PhD/PsyD Gabor Maté is "worse than wrong" on ADHD

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PsychSupreme

Ph.D. Student | M.A. Clinical Psychology
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Hello folks! Hope all had a restful holiday season free of trauma pseudoscience. Here's a video you all may enjoy in which Russell Barkley dismantles the very viral views of Gabor Maté regarding ADHD (i.e., that ADHD is a primarily traumatogenic disorder). Have fun!


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Why are people taking medical "advice" from someone who sounds like a new Starbucks drink order?
I mean, he's a legitimate family physician, so I'd be hesitant to denounce his basic medical knowledge...however, he's clearly no competent psychiatrist and seems to have taken Mehmet Oz route of choosing grift over legitimate practice.
 
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I mean, he's a legitimate family physician, so I'd be hesitant to denounce his basic medical knowledge...however, he's clearly no competent psychiatrist and seems to have taken Mehmet Oz route of choosing grift over legitimate practice.

When you diagnose a British royal with ADHD very confidently on camera because you have read their autobiography, no one has to take you seriously any more.
 
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When you diagnose a British royal with ADHD very confidently on camera because you have read their autobiography, no one has to take you seriously any more.
I do not disagree with you--he's not someone we should take seriously...but he is a knowledgeable unserious person, which is why it's so frightening to witness him become the next viral thing.
 
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I mean, he's a legitimate family physician, so I'd be hesitant to denounce his basic medical knowledge...however, he's clearly no competent psychiatrist and seems to have taken Mehmet Oz route of choosing grift over legitimate practice.

Just because someone is licensed, does not mean they have adequate understanding of medical/healthcare knowledge and how to apply it. Some of these people are just grifters, but some are just *****s who stumbled their way through a doctorate.
 
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Just because someone is licensed, does not mean they have adequate understanding of medical/healthcare knowledge and how to apply it. Some of these people are just grifters, but some are just *****s who stumbled their way through a doctorate.
I mean, maybe, but an unknowledgeable idiot does not pass multiple STEP exams as well as the MCAT and CASPer. It takes at least a level of competency to complete medical school--even if one does not internalize the scientific spirit or simply chooses to ignore the science, one must still have learned it well enough to get through a rigorous learning process. The man knows what conventional medical science teaches, he just chooses to ignore it.
 
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I mean, maybe, but an unknowledgeable idiot does not pass multiple STEP exams as well as the MCAT and CASPer. It takes at least a level of competency to complete medical school--even if one does not internalize the scientific spirit or simply chooses to ignore the science, one must still have learned it well enough to get through a rigorous learning process. The man knows what conventional medical science teaches, he just chooses to ignore it.

He was taught facts, he was not necessarily taught how to evaluate research and how it applies to his clinical practice. Unfortunately, this is all too often the case here of not "knowing what you don't know" and being overconfident in your abilities. Plenty of people out there with good memory skills, and poor reasoning skills.
 
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I had never heard of him, so looked him on wikipedia. I have quite a bit of respect for James Coyne even if I don't agree with him on everything. He is also never one to mince words. At least per wikipedia he stated Mate is "piling bonkers claims on bonkers claims" which...seems to track. :rofl:
 
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He was taught facts, he was not necessarily taught how to evaluate research and how it applies to his clinical practice. Unfortunately, this is all too often the case here of not "knowing what you don't know" and being overconfident in your abilities. Plenty of people out there with good memory skills, and poor reasoning skills.
I didn't say he was a competent researcher. I agree, in principle, that people can learn facts and not learn science (hence why I said he is either ignoring science or didn't internalize the scientific mindset). I said he is knowledgeable and a credential physician, which means he knows certain medical facts, especially within his specialty...and I'm leaning on the fact that he has credentials and knowledge to express why that makes him even worse than someone who doesn't have his background--because it gives him the facade of reliability and because he should know better than to opine on topics outside of his realm of practice (that's why he's "worse than wrong"). I didn't want to argue about his credentials, anyway...we agree that he's not someone whom mental health professionals should be taking seriously, but it's extremely clear why laypeople without mental health expertise would take his advice. I just wanted to post a cool video in which a real scientist takes a popular but shoddy scientist to the cleaners because we as a field do not do nearly enough of this kind of thing--we are scarily content to allow misinformation to proliferate on the internet or otherwise convince ourselves that "other people are handling it."
 
