite the list, isn’t it? All of these drugs come with their own side effects to be dealt with. All of these medications have contributed to profits at their respective drug companies, not to mentions insurance companies. The pesticides that we spray on our crops contribute to profits at their respective manufacturers. Dow AgroSciences, the maker of chlorpyrifos, is a wholly owned subsidiary of Dow Chemical Company which reported a profit of $5.7 billion dollars last year. According to Opensecrets.org, Dow Chemical had lobbying expenses of $2.375 million dollars last year. We’ve seen the power of Big Pharma’s lobbyists during the recent health care debate as they negotiated a backroom deal with the Obama administration. I can’t help but feel that these corporations are making billions selling us antidotes to the poisons they sold us earlier, while buying off the government agencies that are supposed to be watching out for quaint things like public safety. How else can we explain the utter disregard for any kind of testing (let alone regulation) on the majority of these chemicals for potential harm? Instead, we go ahead and release these chemicals into our environments, breathe them in, eat them with our food, drink them with our water, and then we wonder why cancer and other disorders are so prevalent.
I think a less scientific explanation should be explored as well. There are scores of children being raised in dysfunctional homes by bad parents. These kids don't behave well, act right, or learn at appropriate rates. Their families are poor. An ADHD diagnosis gets them on SSI, which means a monthly benefit check, health care coverage and possible subsidies which permit family members to be paid for acting as a personal assistant for the disabled child.
Sarah-
What percentage of the 4.5 million children that have been diagnosed with ADHD as of 2006 do you suppose come from such dysfunctional homes? Do you believe that there is, in fact, no medical, psychological or neurological basis for a diagnosis of ADHD? Do the following facts change your opinion at all?
# ADHD diagnosis is significantly higher among non-Hispanic, primarily English-speaking, and insured children.
# Prevalence rates are significantly higher for children in families in which the most highly educated adult was a high school graduate (or had completed 12 years of education), compared with children in families in which the most highly educated adult had a higher or lower level of education.
(source- CDC)
I think it is a combination of both. Toxic substances abound, and yes, they make us sick.
Social programs provide the opportunity for care and funds, so long as a child is tagged with a diagnosis. Yes, I think there is over diagnosis. The fact that there is insurance does not provide an incentive to diagnose honestly.
It is both. Toxic substances and social motivations to over-diagnose. I believe any accurate study would confirm that it is both.
An ADHD diagnosis gets a middle class family free tutoring. An ADHD diagnosis gets a poor family free medical care and monthly aid.
ADHD is a catch all diagnosis–like depression. A diagnosis is required to trigger entitlement to benefits under insurance programs.
You cannot exclude social motivations in studying increases in diagnosis.
Sarah–
Thanks for your comments. I agree that the potential for over-diagnosis exists. But I wonder to what extent it occurs?
After reading your comments, I did a little research to find out how to claim the "benefits" of having a child diagnosed with ADHD. Here are the steps:
<span style="font-weight: bold;">All 3</span> of the criteria for the "A" category must be diagnosed by a medical professional:<span style=";font-family:arial;font-size:100%;" ><span style="font-size:85%;">
</span></span>Marked inattention; andMarked impulsiveness; andMarked hyperactivityThen, 2 out of 3 criteria must be met for the "B" category:
Marked impairment in age-appropriate cognitive/communication functionMarked impairment in age-appropriate social functioningMarked impairment in age-appropriate personal functioningEach of the items under the B criteria must have supporting documentation, which may include medical findings, statements from teachers or parents, and results from standardized testing. Since the potential for parental bias is known, less weight is given to statements from parents as compared to the other supporting documentation.
Once all the information is gathered and submitted, it is reviewed by a psychologist who makes a determination as to whether the claimant qualifies for benefits. So here also, the shortcomings of the system are apparent: the psychologist is rendering an opinion, based largely on reading the opinions of others- whether medical professionals, teachers, or parents. This is why still greater weight is placed on the few areas of objective performance– that is, on the child's academic performance. As one site put it:
<span style=";font-family:arial;font-size:100%;" ></span>
Another site reported:
Both are sites which purport to offer advice for parents seeking a disability claim, yet they do not make the process seem easy or guaranteed at all. (see here also for another example)
I couldn't find any articles which discussed the potential abuse of the system by those who unfairly claim benefits through a diagnosis of ADHD. Can you point me in the direction of some? What I did find, was several message boards where people expressed frustration with the "welfare queen" stereotype, much like what you describe (see here for a typical example). That is, people gaming the system in order to gain an advantage or benefits to which they should not be entitled.
