November 15, 2007, 9:52 pm
Here we go again, I thought. Another round in the Ritalin wars.
I barely had to read beyond the first two paragraphs
Educators and psychologists have long feared that children entering school with behavior problems were doomed to fall behind in the upper grades. But two new studies suggest that those fears are exaggerated.
One concluded that kindergartners who are identified as troubled do as well academically as their peers in elementary school. The other found that children with attention deficit disorders suffer primarily from a delay in brain development, not from a deficit or flaw.
to know what the reaction to the story would be.
A ground-breaking new National Institute of Mental Health brain imaging study showing that the brains of kids with Attention-Deficit Hyperactivity Disorder were delayed in development? Indications that some kids eventually outgrow their symptoms? A major education study by researchers at a number of prestigious universities finding that bad classroom behavior (read: ADHD, as most readers did) doesn’t lead to later academic failure?
Ammunition for the let-kids-be-kids critique of attention deficit hyperactivity disorder. Vindication for all those who believe that ADHD isn’t a “disorder” at all. Validation for all those freewheeling, high-spirited kids who can’t shut up or sit still. And, of course, scientific confirmation for the view that to medicate kids with attentional or behavioral issues is unnecessary, potentially injurious and cruel.
“First, get the child off pills!” wrote “Hazel,” one of the first posters to the site the Times set up to welcome reader comments.
“It is a shame to treat normal children with drugs because they are a bit slow in development and are being forced to do things above their maturity level,” concurred “jayne.”
“We are medicating children to conform to chronological age expectations when we should be allowing them to develop at their normal pace,” said “Lee.”
“The fact that so many kids grew out of their A.D.H.D proves that parents, and doctors have been turning a whole generation of American children into drug users, unnecessarily,” said “Jo.”
“So much anger unleashed here,” added “ald.”
I came away from reading the Times and from listening to NPR (“Good news” announced Diane Rehm. “The brains of children who suffer from ADHD develop slightly later but without any long-term impairment”) wondering if everything I’d learned about ADHD in three solid years of book research was wrong.
After all, as I’d come to understand it, ADHD is a disorder that dogs most sufferers throughout their lives. Its durability is part of what qualifies it as a “disorder,” distinct from, let’s say, situational, stressed-out or anxious distractability, childish immaturity or plain old bad behavior.
Not only does ADHD tend to last, I’ve read, and heard, again and again, it’s associated with all kinds of bad outcomes over time: increased rates of depression, anxiety and substance abuse, and low self-esteem, at the very least. It was hard to believe that the new “good news” could turn decades of research on its ear. It was troubling, too.
So, as the brain imaging study wended its way through the week’s news cycle, I contacted some of the leading minds on the subject of ADHD, including psychiatrists Philip Shaw, the lead author of the NIMH study, and Judith Rapoport, a co-author. I asked these clinicians and researchers if my understanding of ADHD had now been proven all wrong.
Had ADHD finally been shown to be a rather trivial disorder, of a type with the waywardness of natural boyhood, better left untreated, best handled through maturation, unconditional love and chemical-free good living?
Rapoport, who has been Chief of the Child Psychiatry Branch at the NIMH since 1984, was momentarily struck dumb by the question.
Shaw said, “That’s certainly not what I would take away from this study.”
Greg J. Duncan, a professor in the School of Education and Social Policy at Northwestern University and the lead author of the school study, was somewhat mystified that his research – which attempted to understand the links between kindergarteners’ math, reading, attention-paying and “socioemotional” skills and their later academic achievement – was being discussed in the same breath with ADHD at all. The study, he said, wasn’t “about clinical levels of attention problems.”
This was true. Duncan’s research didn’t measure the effect of ADHD on future achievement; in fact, it made no mention of ADHD at all. There was mention of “attention skills” and “attention problems” — which did correlate with lesser academic achievement — and there was talk of “externalizing” behavior (“anti-social behavior, losing your temper, getting in fights, being disruptive,” as Duncan defined it for me).
But neither attention problems nor bad behavior are synonyms for the very specific, clinically significant, impairment-causing disorder that is ADHD. “The term disruptive behavior hardly equates to the clinical diagnosis of ADHD,” Russell A. Barkley, author, most recently, of “ADHD in Adults: What the Science Says,” and of “Taking Charge of ADHD: The Complete, Authoritative Guide for Parents” told me via email.
In the popular mind, though, it does.
In fact, we tend these days to think that bad behavior – and bad boy behavior in particular – has been made synonymous with ADHD (“We used to have a word for sufferers of ADHD. We called them boys,” quips a psychoanalyst in Christopher Lane’s new book, “Shyness: How Normal Behavior Became a Sickness”). Our thinking this, however, doesn’t mean that it is so. No matter how many times, or how fervently, the cliché is repeated.
“It’s a shame the whole thing is so politicized,” said Edward Hallowell, whose 1994 book, “Driven to Distraction,” co-authored with John J. Ratey, put attention deficit on the national map.
ADHD belief, Hallowell sighed, has become like “religion.”
Years of research back up the basic assertions of the NIMH study: that there are biological differences in the brains of people with ADHD, and that some people see their symptoms disappear over time. (Fully two-thirds of ADHD sufferers don’t get entirely better, though, Shaw stressed to me. Their symptoms live on into adulthood and are “greatly impairing.”)
So why, this week, did the gloves come out, with the armies of all that is Good taking on the usual forces of Evil psychopharmacology? Why did my stomach drop so quickly to my knees, why was I so quick to think it possible that, after countless interviews and lectures and hours of reading, I’d simply fallen for a hoax manufactured by the drug companies and wrested upon the innocent?
Facts don’t have much sway when you’re in the grip of a religion. And the beliefs underlying the Ritalin wars (I am using “Ritalin” here as shorthand for the whole practice of diagnosing children and treating them with psychotropic drugs) have truly now become like a creed. They’re only superficially about diagnosis and medication. For most people, they’re more profoundly about a sense of menace bearing down upon the world of our children.
There’s a sense that greater powers, profit-driven and amoral, are pulling the strings in our children’s lives. There’s a sense that those who should best protect us — our government and our doctors — are so corrupted that they can no longer do the job. There’s a sense that childhood has, in many ways, been denatured, that youth has been stolen, that the range of human acceptability has been narrowed for our kids to a point that it has become soul-crushingly inhuman.
I share all these feelings. I think that most of us do. But where I differ (now) from those eager to pile onto the anti-ADHD bandwagon is that I’m not willing — anymore — to sacrifice real children and their parents on the altar of ideology.