ADHD Cyber Command On The Watch!

There’s a cartoon floating around among my Facebook friends. One character says: “Come to bed, honey.” And the other character, at the computer keyboard, says, “I can’t. Someone is saying something wrong on the Internet, and I must correct it!”

For 10 years, I’ve resembled that character, rat-a-tat-tatting at my keyboard to counter fallacious information about ADHD on the Internet. The latest just this morning, which as both an ADHD advocate and responsible journalist, was too hard to resist.  (If you’d like to skip my preamble, scroll to the end of this post to get to a recent CNN article and my response to it.)

And yes, it’s been a  personal mission, though it hasn’t kept me up late at night and I aimed for surgical strikes, not omnipresence.   As a writer and editor with a long-held reputation for fairness and accuracy, though, I’ve found this new “medium” of the Internet by turns extremely exciting yet unsettling.

The Power of the “e-Printed” Word

Words are powerful, the printed word even more so.  Yet anyone with a keyboard could suddenly “print” anything at all and distribute it instantly to masses of people without  regard for accuracy or the real-life impact on real-people’s lives   We’ve all seen in recent years that a hefty percentage of the American public  lacks the critical-thinking skills to parse this deluge of electronic information. I felt  it worrisome, especially when it came to ADHD, because so much was at stake.

My husband, sitting in the next room, could always tell when I’d hit upon an especially egregious bit of mis- or disinformation on ADHD online. “It sounds like machine-gun fire in there!” he’d call out. And, in a way, it was.  I was fighting with the only weapon I had: my keyboard.  Soon he was calling my office “ADHD Cyber Command” and suggesting appropriate logos, something along these lines (see image above right). Submissions for a real ADHD Cyber Command logo welcomed!  An autographed copy of my book, and my thanks, to the winning design.

Fortunately, Internet-based information on ADHD has improved greatly in the last two years. What a relief! Maybe it’s critical mass. Or maybe something to do with a “sobered” economy leaving little room for happy stories and snake-oil remedies that are devoid of all usefulness except short-term distraction.  As for the anti-psychiatry wing-nuts, they even seem less omnipresent; perhaps they just got bored and moved on.

Who Decided That  Story’s “Expert” is Truly an Expert?

At the same time, however, the long-dreaded deleterious impact of “corporatization” on the major media seems to have fully settled into status quo. What’s worse, the Internet has given the  major media the capacity to broadcast its more poorly done stories to even larger audiences — in the blink of an eye.

I know what a busy newsroom in like. I used to work in one, and for a salary  much  lower than those at The New York Times, CNN, CBS, etc. But I never accepted that as an excuse to choose poorly vetted sources for a story or to accept without question whatever “expert” some PR firm was trying to palm off.  Yes, those canned “experts” often made easier interviews; they were readily available  and had been coached in the art of sound bytes, thus didn’t require the reporter to do much research (especially in the days before Google searches and voicemail when a writer or reporter had to schlep to the library, telephone sources to get recommendations of other sources, and so on). But they didn’t pass muster as a source until their credentials had been checked.

Moreover, we mostly found and vetted our own sources instead of copy-catting the omnipresent “talking heads” from other media outlets. (The public would be truly frightened to know how many news stories today are almost verbatim lifted from press releases.)

So yes, I take my news seriously. Even as a little kid, I was struck by the power of newspapers to educate and elevate. I remember being impressed by the Scripps-Howard logo on our daily Memphis Press-Scimitar:  a lighthouse beacon and the words “Give light and the people will find their own way.”

Today, ach…. Sometimes “the media” shines the right light on ADHD. Sometimes the beam is abysmally off-target. Sometimes it’s a mix. Trouble is, it takes someone already knowledgeable on the topic to see the flaws.

