If you missed part 1, please click here: Part I: The Truth Behind “10,000 Toddlers” Report.
In this continuation, I examine one aspect of problematic reporting on ADHD. Then, I offer the guidelines from a legitimate ADHD expert on the cases when treating toddlers with medication can be warranted.
The New York Times‘ Alan Schwarz continues to seek sensation in the “click-bait-osphere” by relying on media gadflies and fringe figures as sources (e.g. Allen Frances, Larry Diller, etc.).
Meanwhile, legitimate experts continue to perform legitimate research, including that for establishing guidelines for treating ADHD in young children. (Click here for a review.)
These legitimate experts understand the complex nature of ADHD, and the nature of its 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 they are busy working. They don’t hire PR firms to place them in the Times op-ed pieces (that’s how those fringe players get there, you know; it’s not due to the op-editors doing their job). Real experts don’t have time to fritter away on Psychology Today or Huffpo blogs. Most would even consider that demeaning to their profession and integrity. So, I will share some important excerpts of their perspectives on treating young children with ADHD below.
Sidenote: HuffPo founder Arianna Huffington is an infamous ADHD-denier (see previous post).
Shameless Marketers Fueling Anti-ADHD Fury
When it comes to what’s fueling anti-ADHD hysteria, we cannot overlook this shocking post from Ned Hallowell, below, on his blog. He has a long history of muddying ADHD waters, but I find it truly breathtaking in its recklessness. Especially because he repeated it on the Fox airwaves later.
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.
According to Hallowell, all you slacker parents of young children with ADHD just need to pay attention to them and love them more. Then poof!—ADHD is gone. Moreover, medications for ADHD are all about parents seeking a “quick solution”?
This sounds straight from the anti-ADHD wingnuttery playbook, but it’s coming from an self-proclaimed ADHD expert. One who has sold his name to certifying chiropractors to treating ADHD. (Yes, chiropractors. He concocted a “protocol”—based on what, it is unclear, perhaps fantasy and pink smoke.) You can read about it at American Chiropractor.
Please explain to me how a psychiatrist goes on the national airwaves to tell 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 some kind of sanctified figure. But simply consider the facts of his actions. It’s all there in black and white—and video.
That sensationalist statement above landed Hallowell center-stage at Fox and Friends. But at what cost? Is greater fame and more money truly worth making life harder for sick children and their beleaguered parents—and fueling the anti-ADHD hysteria in this country?
Sorry to say, having ADHD does not always make one an expert at treating ADHD.
What legitimate, compassionate, and thoughtful ADHD expert would not be astounded at Hallowell’s abject denial of the very severe presentations and physiological effects sometimes created by ADHD?
- Telling an ignorant public what they want to hear, aside from being dishonest, is harmful to the common good.
- Judging parents he’s never met for their children receiving medical care he knows nothing about. (For years, he told audiences he “treats” his own ADHD with coffee.)
- Issuing a blanket dictum to “abruptly stop medication” for children he’s never seen and whose cases he knows nothing about is impulsive and mindless of consequences.
- If anything is “crazy,” it is Hallowell’s blog post and his grandstanding on national TV.
So, why am I the only one calling this out? It can’t be that I’m the only person left with journalistic standards, medical ethics, or a sense of foul play? Respected experts tell me they are reluctant to get into a “mud-slinging” contest with the attention-seeking gadflies; they hope that legitimate research and medical consensus will hold sway. So they take the high ground.
Unfortunately, I’m uncertain of the public’s ability to distinguish, especially given the overwhelming marketing presence of the hucksters online. The public seems to confuse having an MD or PhD with automatically being an authority. The public also confuses confidence with reliability. But someone must really say, “Stop.” The stakes are too high.
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, who 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.”
Manos Describes His Team’s Research:
“In a naturalistic study of a community sample of young children with ADHD, we examined the quality of behavioral response, and we delineated the side-effect profile of 4- to 5-year-old preschoolers naive to previous psychostimulant treatment. Our preschool sample is not unlike children who might present in typical pediatric practice for treatment of symptoms of ADHD.
“The study provides support for the short-term efficacy and safety of psychostimulant medications for preschoolers. Behavioral ratings improved for all children across home and school settings, with 82% of the children receiving clinical ratings of normalized behavior on their optimal dose of medication. In addition, undesirable side effects did not differ from the profile one might see in older children (6-12 years).
“Many parents reported more side effects during the baseline and placebo weeks than during the best dose week. (This result is reported in other studies as well.) Irritability and diminished appetite are often cited as side effects of stimulant use in young children, but it is important to note that irritability also appears to be a by-product of the disorder itself. Baseline data from our sample indicated that over 33% of preschoolers were rated as irritable by their parents before medical management. These reports are consistent with Connor’s review in which he argues that preschoolers benefit from stimulants, side effects appear minimal, but great care should be used in the diagnostic process.”
These Children Are Individuals, And their Cases Complex
No legitimate expert is going to rush in and medicate a young child, especially a child under four, when behavioral strategies are in order—or possible. Each child’s case involves many factors and much deliberation. But this hysteria, fueled by ignorant physicians, sharp-elbowed reporters, and concocted numbers, offers no gray area. It’s all sensation all the way. Because that generates web traffic.
With this latest hit piece from The New York Times and Alan Schwarz, the Internet is today absolutely 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.
Please speak out against this co-option of rational discourse by a hits-hungry media and physicians 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