Several academic studies have examined the potential for overdiagnosis of ADHD. They were unable to come up with a broad finding of overdiagnosis, although one did find some overdiagnosis in certain localities. The other articles I found which asserted that widespread overdiagnosis exists did not provide any evidence, although they did suggest diet modification rather than medication as a potential treatment option (see here for an example). I did also find this 1999 article from CNN which reported on a study which suggested the potential for over-diagnosis, but was inconclusive. Are you aware of any others?
I think part of the issue is that ADHD <span style="font-style: italic;">seems</span> to be subjective, to the layperson anyway. Looking at a kid, any sort of psychological issues are not immediately apparent, the way other medical issues can be. For instance, you can measure blood pressure, heart rate, etc… with a fair degree of accuracy, but how does "marked inattention" differ from "moderate inattention"? As you suggest, the same potential exists for a diagnosis of depression, although some doctors would also say that depression is, if anything, <span style="font-style: italic;">under</span>-diagnosed. Where exactly, does one draw the line between "sadness" or "melancholy" and "depression"? In addition, diagnostic categories are somewhat malleable, and can change with our new understandings of the brain and related scientific fields.
So you're probably right, there probably is a certain amount of over-diagnosis. I'm glad to see that we agree that toxins in the environment can be problematic as well, which is what I hoped to convey with my post. Thanks again for your comments.
Brynn: Thank you for your informative and disturbing post, but also the equally helpful follow-up.
I think there is an incentive for medical practitioners to label children as suffering from ADHD, autism, learning disabilities and the like. There are several motivations to diagnose liberally–some caring physicians want patients to receive services or aid to which they may not be entitled while other physicians want to bill insurance. The reality is that contract Social Security examiners have about a half hour to determine whether someone will be entirely dependent upon the taxpayers until the age of majority or death. And a fraudster has what incentive to pass the test exactly?
If you read about the SSI program, you will find that it is subject to widespread abuse. SSA cannot even estimate the percentage of its payouts which are due to total fraud. The reality is that Welfare to Work reforms pushed folks from the generic welfare rolls onto disability programs.
As for toxins being part of the mix, I think part of the toxins are the absolute crap some people feed their children, leading to all sorts of metabolic and behavioral dysfunction.
Sarah,
There is a book of standard guidelines for diagnosing psychiatric disorders which includes all learning disabilities, substance abuse, senility, neuroses and psychoses.
It is Diagnostic and Statistical Manual of mental Disorders. The current version version 4, text revision, known as DSM-IV TR, replaced version 3 in 1994 and because it expanded the diagnostic descriptions of many learning impairments, was initially blamed for the increase in cases of Autism, ADD, and ADHD by making it possible to include previously undiagnosed or misdiagnosed children.
The change in diagnostic criteria most certainly had an initial effect in the increase of diagnosed cases in the late 1990s, but 16 years later the cases are on the rise, not because of fraud, but because something is affecting these kids.
I have a 16 year old son with severe autism and mild retardation. Over the years I've seen fraud by medical providers that took SSI money and provided no services, I've seen SSA caseworkers who wold falsify reports to make honest people look like crooks so the caseworker could get a promotion. I've had to provide complete financial statements on a quarterly basis, after some desk-jocky claimed I made 3 times my annual salary, and I have been presumed guilty and had to prove my innocence. I have seen a lot of crap from the inside of the system.
SSI is a major P.I.T.A. and there are many physicians who will not take SSI patients because of it.
Hi!
ADD / ADHD signs in kids are continuously being researched and studied to create suitable therapy and treatment.
Attention Deficit/Hyperactivity Disorder is a very wide topic, not only related to children. There's the medical and the holistic side of ADD. To learn and get more information regarding ADD or ADHD, including ODD presented in children. Also if you're interested in proper child behavior, refer to Oppositional Defiant Disorder and for a wider information regarding ADD symptoms, have a look in ADD Symptoms blo ghttp://www.addsymptomsinchildren.org/ref/d1.gif