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Letter to the Editor AJP

By Manuel Mota-Castillo
April 15th 2010

Distinguished Editor:

In 1995 Dr. Joseph Biederman made a huge contribution to the understanding of pediatric bipolar disorder1.  Ironically, 15 years later, he leads a team of outstanding researchers in the publication of a paper2 which I perceive as a sabotage of his own pioneering work. I am afraid that the evil Joseph Goebbels was right when he said: "if you tell a lie big enough and keep repeating it, people will eventually come to believe it."  

The "big lie" I am referring to is the widely accepted diagnosing of multiple comorbidities with ADHD. As in a case of collective blindness, the psychiatric establishment has rallied around this fallacy that a few of us have tried to debunk, only to encounter widespread rejection. Still, like the solitary priest in Massachusetts, I am going to challenge "the Pope" to prove me wrong.

But I am not holding my breath because even the prestigious voices of Drs. Hirschfeld and Nassir Ghaemi were ignored when they published evidence (in APA journals) showing that "it took Bipolar I patient nearly 6 years and Bipolar II patients 11.6 years from first contact with the mental health system to achieve a correct diagnosis."  Those years of missed diagnoses are partially the result the "comorbidities" highlighted on page 414 of the "green journal" by Dr. Biederman and his colleagues. Obviously anybody can have PTSD, however the supposed comorbidity of ADHD with Conduct Disorder, Oppositional-Defiant Disorder (ODD), substance abuse, etc., are based on flawed studies that time will prove to be wrong.

In contrast, we can present Dr. Biederman's group with the findings of an ongoing study in which several clinicians are re-evaluating every pediatric patient (new or ongoing) who is on an ADHD medication: During the first month of this epidemiological research only four subjects, out of 137 patients have been found to truly have ADHD. In some cases, patients in full state of mania or hallucinating are still taking high doses of amphetamines, in many instances along with mood stabilizers for "comorbid" bipolar disorder, ODD and ADHD.   

A challenging priest can be fired and OUR letter disregarded but, at the end, the truth will prevail because, as Henry Thoreau said, truth is not a matter of majority vote. One day, many will see that when ADHD and anxiety are actually comorbid, amphetamines are contraindicated. They may also realize that the child of a bipolar person has a high probability of presenting with mood disorder.3  After a while doctors must begin to accept the fact that distractibility, restlessness and impulsiveness are also symptoms of the bipolar spectrum disorders and that aggression is not a symptom of ADHD, as Dr. Biederman used to teach.

  1. Biederman, J., M.D., Childhood Mania, it does Exist and Coexist with ADHD, American Society of Clinical Psychopharmacology Progress Notes, 1995.
  2. Biederman, J., M.D. et al., Adult Psychiatric Outcomes of Girls with ADHD: 11-Year Follow-Up in a Longitudinal Case-Control Study; AJP, 167, 4, April 2010.
  3. Egeland JA, Shaw JA, Endicott J et al. (2003), Prospective study of prodromal features for bipolarity in well Amish children. J Am Acad Child Adolesc Psychiatry 42(7):786-796

Disclosure:  Dr. Manuel Mota-Castillo is a C&A psychiatrist practicing in Florida with no financial links with pharmaceutical companies and not conflict of interest to disclose.
Ambrose Panico is a 3rd Year medical student doing his Psychiatric Core Rotation.

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