ADHD Cyber Command’s Latest Salvo

Today, a friend who is parent to a child with ADHD sent this link from CNN to me: ADHD: Who Makes the Diagnosis? As the parent of a child whose ADHD went unrecognized until a concerned teacher pointed to the possibility, he was duly chagined at the quotes from some of the “experts” in the story.  I credit the reporter for finding two excellent “real-life” sources and telling their stories well. But the “experts”?  Oh dear.

For some reason, CNN’s posting function isn’t working for my post. But ADHD Cyber Command will not be stymied or censored!   Besides, I’d like to share with you how a news editor  might have better vetted the sources in such a story. So, here is my response (below), a   much-lengthier version here than my attempted post to CNN’s comments section.

I hope every ADHD Roller Coaster reader will consider yourself an ADHD Cyber Commando, and when you can — a few minutes here or there — talk back to nonsense (and worse) about ADHD.  I believe even the shortest comment — “ADHD is real” — has an impact.

My comment to this CNN story:

—————

Several points here on this story, which contains three excellent sources (mother Amy Barr, teacher and mother Alana Morales and CHADD’s Clarke Ross) but some extremely questionable sources, and I say this as an award-winning journalist and respected newsroom editor:

1. Thank you for finding and quoting teacher and mother Alana Morales at length. She makes eminent sense on this complex topic and is a credit to her profession.  Also credit for mother Amy Barr’s honest and helpful account.  The reporter did an excellent job of weaving in their stories, which often countered the advice of the “experts” – and rightly so.

2.  I’ve visited the website for another of the story’s sources: psychiatrist Elizabeth Roberts. Frankly, it strikes me as unusually self-promotional for an “expert” who is not as well-known as her website suggests she is.

From the story: “Roberts estimates that only about 10 to 20 percent of children who receive the diagnosis of ADHD actually need medication.” On what does Roberts base this highly idiosyncratic opinion that is not supported by the published literature or a consensus of leading authorities on the topic?

Guess what? Some “experts” seek to carve out their niche in a crowded market of reasonable consensus by writing highly biased op-ed pieces that only fuel controversy and misinformation, such as this from Roberts in 2006: “A Rush to Medicate Young Minds.”

Her book’s ranking on Amazon is 462,076 and has only four reader reviews, all of which resonate with anti-medication sentiment. I’d like to know this reporter’s rationale in choosing Roberts, who has such obvious biases and fringe opinions (the 20% statement above), when so many more noteworthy and more balanced  medical authorities are available.

Beyond that, judging by her quote, Roberts needs to chill. Or try living in the real world for a few days.  Some physicians, you know, are a little “jealous of their positions” and really would do well to come off their high horse.

Many parents of children with ADHD have ADHD themselves (it’s genetic, you know), and often their first clue to this is when that child starts school (or starts “hitting the wall” in school) and a caring teacher points out the possibility.

In my experience, it is total anti-psychiatry wingnut myth that teachers are “diagnosing” children.  The mere suggestion of ADHD from a teacher, though, can be misinterpreted as a “diagnosis” from parents who are overly defensive and whose own emotional and/or cognitive state is a tad myopic.

Listen to teachers and mothers such as Amy Barr and Alana Morales, who truly know the cost of ignorance about ADHD and do their best to help other parents who might be unaware.  Moreover, they have  nothing to gain from sharing their stories but everything to gain for the future of their young charges and others like them.

3. Pediatrician Claudia Gold, another questionable source on such a story, strikes me as another MD who should climb down from her high horse and be grateful that someone or something out there in the real world  is cluing in parents to ADHD.

If  parents do indeed come to her asking about ADHD, she should welcome the opportunity to problem solve and clarify the issues instead of criticizing the factors that acted as the catalyst.  Too many pediatricians and family therapists miss the signs of psychiatric disorders. If the teachers and schools are issued a gag order to never even broach the subject, what will happen to those kids?

