ADHD Cyber Command On The Watch!

What is ADHD Cyber Command? My husband suggested it. As a military-technology buff, he saw links between our National Cyber Command and the machine-gun-rapid firing emanating from my office. Let me explain.

For at least the first ten years of my advocacy, starting in the early 2000s, I resembled that character in the cartoon below. Was there an attack on ADHD as a legitimate condition? Was someone casting aspersions on the legitimate medications used to treat this legitimate condition?  I was on it! Nobody was paying me. I was not a “pharma shill” or, egads, a “pharma whore”—though that’s how some tried to discredit me.

Yes, it’s been a  personal mission, and I made many good friends in so doing. But heading up ADHD Cyber Command hasn’t really kept me up at night. I aimed for surgical strikes, not omnipresence.  The latest came just this morning. As both an ADHD advocate and responsible journalist, I found it a perfect case study.

[I updated this article, originally published on August 11, 2010, on November 27, 2018.]

The Power of the “e-Printed” Word

Words are powerful, the printed word even more so.  Yet everyone with a keyboard can suddenly “print” anything at all.  They can also distribute it instantly to the masses. Without regard for accuracy. Without consideration for the real-life impact on real people’s lives. Now with social media and Google analytics, the competition for web traffic almost requires the mainstream media to cover the “clickbait” stories. This mess reached fever-pitch leading up to the 2016 elections. Yet it didn’t take a soothsayer to predict it.

As a veteran print journalist with a reputation for fairness and accuracy, I’ve found this new “medium” of the Internet by turns extremely exciting yet unsettling.

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 “going to war with the weapon I had”:  my keyboard.

Soon he was calling my office “ADHD Cyber Command”. He suggested suitable logos, something like that in the main image above.

Fortunately, Internet-based information on ADHD started improving around 2008-2009. Maybe it was critical mass or the growing number of professional sites and blogs by adults with ADHD. Or maybe it had to do with a “sobered” economy. Perhaps that reduced tolerance for ADHD happy stories and snake-oil remedies. But they have not entirely diminished.

These days, “the media” sometimes shine the right light on ADHD. Sometimes, however, 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.

Beware the ADHD Clickbait Op-Ed Piece!

I bet you’ve noticed the phenomenon. Guest opinion-editorial writers seek to carve out their niche in a crowded market by writing “contrarian” op-ed pieces designed to fuel controversy, web traffic, and “sharing”. The New York Times has been the biggest offender. For a few ADHD Cyber Command selections, see:

1. Talking Back to The New York Times’ ADHD Myth-Mongering
2.  The New York Times Unnatural Opinions on ADHD.
3. The Truth Behind “10,000 Toddlers Medicated for ADHD”

A clickbait doozy came from Esquire magazine: The Drugging of the American Boy. Seeing my comments challenging the piece, a New York Observer newspaper editor asked me to write a counter: How Esquire Got ADHD Wrong.

Excerpt:

When a headline features the word “drugging,” the report about ADHD that follows will not be well-balanced. Such was the case with Esquire’s recent salvo into the topic, “The Drugging of the American Boy.”

Esquire joins The New York Times in treating one of the most well-researched and documented conditions in medical history as a piñata. Bash ADHD and all the goodies fall out. Web traffic soars. The immense anti-psychiatry blogosphere races to showcase the latest proof that they’ve been right all along. Esquire actually calls this piece a “blockbuster investigation” — just in case the ASME judges missed it.

Lost in the shuffle: Accurate reporting on a critically important public health issue affecting millions of Americans.

ADHD Cyber Command’s Rules For Reporting

Let’s consider a case study. This scrutiny might help you assess the legitimacy of ADHD news articles and broadcasts.

Today, a friend sent this link from CNN to me: ADHD: Who Makes the Diagnosis? He is the parent of a child whose ADHD went unrecognized until a concerned teacher pointed to the possibility. As such, my friend took offense at the “experts” cited in the story depicting concerned teachers as “diagnosing ADHD”.

I credit the CNN reporter for finding two excellent interview subjects with the “lived experience” and one an ADHD non-profit executive. As for the other “experts”?  Oh dear. When reporting a story on ADHD and identifying sources, reporters must remember:

• This is not a “controversial” diagnosis. It is a valid condition with massive amounts of published research.
• Select knowledgeable sources. Not just any random pediatrician, child psychologist, or school psychologist will do.
• The mental-health field is a huge, er, crazy-quilt of competing ideas, beliefs, narratives, charismatic gurus, and sometimes science. Fortunately, the Internet has made it incredibly easy to identify such experts. (I started reporting before the Internet and even before answering machines. Ha!)
• Beware of interview sources delivered by PR firms.  Culturally, we are swimming upstream on this one. Self-promotion is the trend. For example, take-all-comers sites such as Psychology Today propagate a massive amount of sensational “clickbait” from dubious people in the mental-heatlh field. TV shows such as “Dr Phil” bypass the time-consuming process of staff seeking interesting guests; the guests are all (I  mean all) “PR Placements.” Moreover, once a show or a news outlet has featured such a person, that reinforces credibility for other reporters; they figure it’s safe to use that person, too, and so forgo any attempts to find their own source. It’s quite the echo chamber.
• You know who isn’t hiring PR firms to elevate their profile? In-the-trenches ADHD researchers, professors, and clinicians.

