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If you missed Part I: The Truth Behind “10,000 Toddlers” Report.

The New York Times‘ Alan Schwarz continues to seek sensation in the “click-bait-osphere” by relying on media gadflies 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 experts understand the complex nature of ADHD, and the nature of its suffering. You don’t hear about these experts as much because they are busy working, not prone to show-boating online on flashy websites or in op-ed pieces. They would find that embarrassing. I  share some important excerpts below.

By the way, only Huffpo (and Schwarz himself) would be arrogant enough to consider  Schwarz an ADHD expert in its “broadcast” following his latest egregious effort at reporting on ADHD (my policy is not providing links to “clickbait”). HuffPo founder Arianna Huffington is an infamous ADHD-denier (see previous post).

Shameless Marketers Fueling Anti-ADHD Fury

But when it comes to arrogance and ignorance, we cannot overlook this shocking post from Ned Hallowell, below, on his blog. It is truly breathtaking in its audacity. Especially because he repeated it on the airwaves later.

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.

Really?  So, all it takes is a little parental attention and—poof!—ADHD is gone? So medications for ADHD are all about parents seeking a “quick solution”?

This rubbish might have landed Hallowell center-stage at Fox and Friends. But is greater fame truly worth making life harder for sick children and their beleaguered parents—and fueling the anti-ADHD hysteria in this country? From a physician who claims ADHD expertise?

(Side issue: What kind of ADHD medical expert shills a certification program for chiropractors to “treat” ADHD with a “strengths-based” approach? How does such a psychiatrist retain his medical license? Good question.)

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. Issuing a blanket dictum that children he’s never seen and whose cases he knows nothing about “abruptly stop medication” is impulsive and reckless of consequences. If anything is “crazy,” it is Hallowell’s blog post.

This brand of crazy has gone on long enough. 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. I’m uncertain of the public’s ability to distinguish; they seem to confuse having an MD or PhD with automatically being an authority. 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.”

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

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  1. AlisonM’s avatar

    People love hyperbole and confirmation bias. People who provide them with that make money. Ergo, they must be right.

    Reply

    1. Gina Pera’s avatar

      Bingo, Alison! Still shameful. Even sociopathic, in my estimation.

    2. Katharine O'Moore-Klopf’s avatar

      Bravo, Gina! The excerpts from Manos that you provided precisely describe what life in our household was like when our oldest son, now 19 and doing quite well, was a toddler and no one wanted to prescribe medication for him. When he was almost 5 years old, we finally got a good diagnosis and he began treatment, which included medication. Miraculous difference in him! All these years later, he continues to take ADHD medication, and since age 13, he has taken an anti-anxiety medication. He ended up functioning so well when he was still in public school that he was able to be valedictorian of his small-classroom program. He is a smart, kind, wonderful person whose true self is able to shine through with the assistance of medication and our family having done lots of work on behavioral training.

      Reply

      1. Gina Pera’s avatar

        Thanks for your comment, Katharine. And kudos on your perseverance.

        What physician in his right mind would have wanted to deprive your son and your family of that? That is some kind of sickness that leads to pandering in such a narcissistic way.

      2. Katharine O'Moore-Klopf’s avatar

        And we persevered through eventual diagnosis and treatment for my husband and later, for our youngest son, who is now 12 and doing well. It can be done, but it takes courage, strong love, and most of all, help from professionals.

        Reply

        1. Gina Pera’s avatar

          And there you have it, folks: “Lazy” parenting. :-)

        2. AlisonM’s avatar

          Horrible, horrible stuff is being said about people with ADHD and their parents all over the internet right now. At one site, I am being told that I am an evil troll who is being paid by Big Pharma because I don’t agree that ADHD is fake and can be controlled with corporal punishment and lots of exercise. (I find it especially interesting how many people say “it’s not real” and then follow with their own ideas about how to cure it. Can you say cognitive dissonance, kids? I knew you could!)

          Reply

        3. David’s avatar

          My son was good for one “bonk” on the head every day. I would’ve traded some diminished appetite for less head injury. We were told he couldn’t start until age 5. Of course, we weren’t keeping a good enough eye on him and giving him enough attention. This, from my Mom whom is telling me this to me while walking away with the burner lit on the stove after she was done cooking.

          Reply

          1. Gina Pera’s avatar

            Oh David, that just says it all, doesn’t it?

            There is a reason that children with moderate-to-severe ADHD compound their challenges with head injuries.

            I was just looking online for some photos of children with “bumps and bruises.” I wanted images that countered the ones constantly used by news outlets to depict ADHD: angry, screaming “brats.” (Ah, but they’re not biased, are they?)

            And I found a parenting blog where at least 15 moms were saying how it’s okay to let your young child keep banging his head. That they’re doing it for attention and will grow out of it.