But again, I would ask CNN, who is this Claudia Gold, MD, and what was the rationale for quoting her in this story? This story doesn’t even identify her location. Since other sources are in SoCal, I’ll assume she is in Orange County and, according to a Google search, is a pediatric emergency physician.  As such, I see no listed credentials that would qualify Gold as a source for this story. As far as I can tell, she’s not even board-certified in psychiatry.  Generally, an ER pediatrician deals with issues such as appendicitis, asthma, anaphylaxis, etc., NOT neurocognitive conditions or even psychiatric conditions. What  kind o f evidence does CNN posesss for using Gold as a source on this story?

4. As for this source: Cheryl Rode, Director of Clinical Operations at the San Diego Center for Children in California. “Medication is quick and easy but it’s not the answer alone for working with kids who have ADHD.”

Wearing my newsroom managing editor’s hat, I’d consider this center and its representative another very poor choice of source, especially given the deficit of more solid experts.  And especially when San Diego has a nationally known expert far more qualified to interview about ADHD: psychologist Mark Katz at Learning Development Services in San Diego.

First, medication is NEVER quick and easy. Anyone who has had success with it knows that it can take much trial and error to establish an effective regimen with minimal side effects. So, that “quick and easy” statement is always a red flag to me of an anti-medication bias.

Moreover, I am extremely skeptical of a non-profit that calls itself the “center for children” and has what appears to be a surplus of marketing people on its staff and board but NO physicians.  Moreover, there is only one MD on its board — but an MD who markets consulting services but, as far as I can tell, does not practice psychiatry. How will this center’s staff know when a child will benefit from behavioral interventions and when medical ones are more appropriate, or at least an adjunct strategy. As for Ms. Rode, I see a “PhD” after her name on the center’s website but in what? And what is her training?

In fact, I think this center is a worthy candidate for further inquiry. For example, who truly profits at this non-profit and what kind of evidence-based medical treatments  might children be deprived of  — all under the auspices of this center’s “strength-based approach?”  These are questions a good local news editor should be asking.  In fact, I wonder why no CNN editor asked — and I definitely wonder why the writer chose so many questionable sources when we have such a wealth of excellent sources.

5. Finally, it is important to know that some parents with undiagnosed ADHD will “self-medicate” by hyperfocusing on their child’s problems or by fighting the school because the child is doing poorly.

No one would argue that our schools’ standards and methods can always be improved.  Sometimes a child’s poor progress in school, however, is not due to poor teaching but to the child’s unaddressed neurocognitive disorder. Even if the child is being medically treated, too often the treatment is far from optimal.

Additionally, some parents can also be extremely “in denial” about their own ADHD-related impairments as well as their child’s.  “Denial” with ADHD can be both psychological (defensive) and physiological (that is, the symptoms themselves can impair accurate self-reflection and objectivity about oneself or one’s child). A school cannot compensate for a chaotic home life.

An undiagnosed ADHD parent’s “self-medicating” by tussling with the school can cause all kinds of problems. For one, the parent is putting more energy into fighting the school than in focusing on truly helpful long-term strategies for the child. For another, the school might start viewing defensively other parents who ask for reasonable accommodations for their children with ADHD –  because they are tired of dealing with the unreasonable parents who expect the school to do all the compensation for their child’s untreated medical conditions.

Yes, behavioral strategies can help many children with ADHD, with or without medication, and so can accommodations. They can be critically important. No one would argue against that. But many children will find little benefit to even the most informed accommodations without medication that treats their neurophysiological symptoms. And it’s important for physicians and teachers to be very clear that there are a range of issues involved; there is nothing simple about ADHD.  (And yes, too many physicians are haphazard in their prescribing methods, often causing as many problems as they treat, but that is a separate issue.)

Moreover, accommodations alone can seem to work while the child is in primary school and even later. But as the child matures and readies for the real world, they will find much less accommodating.  I know many parents of grown children with ADHD who have looked back and wished they’d been more diligent about medical strategies instead of overly focusing on the accommodations. That way, their young-adult children with ADHD would have better chances of succeeding in the real world.

Gina Pera