ADHD and Medication
How did the ADHD diagnosis come about in the first place? According to Dr. Saul, it has, from the first, been tied to pharmaceuticals. “[In] 1937, Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant . . . “1
That’s interesting. But what does responding well mean?
According to Dr. Alan Sroufe, a psychologist with forty years of experience working with troubled children, “Attention-deficit drugs increase concentration in the short term.”2
Yes! So if the goal is to get kids to stop being impatient and pestering, to get them to sit still in their seats and focus on their worksheets, drugs might be the answer.
But if our goal is a more long term one – developing social awareness, self-regulation capacities, creative problem solving abilities, even improving garden-variety academic achievement – our answer might be different. “When given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.”2
But what can we call that collection of eighteen symptoms that the DSM describes as ADHD? A patient has to only exhibit five of these symptoms for the diagnosis. According to Dr. Saul, “In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.
For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. . . For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.”1
Dr. Saul’s recommendations are slanted toward his adult clients. But, adapted, these recommendations suggest a reasonable way to look at children as well. Why don’t most pediatricians follow Dr. Saul’s model?
Some of the reason seems to be historical: “Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert.”1
What is wrong with treating ADHD – or any diagnosed condition - with drugs? Isn’t that what is recommended by most doctors, whom parents trust for accurate information about their children’s medical conditions and the best ways to address them?
But according to Harvard’s Dr. Marcia Angell, editor of the New England Journal of Medicine for more than two decades, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”3
Why?
“No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top 9 U.S.-based drug companies that it comes to tens of billions of dollars a year in North America alone. By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease.”4
Which brings us full circle to ADHD – a disease “discovered” when a stimulants were found to reduce unwanted behavior in children – in the short term. According to Dr. Alan Sroufe, “To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve.”2
If ADHD is not the cause of difficulties in academic performance, peer relationships, behavior problems, what is? And how can we address these issues in a way that reaches to the core?
Stay posted. We'll continue to explore.
1Doctor: ADHD Does Not Exist by Richard Saul, Time, 3.24.2014
2Ritalin Gone Wrong by L. Alan Sroufe, New York Times Sunday Review, 1.28.2012