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I had never heard of him, so looked him on wikipedia. I have quite a bit of respect for James Coyne even if I don't agree with him on everything. He is also never one to mince words. At least per wikipedia he stated Mate is "piling bonkers claims on bonkers claims" which...seems to track. :rofl:
His claims are indeed bonkers upon bonkers. He also posits that SUDs are universally traumatogenic.
 
Russell Barkley is such a G. Love the content.
 
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Russell Barkley is such a G. Love the content.
I didn’t have any prior exposure to him but I like what I’ve seen so far. I liked his video urging people to chill out on hyping psychedelic therapy.
 
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Somewhat related. There’s this video of Park Dietz saying he could diagnose psychopathy just by walking on a beach and looking at people. It’s pre Yates debacle (where he legit said on the stand something about her doing it because she saw a law and order episode). Really left a bad taste in my mouth for forensic psychiatry. And that it’s all just a game in these big cases. Call the big names. Hope for the best.
 
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I didn’t have any prior exposure to him but I like what I’ve seen so far. I liked his video urging people to chill out on hyping psychedelic therapy.
Wait! If this is the first time you've ever heard of Barkley, you MUST drop what you are doing and read one of the highest cited and most impactful papers in the field of psychology. According to google, it's been cited nearly 12000 times with only about half of those being Barkley citing himself :p.

Honestly, a couple of passes at it is worthy. It's amazing that it's nearly 30 years old, and appears to be standing the test of time.

this: https://frisch-ot.com/wp-content/uploads/2021/11/EFModelBarkely.pdf

In the language of the kids, they would say that Russell Barkley is OP (overpowered). Super nice guy, pretty responsive dude via email. Absolute legend. It's hard to convey how much he's done for the field. Comparable to Einstein, Pope, etc. He is S tier.

He was one of the major player at looking at ADHD as a life course altering impairment - that extends into adulthood. Prolific researcher and his parent management program is something I reach for a lot, especially with oppositionality is present.
 
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We need more researchers like Barkley as opposed to professionals just spouting off opinions about stuff that they haven’t actually researched. A doc who sees kids with traumatic or other types of adverse childhood experiences that are labeled ADHD by whoever is making a fundamental flaw in diagnostic reasoning. I thought the same thing at the very beginning of my clinical training. Ugh.
 
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Wait! If this is the first time you've ever heard of Barkley, you MUST drop what you are doing and read one of the highest cited and most impactful papers in the field of psychology. According to google, it's been cited nearly 12000 times with only about half of those being Barkley citing himself :p.

Honestly, a couple of passes at it is worthy. It's amazing that it's nearly 30 years old, and appears to be standing the test of time.

this: https://frisch-ot.com/wp-content/uploads/2021/11/EFModelBarkely.pdf

In the language of the kids, they would say that Russell Barkley is OP (overpowered). Super nice guy, pretty responsive dude via email. Absolute legend. It's hard to convey how much he's done for the field. Comparable to Einstein, Pope, etc. He is S tier.

He was one of the major player at looking at ADHD as a life course altering impairment - that extends into adulthood. Prolific researcher and his parent management program is something I reach for a lot, especially with oppositionality is present.
Thanks for the info! I am not really in the ADHD sphere so I’m admittedly not super familiar with the major players.
 
Barkley also wrote a great paper criticizing the requirement of neuropsych testing for ADHD diagnosis.
 
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Barkley also wrote a great paper criticizing the requirement of neuropsych testing for ADHD diagnosis.
That paper (and others of his) is required reading in my opinion. If I had a dollar for every time I’ve had to educate patients, family members and other professionals on that issue, I could take a very nice, long vacation.
 
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That paper (and others of his) is required reading in my opinion. If I had a dollar for every time I’ve had to educate patients, family members and other professionals on that issue, I could take a very nice, long vacation.
Sorry—completely irrelevant, but your user flair credentials intrigued me. I was wondering if you’d mind sharing details about how you ended up as both a psychologist and a PMHNP. Just curious.

Edit: To clarify, I know procedurally how. I mean—what led to it, and which came first.
 
Sorry—completely irrelevant, but your user flair credentials intrigued me. I was wondering if you’d mind sharing details about how you ended up as both a psychologist and a PMHNP. Just curious.

Edit: To clarify, I know procedurally how. I mean—what led to it, and which came first.
I’ve posted on this before. Reader’s Digest version: I was a clinical psychologist first and decided to become a PMHNP because of the shortage of psych prescribers, especially child psych prescribers.

Search my past posts for more information or feel free to DM me.
 
