Making Progress, One ADHD Naysayer at a Time

If you’re like me, you get discouraged by ADHD naysaying in the media.  That it is a condition that doesn’t exist, a Big Pharma invention. That individuals with ADHD—or their parents—are seeking the easy way out.  In other words, they’re taking or giving to children “dangerous drugs”  for a made-up condition. Pathologizing childhood.

How do we counter the naysayers?  With science and the “lived experience”—at least for those willing to listen. This post is about one print journalist who started as a naysayer but then became a champion. Doing what good journalists should do: questioning assumptions and seeking more data.

In This Post on Media’s ADHD Naysayers:

• A little background on news outlets as ADHD naysayers
• Excerpts from author Judith Warner’s writing on why she reconsidered “naysayer” status
• Other excerpts from her columns on children’s mental health
• A link to my archive on The New York Times shameful history as ADHD Naysayer and Clickbait Producer.

A Little Background: ADHD Clickbait as “Reporting”

After I left behind print journalism and took up ADHD education and advocacy, I faced a shocking disappointment.  That is, print and broadcast journalist alike sloppily and recklessly feeding fears, not shedding light. All the while insisting they are protecting children.

They went against the science and the evidence. Their editors were worse, failing at their gate-keeping role and instead feeding the frenzy. Many good journalists left the field during this time. Given the choice between being the publisher’s toady and maintaining integrity, they opted for the latter and sacrificed their careers.

When I started this work, in the last 1990s, I saw many well-reported stories on ADHD, from local papers and major papers, such as The Philadelphia Inquirer and The Washington Post. In fact, the latter ran a series of excellent articles and opinion pieces.

As the Internet developed, though, the situation steadily deteriorated.  Venture-capitalist-backed sites jockeyed for position, with ad-selling Google at the helm. Long-established papers were decimated.  A recent article in The New Yorker (Buzzfeed, Gawker, and the Casualties of the Traffic Wars) takes us behind the scenes with those two juggernauts.

Even before the ADHD Clickbait Era, however, The New York Times took a naysaying path when it came to psychiatric conditions of childhood. While The Washington Post ran only well-balanced stories for years, The New York Times rarely did—and never on the front page.  That was reserved for the most incendiary stories.

A columnist on parenting and childhood for The New York Times until 2009, Judith Warner says she planned to write a book along such naysayer themes.  Yet, she kept putting off writing it.  Finally, she realized why. I share some excerpts for her piece below. That book idea eventually became We’ve Got Issues: Children and Parents in the Age of Medication.

Kudos to Ms. Warner for questioning pervasive assumptions and seeking more data—bringing intelligence and compassion to the topic.

NYT Columnist Judith Warner Changed Her Mind

Excerpts from Second Thoughts, an Opinionator column by Judith Warner, March 1, 2007:

My book was initially supposed to be a kind of social reading of the culture of pathology in our time. You know what I mean: this world of A.D.D. and O.D.D. and G.A.D. and O.C.D. and P.D.D.* and bipolar disorder that has replaced the world of playground fights and bloody noses and kids sitting on the floor in the hallway after they’ve been kicked out of class that we all recall from our childhood. I was supposed to deconstruct this world – of “affluent parents and neurotic kids” as my contract put it – taking on “the overanalyzing, the overperfecting, the overpathologizing of America’s children” and raising questions “about the way an anxious culture reproduces itself.”

Some of you may find all this questionable. Even offensive. Parents of kids with “issues” generally do. In fact, when I was starting out with the book, a fair number of people, including good friends of mine whose children suffer from emotional, behavioral, learning or developmental difficulties, found my attitude – and my early postings here on the subject – just plain mean.

I didn’t see what was mean about them. I didn’t see what was offensive or objectionable, or even particularly opinionated. After all, there had been no end to the news stories bringing to light how the drug companies manipulate and mislead consumers.

Changing Her Mind, Continued

The central argument of the book I had in mind was a tenable one in theory, but it crumbled in practice, when I ventured further than reading books and newspaper and magazine articles, and got beyond theory and started to talk to real people.

To real parents who consistently told stories of how they’d painfully accepted labels and medications for their kids only after exhausting every other possible option, and to practitioners who often enough had themselves approached the whole issue of ‘flavor of the month’ diagnoses like attention-deficit hyperactivity disorder with skepticism, but had then come to see their validity – and the value of properly prescribed medication – from the weight of evidence they’d amassed in clinical practice.

I became aware, over time, that there was a name for people like me within the community of parents and doctors whose lives were consumed with treating children with A.D.H.D. and other issues: ‘naysayers.’ I learned that we – the people who had no idea what it was like to parent a child with serious issues but found it easy to theorize and moralize and pontificate about the ‘abstract other’ – were just one more burden that these parents and their children had to contend with in their already overburdened lives.