One caveat: It’s also true that ethical editors can develop a perfectly above-board working relationship with a PR firm. As a business newspaper editor, I trusted a few firms to provide well-written and useful one-time columns from respected local businesspeople. Yet, I cannot remember ever in my professional life including a PR-provided source in actual reporting. Yech!

Criteria For Selecting Expert Interview Subjects:

Make no mistake: I do not suggest that a reporter interview exclusively “ADHD experts.” That would present its own bias, but there should be at least one or two!
Generally, interview subjects should meet most of these criteria:

• Has current knowledge of, and apparent respect, for the published literature and evidence-based clinical practice (that is, no fringe-dwellers)
• Has published research, authored clinical or well-respected popular books, and/or is an established faculty member at a respected university in the field of psychology or psychiatry—but not necessarily specific to ADHD
• Is specifically qualified to opine on the most common psychiatric conditions of childhood (that is, ADHD)
• Is not be a director or employee of a commercial or private clinic that offers only behavioral strategies with no regard to underlying psychiatric conditions
• Can substantiate any unusual data cited (see below)
• To reiterate: does not come to the reporter via a public relations firm

This takes more time and deliberation. But, seriously, for a critical thinker with access to the Internet and ethical values, it’s not that hard.

Case Example: CNN’s “Who Makes the Diagnosis.”

In that piece, we hear from two credible-sounding laypeople and two mental-health professionals with extreme, unsubstantiated views:

1. One mother, and one teacher and mother, with a brief comment from the director of an ADHD-centered non-profit
2. A psychiatrist with no stand-out reputation professionally or academically who four years earlier wrote a sensationalized op-ed piece in The  Washington Post
3. A pediatrician on the faculty of an institute for psychoanalysis (psychoanalysis!)
4. A psychologist working for a non-profit—ostensibly with large public contracts (e.g. foster care system, etc.)

Source by source, I’ll try to explain how I, as a news editor, would have pressed the reporter to better identify and vet sources. (I do not blame the reporter; perhaps she was assigned these sources along with the story.)

1. “You Interviewed Three Sources with Direct Experience—Excellent!”

This piece contains two excellent and credible-sounding “lived experience” sources: mother Amy Barr, teacher and mother Alana Morales,  It is not easy getting sources to go on the record with their full names.  Also interviewed:  CHADD’s [former CEO] Clarke Ross.

Morales makes eminent sense on this complex topic and is a credit to her profession.  Credit also goes to mother Amy Barr for her candid account.  The reporter did an excellent job of weaving in their stories, which directly countered the advice of the chosen “experts”—and rightly so.

2.  Why Is This Psychiatrist Qualified To Comment?

Next, consider one of the two quoted mental-health professionals: psychiatrist Elizabeth Roberts. Judging from her website, I’m not seeing the prerequisite foundation of expertise. Not even close.

In fact, I am rather horrified that someone who has apparently been treating children in foster care, in substance-abuse treatment clinics, and the like shows so little understanding of ADHD. Chances are good that ADHD was over-represented in those situations.

From the story:

Roberts estimates that only about 10 to 20 percent of children who receive the diagnosis of ADHD actually need medication.

What? This idiosyncratic opinion is not supported by the published literature or a consensus of leading authorities on the topic—or really anyone who knows anything about ADHD. Unless the point of the story is to cast doubt on a source’s reliability, this kooky quote bears no relevance.

The Washington Post has a good track record vis a vis responsible reporting on ADHD.  But WaPo slipped in running this op-ed  from Roberts in 2006: “A Rush to Medicate Young Minds.”

Excerpt: A Rush To Medicate Young Minds

These days parents cruise the Internet, take self-administered surveys, diagnose their children and choose a medication before they ever set foot in the psychiatrist’s office. If the first doctor doesn’t prescribe what you want, the next one will.

There was a time in the profession of child psychiatry when doctors insisted on hours of evaluation of a child before making a diagnosis or prescribing a medication. Today some of my colleagues in psychiatry brag that they can make an initial assessment of a child and write a prescription in less than 20 minutes. Some parents tell me it took their pediatrician only five minutes. Who’s the winner in this race?

