The Media: Getting a Lot Wrong about ADHD — Again

A new front-page article about attention deficit in the New York Times is inaccurate in places, outdated in others, and unnecessarily frightening to many people.
Speak Up, Please | posted by Thomas E. Brown, Ph.D.

It seems irresponsible for such a reputable newspaper to present such information without more careful attention to underlying assumptions that may be inaccurate, outdated, and unnecessarily frightening.

The front page of the New York Times on Sunday, December 15, 2013, featured an article, “The Selling of Attention Deficit Disorder,” by Alan Schwarz. It says that the number of diagnoses of ADD soared amid a 20-year drug marketing campaign. This lengthy article says that “classic ADHD,” historically estimated to affect 5% of children, is a legitimate disability that impedes success at school, work, and personal life.” It also says, “medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.”

In his piece, Schwarz describes in detail how several pharmaceutical companies have waged extensive campaigns to educate physicians and parents about ADHD and to promote their medications used to treat ADHD. He also provides a number of examples that show that pharma advertising or physicians have made excessive claims for the potential benefits of these medications, have minimized potential risks of treatment, and have made inadequately supported statements about the disorder. Many of these examples warrant criticism.

Yet Schwarz’s article is seriously flawed in four important ways:

1) It assumes that the substantial increase in ADHD diagnoses over the past 20 years is due to pharma companies seducing doctors and parents into medicating children needlessly for problems that are trivial or nonexistent. It shows no real grasp of how science-based understanding of ADHD has substantially changed over the past 20 years from the “classical” focus on young children with disruptive behavior. Schwarz does not recognize that this disorder is now understood as developmental impairment of the brain’s management system — its executive functions. He sees efforts to address these problems in adolescents and adults as just a search for more people to medicate rather than as recognition that many, though not all, who have ADHD in their childhood continue to suffer from these impairments throughout adolescence and, in some cases, much of their life.

2) Schwarz claims that ADHD now is understood as including “relatively normal behavior like carelessness and impatience.” While it is true that all of the characteristics of ADHD occur for most people some of the time, legitimate diagnosis of ADHD requires that these problems significantly impair the functioning of the individual in ways that are inconsistent with usual expectations for the person’s age and negatively impact the person’s functioning — not just occasionally, but persistently for more than half a year.

3) The article begins with an alarmist quote from Keith Conners, a retired researcher in ADHD, who recently lamented that the rising rates of diagnosis are “a national disaster of dangerous proportions…a concoction to justify giving out of medications at unprecedented and unjustifiable levels.” Both Conners and Schwarz apparently assume that the incidence rate for ADHD should remain forever set at that earlier level. They do not allow for the possibility that the earlier estimate may have been incorrect or that the more recent science-based understanding of ADHD may describe a problem that impairs a larger number of children and adults.

4) In this article and several earlier articles in the Times, Schwarz correctly emphasizes that medications used to treat ADHD can have serious adverse effects. This is true of any medication, including such common over-the-counter medications as Tylenol. Yet he tends to exaggerate the risk of severe adverse effects — “cannot sleep for days, lose their appetite or hallucinate” — by not mentioning that hallucinations due to these medications are quite transient and extremely rare. Nor does he note that problems with sleep or appetite can almost always be alleviated without any significant or lasting harm. If prescribed medications are not effective or cause any significant adverse effects, any responsible prescriber will correct it with dose adjustments, medication change, or discontinuation.

It is reasonable for the Times to make readers aware of problems, such as the ones Alan Schwarz describes in his article. But it seems irresponsible for such a reputable newspaper to present such information without more careful attention to underlying assumptions of the piece that may be inaccurate, outdated, and, for many readers who may be struggling with this disorder, unnecessarily frightening.

Thomas E. Brown, Ph.D., is a clinical psychologist and associate director of Yale Clinic for Attention & Related Disorders at the Yale University School of Medicine. You can reach Dr. Brown at www.DrThomasEBrown.com.

 
 
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