A specialist in attention deficit takes on — and corrects — the "facts" about ADHD.
by William Dodson, M.D.
It seems that the New York Times subscribes to the belief that children do not ever have mental disorders, so it follows that the treatment of mental disorders is a scam by pharmaceutical companies. Anyone who disputes this view, or who looks at the evidence, is labeled a bought dog of the drug companies and a bad physician.
The Times article, "Attention Disorder or Not, Pills to Help in School", which ran last week, claims that some physicians allegedly try to battle inequality by providing low-income children with bogus ADHD diagnoses in order to justify their stimulant prescriptions. The author offers no evidence for this assertion. He gets his "facts" from people who share his fears that medications are being misused.
Fear-based opinions from people who don't like the "idea" of mental conditions in children are not the same as facts and evidence. The author's supporters also reveal that they have not read any of the research literature in the last two decades. Ignorance, bias, and unfounded fears do not make a firm foundation for deciding what is in the best interest of a child.
Let's see if I can correct some of the more egregious disinformation:
1) The rate at which ADHD is diagnosed and treated in children has not increased in almost a decade. The increased rate of ADHD diagnoses is almost entirely due to adults over 18 years of age being diagnosed with the disorder.
2) The author gives us his thesis statement -- that ADHD is not real -- in the second paragraph. He says it is made up and an excuse for bad parents. This will come as a surprise to almost every professional medical organization in the United States, along with the CDC and the FDA. The author searched out the one physician who thinks he knows that ADHD is a fabrication of drug companies and lazy parents.
3) The author states that as school budgets have been cut to the bone during the last six years, in-school interventions and special individualized behavior plans have been dropped because they are costly. While this is partially true, the fact is that schools and teachers have never been trained or are psychologically ready to perform these activities.
Although it is currently popular to malign teachers as having only their own interests at heart, this is an example of school systems stepping in when they have no mission, training, or support to be mental health workers. The real culprit in this is the insurance companies, who have the legal obligation to treat mental disorders but who have denied benefits by declaring that many children have "educational problems" that are not covered by benefits.
4) The author directly says, or puts in the mouths of his selected group of people who agree with him, that medications are substituting for other non-medication based therapies. Since the writer has no use for facts and research, he is blissfully unaware that all of the non-medication therapies have been definitively shown to have absolutely no lasting benefits. The most recent Guideline Update from AACAP (2007) backs that up.
5) The author states that ADHD medications are dangerous, addicting, and expose children unnecessarily to harm. If they were addicting, it flies in the face of Nathan Capone's research. It shows that people with ADHD do not stick with treatment precisely because they have ADHD. Capone showed, in a study of 10,000 children and adults, that 50 percent never filled the third prescription and that 85 percent were no longer filling prescriptions at nine months. To put this into perspective, schizophrenics have a 50 percent adherence rate at one year; psychotics have three times the rate of sticking with medications than do people with ADHD.
The biggest problem in the ADHD field is getting patients to continue taking medications that they will need and from which they will benefit their entire lives. The author still tries to scare his readers into believing that medications are dangerous when the fact is that all of the first-line stimulant medications are FDA-approved in all three stages of pregnancy! It is impossible to rationally support the idea that these medications are harmful, but the author is not concerned with accuracy or facts based on research and 100 years of clinical experience.