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I’ve posted on this before. Reader’s Digest version: I was a clinical psychologist first and decided to become a PMHNP because of the shortage of psych prescribers, especially child psych prescribers.

Search my past posts for more information or feel free to DM me.
No, thanks for answering! I was genuinely just curious.
 
I mean, he's a legitimate family physician, so I'd be hesitant to denounce his basic medical knowledge...however, he's clearly no competent psychiatrist and seems to have taken Mehmet Oz route of choosing grift over legitimate practice.
I wouldn't. I don't think many (any?) of us receive all that much training in the theory behind ADHD beyond basic sciences in med school and that isn't much.
 
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I wouldn't. I don't think many (any?) of us receive all that much training in the theory behind ADHD beyond basic sciences in med school and that isn't much.
Don’t doubt it. But how many laypeople know enough to feel the same way as you?
 
That paper (and others of his) is required reading in my opinion. If I had a dollar for every time I’ve had to educate patients, family members and other professionals on that issue, I could take a very nice, long vacation.

How do you handle the DSM statement that patient's reports are not accurate?
 
That paper (and others of his) is required reading in my opinion. If I had a dollar for every time I’ve had to educate patients, family members and other professionals on that issue, I could take a very nice, long vacation.
I think the original MTA study is also required reading the ADHD sphere. This is how I over simplify it for families:

  • I need to share with you the results of a huge study, that has been repeated many times, since then with a bunch of different medications and they all show similar results. But, it was foundational in understanding of how to treat kiddos with ADHD. But this is the study that had probably too many kids put on too much ritalin in the 90s (I only add that part if they are weary of meds).
  • I draw a graph with three dots near the top - "this study randomly placed kids with ADHD into three groups - and at the beginning of the study, they're all showing high levels of ADHD symptoms, but theyre all about equal (I draw two equal signs between the three groups) because they're all kids with untreated ADHD.
  • The first group treated their ADHD with good behavior therapy/just community treatment alone, and you see a little symptom reduction. (draw arrow and another dot indicating a little reduction) note: sometimes I break up behavioral therapy/community treatment and start with four dots.
  • "The second group just got ritalin - and well, they showed a ton symptom reduction when THE MED IS IN THEIR SYSTEM. In fact, laters study show that about 80% kids with ADHD NORMALIZE when they take their meds and THE VAST MAJORITY of kids respond well to meds." Draw an arrow to it's dot indicating symptom reduction.
  • "Now let's talk about the third group - they both - good behavioral interventions and medication. Now, on main symptoms ADHD, there was no added benefit of adding therapy to the mix and that kind of bums me out as a psychologist, because research generally shows combination treatments are usually superior."
  • "but this study kind of tells us a lot about ADHD and how it works. Put simply, these meds are some of a best psych meds out there, they generally target symptoms of adhd with great effect and minimal side effects. When they work - they really work. But, really the study shows that a lot of ADHD just has to do with how brain cells in the front part of our brains communicate with each other, and when we narrowly target a chemical messenger there, bam, huge reduction in adhd symptoms." if the kid is anxious/depressed/ODD, I further explain that therapy/parent management training continues to be a very important part of treatment.
  • then I will talk about how ADHD is not a skill deficit disorder, they know how to behave, they trouble behaving how they know (unless it's something that they like), usually because that ol frontal lobe is underdeveloped and under activated and then we might discuss ol phineas gage, a little history on what adhd has been called through the eras, some positive benefits of medically treating ADHD. I also might discuss the generic name for adderall with them, to not allow them to form misconceptions when they go to Walgreens. We also discuss if they choose to not have med consult, there is tons of stuff we can still try.
 
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Barkley also wrote a great paper criticizing the requirement of neuropsych testing for ADHD diagnosis.
He has some videos where he goes over the findings. Very useful for class presentations and consumers.

I have watched a great deal of his videos. I find that about ~95% of what he says is valid and reliable. I am not an ADHD researcher, so perhaps people more in the know would find some other flaws. You can tell he is a bit of a libertarian, so the biases within that mindset pop out once in a while. Though, he generally does follow the best science of ADHD.
 