Unfortunately, when a child is diagnosed with a mental illness, almost everyone benefits. The schools get more state funding for the education of a mentally handicapped student. Teachers have more subdued students in their already overcrowded classrooms. Finally, parents are not forced to examine their poor parenting practices, because they have the perfect excuse: Their child has a chemical imbalance.

Her lurid 2006 book title,  Should You Medicate Your Child’s Mind, was reason alone to keep looking for a better source. By 2010, when the CNN article ran, that book’s ranking on Amazon was 462,076 with only four reader reviews. No surprise: They all expressed anti-medication sentiment. Today, the ranking has dropped to 2,300,000. On her website, Roberts says she now directs a residential addictions program in tony Newport Beach.

3. Out of All the Pediatricians in the Country….This One?

If I was this reporter’s editor, I would ask: Who is  Claudia M. Gold, MD, and what was the rationale for quoting her in this story? What expertise does she bring? What bias does she bring? Does it balance current sources or is more fringe opinion?

The CNN piece came out in 2010. But Gold’s first book wasn’t published until 2011. Shortly after, she joined the Berkshire Institute for Psychoanalysis faculty. Nothing in her resume suggests expertise on ADHD or even neuroscience.  (Especially not psychoanalysis.) Prior, she worked as a behavioral pediatrician but not a board-certified child psychiatrist.  The title of her 2016 book? See if you can spot the bias. The Silenced Child: From Labels, Medications, and Quick Fix Solutions to Listening, Growth, and Lifetime Resilience.

Excerpt from CNN piece:

All too often, parents come to pediatrician Dr. Claudia Gold’s office asking for a prescription for ADHD, based on a recommendation from school.

When she consults with parents alone, however, she’s likely to hear stories of trauma: a death in the family, an abusive relationship, and other life experiences that the teacher knew nothing about.

We see this a lot: A refusal to see the complexity of ADHD and instead to pin all challenges on “trauma.”

(Yes, there is a powerful trauma industry. Some powerfully self-promoting proponents insist that ADHD is not neurogenetic and does not leave a person more prone to experiencing trauma. No, it is the reverse.  ADHD is caused by trauma, they insist. By the way, they have some costly but unproven therapy to sell you. More on that in a future post.)

The fact is, ADHD runs in families. That means, when left poorly managed, it can create disruption, chaos, hot tempers, neglect, and even domestic violence. Generation after generation, it can compound in complexity. Yes, there is often trauma, but this is also a neurogenetic condition that, if left untreated, might leave that person unable to heal from trauma. A humble clinician considers “both and” rather than trauma alone.

I for one am not buying the notion that parents make a beeline from the school to her office, demanding ADHD medication for their children. In my experience, most parents require careful education and encouragement to even consider it.

https://giphy.com/gifs/iI6eeGjwScTCM

 4. “Medication is Quick And Easy”—Oh Really

Moving onto another source: Cheryl Rode, Director of Clinical Operations at the San Diego Center for Children in California. She opines:

“Medication is quick and easy but it’s not the answer alone for working with kids who have ADHD.”

Why this center and its representative, especially given the deficit of more solid experts in the story?

The first red flag signaling bias and eagerness to promote anti-ADHD medication stigma: Medication is never quick and easy. Most people learn that good outcomes require much trial and error.  As for the strawman argument tacked on (it sounds so readonable to the unschooled reader), no legitimate ADHD specialis claims that medication is the “answer alone.”

I am editor-skeptical of a non-profit that calls itself the “center for children” showing a surplus of marketing-businesspeople on its staff and board but no physicians or neuroscientific experts.  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?

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 claimed “strength-based approach?”  These are questions a good local news editor, and especially the CNN reporter and editor, should be asking.

Be Curious and Reject Myth-Mongers

As for the criticism that “teachers are diagnosing ADHD!”: It’s not hard to understand. Many parents of children with ADHD have ADHD themselves (it’s genetic, you know). Their first clue to this comes that child starts school (or starts “hitting the wall” in school) and a caring teacher points out the possibility. That’s what happened with my friend, as I noted at the beginning of this post. Many parents today did not grow up in families with lots of kids or even extended families; they don’t know what lies outside the range of “normally developing.”

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

Listen to teachers and mothers such as Amy Barr and Alana Morales. They truly know the cost of ignorance about ADHD. That’s why they do their best to help other parents who might be unaware.  They have nothing to gain from sharing their stories. The beneficiaries are their young charges and others like them.  If the teachers and schools receive a gag order to never even broach the subject of ADHD, what will happen to those kids and others whose parents see anti-ADHD biased physicians?

I welcome your opinions and reports for ADHD Cyber Command. 🙂

Gina Pera