            Sigh.

            Very frustrating to be living in an era where we know and understand so much more….but can’t drag a large portion of the public behind us.

          2. Tom Nardone’s avatar

            This was great. My ADHD as a child was quite severe. I found myself chuckling in reference to the the “Fox and Friends” line.

            I think when people are constantly discussing something all day every day they forget the true weight of it, and can end up advocating parents to stop medication, not having seen their children personally. Thank you Gina for not being such a person. I might have missed this myself.

            Reply

            1. Gina Pera’s avatar

              Thanks, Tom. Yours is the more charitable explanation. I, however, have seen a very calculated pattern over the years, to go with the way the wind is blowing—and add plenty of hot air to hurry it along.

            2. Patty@homemakersdaily.com’s avatar

              Wow! That’s disappointing that Hallowell said that. He obviously doesn’t understand ADHD as well as he thinks he does.

              I hadn’t thought about this kind of misinformation affecting the ability to get treatment and medication. That’s very bad.

              I do believe that the ADD/ADHD label could be overused but that doesn’t mean it isn’t real.

              Thanks for the info.

              Reply

              1. Gina Pera’s avatar

                Yes, Patty, it’s extremely disappointing that he seems out for personal monetary gain (and fame) and throwing the legitimacy of ADHD under the bus.

                Yes, we all want accurate diagnoses. But that is quite a separate issue from creating uncertainty about the diagnosis itself in order to make money.

                It’s been years of me holding back writing about his behavior, but finally I hit my breaking point.

                Someone needs to call him out.

                thanks for your support

              2. Dr. Katherine Nell McNeil’s avatar

                Gina,
                17 years ago, I began my journey into the ADHD world of information after being diagnosed at 40. One of the first books that I read was Hallowell’s. I even went to a conference where he was the keynote speaker. However, in the time since then I have read and researched volumes of research about ADHD. Hallowell’s time has come and gone. As the other researchers in the field have move on by completing more research, Hallowell has not. His deficit/gift mantra only had a place with me for a very short time…and only because I got proper treatment, meds, and behavior modification. Only with the three prong approach that Dr. Russell Barkley recommends did I find my “gifts.” His approach now is no longer relevant to the discourse on ADHD. He remains in the past, a dinosaur of outdated and now irrelevant material. His goal is to now prostitute himself to the highest bidder. Sadly, how many children and others with ADHD will suffer needlessly because parents believe his
                dangerous message.

                Reply

                1. Gina Pera’s avatar

                  Hi Katherine — I appreciate that. I know the book (written with Dr. John Ratey, whom I respect a great deal) has helped many people.

                  It is too bad that Paul Wender, MD, the “dean of ADHD” was never given credit in that book. Without him, neither Hallowell or Ratey would have known they had ADHD. He put it on the map. He was at Harvard. I’m sure they knew him. But no credit.

                  But one book written (perhaps ghost-written) decades ago does not balance out the tremendous harm this man has done for a long time. It’s no “gift” what he does. It’s reckless, discompassionate, and, yes, amoral and unethical.

                  g

                2. GloryB’s avatar

                  Hi Gina,

                  Thank you for taking the time to write this. You are right. That 10,000 Toddlers headline was all over the Internet, including at some “reputable” news sites. Yet, your post is the only time I’ve seen anyone question how the CDC arrived at that number. Thank you for being the “real deal” when it comes to journalists. Some days, I just want the Internet to go away. It feels like a losing battle, fighting against all the propaganda. Thanks for doing your part (actually much more than your part).

                  Reply

                3. Betsy Davenport, PhD’s avatar

                  A long time ago I wrote an article – The New Mythology – for a now defunct online magazine, in which I described the Gifter idea and how incorrect, misleading and harmful it is to fill the heads of suffering people with sugar plums instead of actual help. In it I said people with ADD are not more creative; there is nothing creative about an interesting thought. You have to actually make something in the material world. I said it’s not a mark of intelligence to forget where you put the car keys again; it’s not a mark of lacking intelligence, either, but it’s not intelligent to think that’s unimportant. And on and on. What was frustrating then, and continues to be, is that someone who others consider knowledgeable I’d the purveyor of the mythology. And that word is too kind, given the offenses being committed. I’m glad you’ve decided to take a stand. I’ll stand with you. Incidentally, parents of children with ADD are just as good at parenting as other parents; and then they have to learn to be even better at it.

                  Reply

                  1. Gina Pera’s avatar

                    Thanks, Betsy. I just don’t know what to think when an alleged ADHD expert tells parents he’s never met to stop medication and pay attention to their children he’s never met. It simply further perpetuates the myth that ADHD is caused by lax parenting.

                    g

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