Three More from Warner’s Archives

Again in her Opinionator column, Ms. Warner went on to offer clarity on several other mental health topics that affect children, including these:

“An Epidemic of Misunderstanding About Children’s Mental Health“

Complicating the question further, as Slate medical columnist Arthur Allen notes this week in The Autism Numbers, no systematic reporting of childhood mental illness was done until 1980, when the epoch-making diagnostic manual, the DSM-III, was published by the American Psychiatric Association. Attention-deficit hyperactivity disorder – the epidemic disorder of our era, did not exist as a diagnosis until the DSM-III gave it its original name, attention-deficit disorder.

That didn’t mean children never exhibited any of the behaviors associated with the disorder. (German psychiatrist Heinrich Hoffman’s 1844 poem, “Fidgety Phil,” is considered the first known description of a child with ADHD-type symptoms: “Let me see if Philip can/Be a little gentleman;/ Let me see if he is able/To sit still for once at table.”) And bipolar disorder, which seems poised to become the next out-of-nowhere epidemic, wasn’t believed to exist in children until very recently, and remains a highly controversial diagnosis.

You sometimes hear (if you spend a lot of time interviewing university-based psychologists and psychiatrists) that much of what’s behind the so-called epidemics of our time is a transparent play for research funding. That’s undoubtedly true. But as a means to a worthwhile end, I don’t find that terribly troublesome. What is problematic for me is when talk of epidemics starts to feed magical thinking. By which I mean: the tendency today among certain parents – and certain ideologues – to advance arguments that aren’t based upon reason and depart, potentially dangerously, from reality.

“Children in the Mental Health Void“

Remember the Nebraska law meant to keep desperate new mothers from abandoning their babies in dumpsters by offering them the possibility of legal drop-off points at “safe havens” like hospitals?

As was widely reported last year, the law neglected to set an age limit for dropped-off children, and eventually led to 36 children – mostly between the ages of 13 and 17 – being left with state authorities. Most of these children had serious mental health issues. Some were handed over to the state by relatives who had no other way of securing for them the heavy-duty psychiatric care they needed. Seven of the children came from out of state, including one who’d been driven 1,000 miles to Lincoln, Neb., from Smyrna, Ga.

Recently, The Omaha World-Herald acquired 10,000 pages of case files concerning these children from the state’s Department of Health and Human Services. They paint a portrait of desperation – of out-of-control kids, overtaxed parents and guardians, and an overstretched health care system – that really deserves more widespread national notice.

Their example also serves as a necessary corrective to the popular view that children being labeled mentally ill today are just spirited “Tom Sawyers” who don’t fit our society’s cookie-cutter norms, with parents who are desperate to drug them into conformity.

The children abandoned in Nebraska had big-deal problems. An 11-year-old boy, hearing voices since the third grade, had punched his fist through a glass door and smeared another child with his feces; other children had started fires, tortured pets, sexually abused younger children and made murder and suicide threats. Some of the adults charged with their care had problems, too, mental health issues that made them incapable of properly seeking help. Some parents and guardians had blocked earlier efforts by the state to provide care for their children, by not taking their children to Medicaid-funded therapy sessions or not picking up free psychiatric medications.

“Tough  Choices for Tough Children“

It was disturbing to read in the Times this week (Use of Antipsychotics is Criticized) that the “atypical” antipsychotic Risperdal, a tranquilizing whopper of a drug with serious, sometimes deadly side effects, is now being widely prescribed to children with attention deficit hyperactivity disorder.

This despite the fact that Risperdal, which is used in children mostly to treat bipolar disorder, isn’t approved for A.D.H.D., and apparently doesn’t work for treating it at all.

So why, according to new Food and Drug Administration data on doctors’ prescribing practices, were 16 percent of the pediatric users of Risperdal over the past three years children with A.D.H.D.?

The simple answer is to point fingers at the drug companies, whose aggressive efforts to promote off-label use of this problematic new class of drugs have resulted in a spate of lawsuits, including one recently filed by the Arkansas attorney general that accuses Risperdal’s manufacturer, Johnson & Johnson, of having “engaged in a direct, illegal, nationwide program of promotion of the use of Risperdal for non-medically necessary uses” — like the treatment of A.D.H.D..

But I think the truth is more complicated than that. I think that what’s happening is that children with big problems are being given big, bad drugs because no one really knows what to do with them.

The New York Times’ Repeated Assaults on ADHD

As a former print journalist, now ADHD author and educator, I’ve watched in horror. Over many years. Skewed angle after skewed angle. The New York Times using ADHD as a punching bag.  Let’s just call it what it is: Clickbait.

Here is a sampling of my posts about it:

• 10,000 Toddlers Medicated for ADHD, Part I
• 10,000 Toddlers Medicated for ADHD, Part II
• Talking Back to the NYT’s ADHD Myth-Mongering
• Thomas E. Brown, PhD, Responds to NYT’s Alan Schwarz
• The New York Times’ Unnatural Opinions on ADHD

—Gina Pera

The first version of this post appeared in 2010