Did you miss Part 1? Please click here: Part I: The Truth Behind “10,000 Toddlers”.
Here in Part II, I continue to educate the public on why it’s sometimes wise to medicate young children for their ADHD symptoms.
The public must be helped to understand: ADHD is not just about “bad behavior”—or even “focus.” Dopamine affects many physiological processes throughout the body.
A second motivation: Connecting “cause and effect”. That is, when The New York Times publishes an inaccurate story about ADHD that whips up public fury, it can over time affect public policy. I explain below.
Bottom line: Irresponsible reporting hurts everyone.
Toward that end, this post:
- Offers the guidelines from a legitimate ADHD expert on the cases when treating toddlers with medication can be warranted.
- Examines the dangers of a self-proclaimed ADHD expert using these public controversies as opportunity to self-promote rather than educate.
- Suggests a link between The New York Times anti-ADHD reporting and the recent CDC guidelines on treating ADHD in young children.
Most of you are familiar with the long-running attacks that The New York Times has long waged on psychiatry. It pre-dates Schwarz—but probably not his supervising editor.
The paper’s crusades include performing the unscrutinized bidding of Senator Chuck Grassley (R-I) in persecuting pediatric psychiatric researchers. I touch upon it in this post (Dr. Thomas E. Brown Responds to NYT’s Alan Schwarz), which includes a rebuttal to the paper from preeminent ADHD expert Thomas E. Brown, PhD..
The fact that bipolar disorder exists in children seemed unfathomable to reporters Benedict Carey and Gardiner Harris. So, they unleashed a firestorm against leading researchers in the field of pediatric psychiatry, including some who are also experts in ADHD.
More recently, sports reporter Alan Schwarz has issued a series of sensationalized stories on ADHD. He uses sources who are little more than media gadflies, fringe figures, and the long-retired yet seeking a soapbox (e.g. Allen Frances, Larry Diller, and Keith Conners).
Here is the latest piece: Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries.
[Are you wondering about the periods between the letters in ADHD? That is The New York Times style. Only that paper insists on this non-standard spelling. It is also the title of Schwarz’s new book, A.D.H.D. Nation. I found it a lamentable cobbling together of his terribly reported stories, along with dramatic storytelling around “Big Pharma Is Out To Get You!”]
In Part I, I explain the slapdash way in which Schwarz manipulated the data on which his “hard hitting investigation” is based. I also explain the various potential physical fallout from ADHD.
The Medical Consensus: Some Young Children Need ADHD Treatment
While the craziness tends to dominate on line, the real world has legitimate experts performing legitimate research and treatment.
That includes establishing treatment guidelines for ADHD in young children. Click here for a review: “Clinical diagnosis and management of attention deficit hyperactivity disorder in preschool children.”
These legitimate experts understand the complex nature of ADHD. They understand the breadth and depth of its associated suffering. They understand that ADHD is not just about “behavior.” It has physical fallout as well.
You don’t hear about these experts as much because
- These legitimate experts understand ADHD’s complex impact on neurobiology—and that neurobiology’s impact on the rest of the body.
- They understand the breadth and depth of its associated suffering for the patient and the family.
- They understand that ADHD is not just about “behavior” but can also create physical fallout as well.
The public hears little from these experts because:
- They are busy researching and treating patients.
- They don’t hire PR firms to place their perspectives in the Times op-ed section. (Psst. Did you know that’s how C-list experts get published there? It’s certainly not the section’s editors doing their job and seeking qualified opinions.)
- They don’t have time to fritter away on self-promotional, non-edited blogs at Psychology Today or Huffpo Sidenote: HuffPo founder Arianna Huffington is an infamous ADHD-denier (see previous post).
- Most would consider such skewed self-promotion demeaning to their profession, integrity, and respect for the study of ADHD.
- Reporters are being “fed” experts from PR firms or by “copy catting” other stories. They are not digging up original sources.
Therefore, I will share some important professional perspectives on treating young children with ADHD below.
The Nuanced View From A Serious Expert
Below, you’ll find excerpts from a thoughtful, nuanced piece on the topic by a legitimate expert. Michael J. Manos, PhD, heads the Center for Pediatric Behavioral Health at The Cleveland Clinic and has an impressive record of research:
- “One study of children age 3 and younger in the Michigan Medicaid system found that 44% had problems that coexisted with ADHD, 41% had chronic health conditions, and 40% experienced other injuries.” [Note from Gina – Remember: ADHD can present physical infirmities and risks, not just “behavior problems”.]
- “Severe ADHD in children 2-4 years of age is especially problematic. Young children do not have the ability to use or respond to language to moderate behavior that older children have; subsequently, behavioral interventions often have limited effectiveness. Young children may not make associations between instructions and rules and the consequences of violating them; subsequently, hyperactivity and impulsive behavior are relatively immune to psychosocial intervention.”
