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Wednesday, February 26, 2014

Educating Doctors About A.D.H.D. Without Resorting to ‘Ritalin Wars’

From The New York Times Blog "Motherlode"
Adventures in Parenting

By K.J. Dell'Antonia
February 18, 2014

Not long ago, amid what felt like a rising tide of criticism of parents of children who were being medicated for attention deficit hyperactivity disorder (A.D.H.D.), readers in this space complained, and I joined them.

It’s offensive, we said, to accuse parents (and teachers, and doctors) of using drug treatment to get “off the hook” for more complex problems, or teaching children to “reach for a pill” instead of finding another way to cope with a problem.

It’s also useless. If A.D.H.D. is being over-diagnosed or overmedicated, pointing fingers won’t help either children who do need treatment or those who need something else.

Laguna Design/Getty Images The Molecular Model of Ritalin.

What could help is more and better research into the drugs often prescribed to children diagnosed with A.D.H.D., and better diagnostic tools for the doctors on the front lines — most often pediatricians and family doctors, not mental health specialists.

That last is the mission of Dr. Peter Jensen, a child psychiatrist who offers intensive three-day training sessions to pediatricians and other medical providers on how to properly evaluate children’s mental health issues – especially attention deficit hyperactivity disorder. The Times’s Alan Schwarz describes the training, and notes that many who participate come because most (other) such training is “staffed and shaped by pharmaceutical companies.”

Dr. Jensen’s sessions carry an awareness that the numbers do suggest a problem with A.D.H.D. as a diagnosis. According to the Centers for Disease Control and Prevention, almost 20 percent of all boys receives a diagnosis of A.D.H.D. by the time they turn 18. That one-in-five statistic worries many.

But the training offered by Dr. Jensen’s nonprofit, the Resource for Advancing Children’s Health Institute, comes without the air of accusation that accompanies much that has been written about the topic, like the forthcoming “A.D.H.D. Does Not Exist” by Dr. Richard Saul. As much as A.D.H.D. treatment may need to evolve, such titles invite defensiveness, not change.

That change is needed is further suggested by the February, 2014 article in Nature magazine, The Smart-Pill Oversell, which examines a number of recent studies suggesting that the behavioral changes associated with the use of the stimulants often prescribed for A.D.H.D. “do not translate into better academic achievement or even social adjustment in the long term.”

It’s not a sensationalistic article, but rather, one that understands that those behavioral changes may be enough in themselves to warrant drug treatment. But like Dr. Saul’s book, its headline does not invite parents to read with an open mind.

Most parents who medicate a child who struggles in environments that are easy for most children come to that choice with great deliberation and often reluctance. To tell such a parent that he or she has been “sold a smart pill” is to invite that parent to click on something less judgmental, or to respond, not with thought and consideration, with a screed of his own.

To suggest, instead, as Dr. Jensen hopes more medical care providers will do, that it is better to look long and hard for even a more difficult and complex solution than to get an A.D.H.D. diagnosis wrong is something that few would disagree with. Similarly, most of us want to be sure that the hypothetical pushy father who wants an Adderall prescription for his daughter to improve her grades is turned away.

It’s when we try to lump everyone into one category, whether it’s one that encourages the use of medication to treat A.D.H.D. or one that condemns it, that we stop being open to finding the right solution for individual children and families.

Read more about A.D.H.D. and treatments on Motherlode:


  1. I agree with everything you stated here. Hope more doctors will get those training . It is a must. Most doctors don't know how to treat or diagnose this disorder the right way and people with the disorder are the victims.

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