The fact that some individuals harbor unfounded doubts about ADHD isn't surprising to see in print once again. The fact that a reputable newspaper like the NY Times would publish an individual's opinion stated as fact, without regard to basic science, was more troublesome. If believed, last Sunday's op-ed about ADHD, "Ritalin Gone Wrong," would undermine the lives of countless children and families struggling with the condition.
ADHD is a proven medical disorder. Dozens if not hundreds of studies show that unaddressed ADHD (ADD is not unique from ADHD, it is considered a subtype) greatly increases the risk of everything from school failure and car accidents to obesity. These risks make sense when ADHD is understood as a condition that affects an individual's capacity to manage their lives, moment-to-moment, throughout the day.
To truly and compassionately support a child or adult with ADHD, we need to recognize its underlying - and proven - medical cause. An underactive part of the brain impairs an individual's ability to focus, organize, prioritize, and a host of other related life skills. The reason to seek diagnosis is not to decide about medication; it is to help understand an individual. Dr. Russell Barkley has said ADHD is not a disorder of not knowing what to do, but of not doing what you know. There is a huge difference between a child misbehaving because they have poor impulse control or are overly forgetful, and making the false leap that he doesn't care or is being intentionally 'bad' in some way.
Dr. Sroufe's perspective absolutely slams parents. ADHD causes intense stress because of all the difficulties it leads to in life, and parents of children with ADHD report higher levels of anxiety, depression and divorce. Simply getting out the door in the morning becomes a daily crisis. And this happens regardless of how a child was raised: ADHD is not a parent's fault. ADHD symptoms are influenced by environment and parenting style, and we should continue to explore how we can best manage it, but no reputable study has ever suggested that ADHD is caused by environment alone.
Lastly, regarding medication. No respectable practitioner wants to use medication unnecessarily. Yet there actually are clear, research based guidelines demonstrating concrete benefits to ADHD medications that the NY Times op-ed dismisses. We certainly need to explore behavioral and educational interventions that could help any individual, and I often suggest them first. When trying ADHD medications, these non-medical approaches are still needed; even when well utilized and well tolerated, medication alone can't solve everything. Parents and clinicians alike must consider a wide range of possiblities to fully address this complex condition.
At the same time we should aim to help parents find some objectivity in decision making, to step away from the bombast and propaganda inflamed by essays like "Ritalin Gone Wrong." Regardless of what any individual family chooses, they should at least know that the research says non-medical interventions rarely improve ADHD symptoms nearly as much as medication. Decisions should be made as much as possible by seeking facts, not stoking fear.
In regards to the claims made in the op-ed: Multiple studies do show long-term benefits of ADHD medications, with improvements in academics and many other aspects of life. As examples, Dr. Robyn Powers in a 2008 Journal of Child and Adolescent Psychopharmacology report showed that adolescents, off medication by then, were doing better academically if they took medications when younger than others students with ADHD who never did; one from the Journal of American Psychiatry by Dr. Tomohiro Nikao in 2011 documents a trend towards normalization of brain functioning in those who took medications as children. And the Times article fails to mention that recent, larger studies of ADHD medication do not suggest any persistent growth changes. Meanwhile, while any medication has potential side effects, simply allowing a child to regulate their own behavior well enough to succeed in school, socially, and to have an easier relationship with their family even for a few years has a profound impact on their long term well-being.
It is sad to see these ADHD myths perpetuated. We need to reach out to families that are dealing with it by acknowledging their struggles. A child with ADHD has a developmental delay in their capacity to manage life - and an ADHD diagnosis helps us define the supports they need at home and school to thrive, separate from decisions about medication. Medication itself has been shown, to the best of anyone's knowledge to date, to be at minimum a useful option that does not have long term side effects. Suggesting otherwise lets down children and parents alike.
Originally Published in Child Development Central on February 8, 2012.