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I think the original MTA study is also required reading the ADHD sphere. This is how I over simplify it for families:

  • I need to share with you the results of a huge study, that has been repeated many times, since then with a bunch of different medications and they all show similar results. But, it was foundational in understanding of how to treat kiddos with ADHD. But this is the study that had probably too many kids put on too much ritalin in the 90s (I only add that part if they are weary of meds).
  • I draw a graph with three dots near the top - "this study randomly placed kids with ADHD into three groups - and at the beginning of the study, they're all showing high levels of ADHD symptoms, but theyre all about equal (I draw two equal signs between the three groups) because they're all kids with untreated ADHD.
  • The first group treated their ADHD with good behavior therapy/just community treatment alone, and you see a little symptom reduction. (draw arrow and another dot indicating a little reduction) note: sometimes I break up behavioral therapy/community treatment and start with four dots.
  • "The second group just got ritalin - and well, they showed a ton symptom reduction when THE MED IS IN THEIR SYSTEM. In fact, laters study show that about 80% kids with ADHD NORMALIZE when they take their meds and THE VAST MAJORITY of kids respond well to meds." Draw an arrow to it's dot indicating symptom reduction.
  • "Now let's talk about the third group - they both - good behavioral interventions and medication. Now, on main symptoms ADHD, there was no added benefit of adding therapy to the mix and that kind of bums me out as a psychologist, because research generally shows combination treatments are usually superior."
  • "but this study kind of tells us a lot about ADHD and how it works. Put simply, these meds are some of a best psych meds out there, they generally target symptoms of adhd with great effect and minimal side effects. When they work - they really work. But, really the study shows that a lot of ADHD just has to do with how brain cells in the front part of our brains communicate with each other, and when we narrowly target a chemical messenger there, bam, huge reduction in adhd symptoms." if the kid is anxious/depressed/ODD, I further explain that therapy/parent management training continues to be a very important part of treatment.
  • then I will talk about how ADHD is not a skill deficit disorder, they know how to behave, they trouble behaving how they know (unless it's something that they like), usually because that ol frontal lobe is underdeveloped and under activated and then we might discuss ol phineas gage, a little history on what adhd has been called through the eras, some positive benefits of medically treating ADHD. I also might discuss the generic name for adderall with them, to not allow them to form misconceptions when they go to Walgreens. We also discuss if they choose to not have med consult, there is tons of stuff we can still try.
Can you post a link or citation to this paper?
 
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How do you handle the DSM statement that patient's reports are not accurate?

Isn't that why you obtain collateral? Which can be done via observer symptom inventories
 
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In kids, absolutely. But I've never seen that done in adults. Have you?

I obtain collateral in adults, yes. In fact, I changed our clinic practice to mail out observer forms when appts are scheduled as opposed to giving them at the appt to bring back (which rarely happened).

But, yeah, that's more for ADHD "testing." I'm guessing it's not done with psychiatry evaluations in our clinic.
 
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I obtain collateral in adults, yes. In fact, I changed our clinic practice to mail out observer forms when appts are scheduled as opposed to giving them at the appt to bring back (which rarely happened).

But, yeah, that's more for ADHD "testing." I'm guessing it's not done with psychiatry evaluations in our clinic.

Can't speak directly to the VA but I can only do it because I'm in PP most of the week and my one employed job has a ridiculously high degree of autonomy. More normal employed outpatient psychiatry jobs aren't going to give you extra time to do this; you get the one 60 minute initial evaluation (usually) and then make do with half an hour at best from there on out. Actually speaking with someone's family/friends/etc would have to happen on your own time or them literally showing up to the appointment with the patient.

I don't really use observer forms for collateral in adults much; I find people close to the patient often have a very specific opinion and agenda regarding stimulants, sometimes more than the patient does. I want to talk directly to them and get into the phenomenology of what is going on to try and sidestep the face validity of so many of the questions on most of these things.
 
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I thought you were speaking as yourself in the post I quoted.

Yeah laypeople easily fall for stuff like this.
I was just saying his credentials are legit enough to make it clear why laypeople end up falling for these guru types.
 
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In kids, absolutely. But I've never seen that done in adults. Have you?
I always get what collateral is possible to obtain. That’s relatively easy to do in kids/adolescents, more difficult with some adults.

I often ask to speak with spouses/partners/other family members of the patient or even close friends, as appropriate. If I think the person may be malingering, I insist on this. Sometimes I will refer for testing as it’s another layer of burden and cost that may deter some malingering. But, stimulant seekers can fake their way through testing pretty successfully with a bit of online effort.

I follow my patients frequently (typically every 2 weeks in the beginning for new ADHD diagnoses) and then at least monthly, and I’ve found it’s rare for drug seekers to comply with this level of follow-up.
 