- “Although early treatment of ADHD tends to yield more favorable outcomes, no gold standard has yet emerged for treatment of preschoolers assumed to have ADHD.”
- “Symptoms most likely to be associated with ADHD at young ages are chronic motor restlessness; noncompliance; vigorous, persistent activity level; and destructive play. Children may require constant parental monitoring because they show excessive emotional outbursts (ie, tantrums) that are intense and frequent.”
- “Such children also often have difficulty completing developmental tasks such as toilet training and sleeping in their own beds, and they may demonstrate delays in motor or language development.”
- “Such behavior significantly affects family life as parents have difficulty obtaining and keeping babysitters, and a wife and husband may find their relationship with each other faltering given the constant attention to childcare and behavior control.”
- “The guiding question of medication management in young children with severe ADHD is whether or not the benefit of treatment significantly improves the quality of life for the child and the family. A 2-year-old child with severe hyperactivity and chronic impulsive behavior who is shuttled from one foster family to another has a poor prognosis. That same child, treated, may have a chance of stability in the early years.”
Update: A Brief Digression
Update: October 19, 2016
This two-part post originally appeared on my blog in in 2014, when the story first came out. My motivation: Knowing clearly that there would be long-lasting and damaging repercussions. I was right, unfortunately.
Please note this portion of one of the bulleted items above:
Young children may not make associations between instructions and rules and the consequences of violating them; subsequently, hyperactivity and impulsive behavior are relatively immune to psychosocial intervention.
That’s why the CDC’s new treatment guidelines for pediatric ADHD are so problematic. They insist that behavioral therapy be emphasized over medication.
Russell Barkley, PhD, and I countered that unsubstantiated recommendation in this post: Hey CDC? Why Misinform About ADHD?
Do you think this turn of events is simply coincidence? That these CDC guidelines came out after Schwarz’s campaign had time to percolate up from public opinion to public policy? I do not.
All actions have consequences, and this has been a horrible after-effect for the ADHD community.
Self-Promoters Fuel Anti-ADHD Hysteria
When it comes to factors fueling the anti-ADHD-medication hysteria, we cannot overlook Ned Hallowell, MD.
He posted this shocking message, below, to the public on his blog in response to the “10,000 Toddlers” piece.
It is truly breathtaking in its recklessness. Especially because he repeated it on the Fox & Friends TV airwaves.
Here it is, in its entirety:
Dr. Hallowell: It’s Crazy to Give Toddlers ADHD Medication
People are looking for a quick solution for an age old problem of rambunctious children. We should play with them and take care of them instead. Long term effects are not understood. Controlled substance is not a trivial intervention.
Instead, human connection is the better solution – albeit labor intensive. Physicians that are well-trained do not give into the pressures of the parents.
Dr. Hallowell recommends abruptly stopping medications (no side effects) and instead spending time with them.
Let’s unpack this.
According to Hallowell, parents of young children with severe ADHD simply need to pay attention to them. Love them! Do that and poof! The medical condition called ADHD, with its far-reaching impact on the body and brain, is gone.
Furthermore, parents giving their children medications for ADHD are seeking a “quick solution”?
It sounds straight from the anti-ADHD wingnuttery playbook, doesn’t it? Yet, it comes from an self-proclaimed ADHD expert—albeit one who says he eschews medication himself.
[As an aside, Hallowell has also sold his name to certifying chiropractors to treating ADHD. Yes, chiropractors. You can read about it at American Chiropractor.]
Please explain to me how a psychiatrist takes to the national airwaves telling parents he’s never met, to stop giving children he’s never examined, medication prescribed by a physician he’s never consulted with—and keeps his medical license.
I know this will not sit well with some of you, who consider Hallowell a sanctified figure. But simply consider the facts of his actions. It’s all there in black and white—and video.
Actions have consequences, Ned Hallowell. Your going on Fox and Friends to decry this horrible “medication toddlers” phenomenon was opportunistic at best, destructive at worst.
These Children Are Individuals, Their Cases Complex
No legitimate expert will rush in and medicate a young child when behavioral strategies are in order—or possible. That’s especially true for a child under four.
Each child’s case involves many factors and much deliberation. But it should not involve hysteria, fueled by ignorant hucksterish physicians, sharp-elbowed reporters, and concocted numbers.
Real children’s lives are at stake.
With this latest hit piece from The New York Times and Alan Schwarz, the Internet today finds itself sodden with disinformation and misplaced anger.
If you think this eventually won’t affect public policy, including insurance coverage of ADHD and access to medication, I fear you are much mistaken. [Sadly, I was right. See updated note above.]
Please speak out against this co-option of rational discourse. Avoid the hits-hungry media and hucksters who are more interested in high speaking fees than doing the right thing.
Much depends on your taking action and refusing to let the self-promoters ruin it for everyone else.
I welcome your comments. It’s easy – no annoying codes to deal with. — Gina Pera