Abstract
Unfortunately, the piece uses this abuse to question the validity of the diagnosis and ignores what this first-line treatment means for children who are legitimately impaired. We should be very concerned about the twin problems on display here: on the one hand, no child should receive an improper diagnosis or improper and unnecessary treatment. On the other hand, no child should be denied effective treatment for ADHD because of hostile public attitudes and stigma.
With this article the Times is continuing their series of pieces attacking ADHD medications, this time extensively quoting Dr. Michael Anderson, a pediatrician who says he does not believe ADHD is a real condition but prescribes medications for it anyway. Dr. Anderson says that the ADHD diagnosis is “made up” as an “excuse” so that doctors can prescribe medication for kids who are “mismatched with their environment,” in this case school. And that is what he does—gives stimulant prescriptions to kids who are not succeeding in school. “People who are getting As and Bs, I won't give it to them,” he says. He also says that society is unwilling to fix these underfunded schools, to match them to the needs of his young patients. “We've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid.”
There is a rather large kernel of truth in what Dr. Anderson is saying, but it is clouded by his apparently willful iconoclasm and Schwarz's reporting. It is true that some of the increase in ADHD diagnoses in recent years is very likely linked to the heightened demands our society places on children to succeed in school. But in no way does this mean that the solution to poor grades—or to a poor school—is stimulant medication.
Conflating school failure and ADHD is a mistake that does a disservice both to children who have ADHD and to those whose problems in school need other kinds of attention.
We believe this story and many others like it reflect the public's continued resistance to giving psychotropic medication to any children, including the ones who really do need it. In this story the reporter repeats many familiar prejudices and misconceptions about drugs used to treat ADHD. He wrongly calls stimulant medication “particularly addictive” even though we know it is very safe when taken in the dosage prescribed by and under the supervision of a competent doctor. He also claims that the long-term effects of extended use is poorly understood despite us having used these medicines to treat ADHD for nearly 50 years with zero evidence of negative long-term effects.
And this instinctual wariness about the combination of children and medication has become so pervasive as to bring into question a diagnosis we all know is real and clinically useful. All medications are sometimes misprescribed. There is a great deal more abuse of pain medication—and with fatal consequences—but that does not make people argue that pain is not real or that some people do not need pain medication.
That the press is no friend to child psychiatry is very clear. Unfortunately this puts parents in a difficult position because they read these reports in the paper, or hear them on television, and some of them will be faced with the decision of putting a child on a stimulant medication, or continuing to use one. We encourage everyone in the field to keep an eye out for these stories and be ready to respond to them when a patient asks, because families deserve to hear the truth.