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I always get what collateral is possible to obtain. That’s relatively easy to do in kids/adolescents, more difficult with some adults.

I often ask to speak with spouses/partners/other family members of the patient or even close friends, as appropriate. If I think the person may be malingering, I insist on this. Sometimes I will refer for testing as it’s another layer of burden and cost that may deter some malingering. But, stimulant seekers can fake their way through testing pretty successfully with a bit of online effort.

I follow my patients frequently (typically every 2 weeks in the beginning for new ADHD diagnoses) and then at least monthly, and I’ve found it’s rare for drug seekers to comply with this level of follow-up.
Interesting. I don’t know if I agree with you about passing embedded pvts on cpts, but interesting none the less.

Do you do UDSes on intakes? I know and psychiatry had a big thing about that.
 
I always get what collateral is possible to obtain. That’s relatively easy to do in kids/adolescents, more difficult with some adults.

I often ask to speak with spouses/partners/other family members of the patient or even close friends, as appropriate. If I think the person may be malingering, I insist on this. Sometimes I will refer for testing as it’s another layer of burden and cost that may deter some malingering. But, stimulant seekers can fake their way through testing pretty successfully with a bit of online effort.

I follow my patients frequently (typically every 2 weeks in the beginning for new ADHD diagnoses) and then at least monthly, and I’ve found it’s rare for drug seekers to comply with this level of follow-up.
This is consistent with both my process and my observations from when I was doing ADHD and LD assessments in pp.

On the flip side, I saw a report that dxed dyslexia from a Rorschach, so YMMV I guess.
 
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Do you do UDSes on intakes? I know and psychiatry had a big thing about that.
Occasionally, not typically. When I do, I’ve done them randomly and when I suspect something nefarious. I’ve found regular, frequent follow-up to be quite effective in medication adherence and diverting misuse and drug-seeking behavior.
 
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This is consistent with both my process and my observations from when I was doing ADHD and LD assessments in pp.

On the flip side, I saw a report that dxed dyslexia from a Rorschach, so YMMV I guess.

Omg I had this last week. I had a new patient who was previously diagnosed with ADHD and ASD and they forwarded me their last psych testing report done by this psychologist who is also a licensed school specialist. Their biopsychosocial background was basically non-existent....they had a couple of sentences in the HPI, then they did the Rorschach, TAT, and select measures from DKEFS. They had maybe two bullet points for treatment recommendations. It was probably the most atrocious report I've ever seen.
 
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On a related note, I used to do NP testing for ADHD as that's what my mentors back in Miami really emphasized, but then I grew myself a brain and started to think for myself, looked at much of the updated literature on the topic and found that performance based testing does not add a statistically significant amount of specificity nor sensitivity in the ADHD diagnostic process. People who continue to advocate for ADHD performance based testing tend to say "well, we also want to rule out other co-occuring syndromes that could emulate ADHD such as ASD, LD, SLD, etc." My argument against that, and why I do not do performance based testing anymore is, that goes beyond the scope of the referral question. At that point, it has evolved more-so into a diagnostic clarification case vs an evaluate to determine if ADHD is present or not. In my report recommendations I will add that further testing may be beneficial to rule out or in other syndromes that may be masking or emulating the endorsed problems they have.

I kind of liken this to medical procedures....if you hear the clip clop of hooves, think horses, not zebras. So, in that spirit, I will first set my focus on ADHD, and use measures that help me answer the primarily suspected condition. If that does not materialize, then we can start refining the assessment process at a later point in the future.
 
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Occasionally, not typically. When I do, I’ve done them randomly and when I suspect something nefarious. I’ve found regular, frequent follow-up to be quite effective in medication adherence and diverting misuse and drug-seeking behavior.
I was more leaning towards stoners who mysteriously have difficulties with attention.

I think much more of you, than to think you wouldn’t notice a meth head or an opioid induced problem.
 
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Can you post a link or citation to this paper?

This is the hub to the original study. Also, there has been a ton of follow up. This study and it's members might be the single best study ever done on kids. The follow up studies are interesting. But, the original paper is linked.

Here is full text of the OG study: A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder
 
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I was more leaning towards stoners who mysteriously have difficulties with attention.

I think much more of you, than to think you wouldn’t notice a meth head or an opioid induced problem.
The true stoners don’t want a stimulant ruining their bake, lol. If they complain of attentional issues, I tell them we can talk about that after a month or two T break.
 
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