Cyber Command: “To Ritalin or Not to Ritalin”?

I really thought we were done with stories like this, especially on the blog of a well-known medical school. Ah, but this is Stanford, in my backyard, and if you seek evaluation or treatment for ADHD there, well, good luck to you.

In many ways, I consider the Bay Area, in general, the Third World of ADHD medical treatment. Yes, there are a few excellent clinicians in private practice. And the University of California, Berkeley has as its Psychology Department Chair an internationally renown ADHD researcher, Stephen Hinshaw, Ph.D.  But the two university medical schools that serve as Silicon Valley bookends? For all their Nobel laureates, Stanford and UCSF simply can’t hold a candle to Harvard or the University of Pennsylvania when it comes to ADHD research or expertise, and this lack filters out into the community.   Still, even I was surprised today to read this post in Stanford School of Medicine’s blog, Scope: “Blogger Asks, To Ritalin or not to Ritalin?” It is in response to a blog post by an adult who was treated for ADHD as a child and is now a behavioral therapist.

No time this morning to break it down point by point, but I will share with you my comment on the Stanford blog and welcome your comments on the topic:

————

Hello,

I don’t think most parents need to be encouraged to “think carefully” about the decision to pursue medical strategies for their children’s medical condition.

Many have been scared out of their minds by so much mis-and disinformation on the Internet. Amidst all the fearmongering noise and admonitions along the lines of “don’t medicate away your child’s gifts!”, it’s a wonder any of them can make a balanced decision.

I would like to say I am surprised to read such a naive perspective on a Stanford Medical School blog, but sadly, I am not. Stanford has a very poor track record when it comes to ADHD, as far as providing knowledgeable evaluations and treatment to members of the public seeking help there. Especially adults.  And the Bay Area, in general, is like the Third World of ADHD expertise. We look to the East Coast — Harvard and UPenn, in specific — for that.

It has been very popular the last decade to view ADHD as a “gift,”  and a forgiving economy enabled that idea.  We are in more sober times now, and the facts are valuable.  While the “gift” campaign brought some amount of needed balance to the issue, it has also increased a sometimes-too-frequent way of viewing ADHD in a binary way.   Gift or Disorder. Medication or behavioral strategies.  Often, the wiser perspective is “both and.”  That is born out by the studies.

In fact, “black and white” thinking is not uncommon people whose ADHD symptoms remain unrecognized and unaddressed.  And so the Gift message has been eagerly embraced by those who feel intense shame at being all “Disorder.”  And that’s especially true for those whose care in childhood was, to put it mildly, not done in the most enlightened manner (“Here, take this Ritalin, so you can be tolerable.”)

The answer, however, is not to pander to those who have either developed “emotional baggage” around ADHD due to poor treatment of it or to prop up “self-esteem” by spinning deficits as gifts. What breeds self-esteem  and even a strong self-concept, which is often lacking in people with unrecognized ADHD,  is success, say the top ADHD experts. And that is done with evidence-based strategies, not feel-good pablum.

The answer is to be very clear on the facts of ADHD and to take each person’s manifestations of its symptoms on a case by case basis, humbly but knowledgeably, and without a personal ax to grind.

The very idea that a Stanford blog would still talk about Ritalin when so many better delivery systems exist for stimulant medication shows that your information is very outdated.  And, if you haven’t read the study yet (about children being wrongly diagnosed with ADHD because they are younger), you really need to do that first before re-stating it as fact.   You are, after all, writing a medical blog, right?

“Ritalin,” meaning the stimulants that are the first-line medical treatment for ADHD, is not a “two-edged sword.” The stimulant medications can remarkably reduce problematic ADHD symptoms, when properly prescribed and titrated. Trouble is, many physicians are too haphazard in both areas. Thus, “flattened affect” and other unnecessary side effects.

Unfortunately, many parents are too cowed in the presence of an MD to do their own research and advocate for their child.  (The fact that many parents of children with ADHD also have this highly heritable condition, but don’t know it, often adds to the confusion.)

Today’s parents, unlike Newman’s, do have “other options.”  But lest they be deceived, most children with ADHD do not outgrow it.  And, while you can control a child’s environment at home and at school, providing external structure, you cannot do that once a child leaves home. And that, unfortunately, is when unaddressed ADHD symptoms can truly create trouble — with credit cards, educational goals, jobs, relationships, pregnancy and parenthood, and so forth.   I know many, many parents of adult children with who look back with regret that they did not take the medical remedies more seriously.

Remember that during the teen years, the human brain reorganizes itself on a monumental level, stripping away pathways needed for childhood development and readying for those of adulthood.    It could well be that, not given a chance to internalize certain developmental milestones, there is little chance later. THAT is something for parents to think seriously about, too.

Please also keep in mind that “denial” is a common component of ADHD. It is easy for some people with ADHD to “spin” their deficits into gifts — as long  as there is no independent corroboration.   ADHD is not ADHD unless there is impairment. That’s required for the diagnosis.

Please try to do better medical research for your medical stories.  It is important.

Thank you,

Gina Pera, author

Is It You, Me, or Adult A.D.D.?