Toddlers medicated for ADHD. It’s a hot topic in the news lately. Did you miss Part 1? 10,000 Toddlers Medicated for ADHD? Part 1
Here in Part II, I continue to educate the public on why it’s sometimes wise to medicate young children for their ADHD symptoms.
This story broke in 2014, but the topic remains relevant. The public must be helped to understand: ADHD is not just about “bad behavior”—or even “focus.” Dopamine affects many physiological processes throughout the body.
When The New York Times publishes a false story about ADHD that whips up public fury, it can over time affect public policy. In fact, it absolutely did in 2016. I explain below.
Irresponsible reporting hurts everyone. Especially children.
Toward that end, this post:
- Offers the guidelines from a legitimate ADHD expert on the cases when treating toddlers with medication can be warranted.
- Examines the dangers of a self-proclaimed ADHD expert using these public controversies as an opportunity to self-promote rather than educate.
- Suggests a link between The New York Times anti-ADHD reporting and the recent CDC guidelines on treating ADHD in young children.
To Recap
You might be familiar with the long-running attacks that The New York Times has long waged on psychiatry. It pre-dates Alan Schwarz—but perhaps not his supervising editor.
The paper’s crusades include performing the unscrutinized bidding of Senator Chuck Grassley (R-I) in persecuting pediatric psychiatric researchers. (The only reason I can see is that his Senatorial powers influenced healthcare policy, including what Medicare would pay for. Disparage the conditions, divert government funds to more favored targets.) I touch upon it in this post (Dr. Thomas E. Brown Responds to NYT’s Alan Schwarz) — a rebuttal from preeminent ADHD expert Thomas E. Brown, PhD..
The fact that bipolar disorder exists in children seemed unfathomable to reporters Benedict Carey and Gardiner Harris. Consequently, they unleashed a firestorm against leading researchers in the field of pediatric psychiatry. They included some ADHD researchers.
More recently, sports reporter Alan Schwarz has issued a series of sensationalized stories on ADHD. He uses sources who are little more than media gadflies, fringe figures, and the long-retired yet seeking a soapbox (e.g. Allen Frances, Larry Diller, and Keith Conners).
Here is the latest piece: Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries.
[Are you wondering about the periods between the letters in ADHD? That is The New York Times style. Only that paper insists on this non-standard spelling. It is also the title of Schwarz’s new book, A.D.H.D. Nation, a lamentable cobbling together of his terribly reported stories, along with dramatic storytelling around “Big Pharma Is Out To Get You!”]
In Part I, I explained the slapdash way in which Schwarz manipulated the data on which his “hard-hitting investigation” is based. I also explain the various potential physical fallout from untreated ADHD.
Some Very Young Children Need ADHD Treatment
Craziness might dominate online. But in the real world, legitimate experts perform legitimate research and treatment.
[advertising; not endorsement] [advertising; not endorsement]
That includes establishing treatment guidelines for ADHD in young children: “Clinical diagnosis and management of attention deficit hyperactivity disorder in preschool children.”
These legitimate experts:
- Appreciate the enormous complexity of ADHD’s complex impact on neurobiology—and that neurobiology’s impact on the rest of the body.
- Grasp the breadth and depth of its associated suffering for the patient and the family.
- Realize that ADHD is not just about “behavior” but can also create physical fallout as well.
Compared to the self-promoters and manipulators, the public hears little from these experts because they actually are busy working:
- They are researching and treating patients, not whipping up keywords to drive traffic to their website or jacking up conference keynote fees.
- PR firms aren’t on speed dial to place their perspectives in the Times op-ed section. (Psst. Did you know that’s how C-list experts get published there? It’s not the section’s editors doing their job and seeking qualified opinions.)
- They are not churning out self-promotional, non-edited blogs at Psychology Today or Huffpo Sidenote: HuffPo founder Arianna Huffington is an infamous ADHD-denier (see Liberals, Conservatives Agree: Bash ADHD, Bully People Who Have ADHD).
- Their sense of professional ethics views skewed self-promotion demeaning to their profession, integrity, and respect for the study of ADHD.
- Reporters are being “fed” experts from PR firms or by “copy catting” other stories. They are not digging up original sources.
A Respected Expert on ADHD in Toddlers
Below, you’ll find excerpts from a thoughtful, nuanced piece on the topic by a legitimate expert. Michael J. Manos, PhD, 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.”
- “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.”
- “The 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.”
Politicizing ADHD to Limit Medication Access
Update: October 19, 2016
This two-part post originally appeared on my blog in 2014, when the story first came out. My motivation: Knowing clearly that there would be long-lasting and damaging repercussions. I was right, unfortunately.
Please note this portion of one of the bulleted items above:
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.
That’s why the CDC’s new treatment guidelines for pediatric ADHD are so problematic. They insist that behavioral therapy be emphasized over medication.
Russell Barkley, PhD, and I countered that unsubstantiated recommendation in this post: Hey CDC? Why Misinform About ADHD?
Do you think this turn of events is simply a coincidence? That these CDC guidelines came out after Schwarz’s campaign had time to percolate up from public opinion to public policy? I do not.
We’ve seen this for years in the UK, where access to ADHD treatment is abysmal. The UK media running spates of stories stigmatizing ADHD. I’ve never seen public comments so vicious. No good comes from the media and government health ministries being in cahoots. We’ve seen that in the UK and in the US.
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Promoting Anti-ADHD Hysteria on Fox
When it comes to factors fueling the anti-ADHD-medication hysteria, consider Ned Hallowell, MD.
He posted this message, below, to the public on his blog in response to the “10,000 Toddlers” piece. He repeated it on the Fox & Friends TV airwaves.
Here it is, in its entirety:
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. A 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 in to the pressures of the parents.
Dr. Hallowell recommends abruptly stopping medications (no side effects) and instead spending time with them.
Note: He did not say, “Get a second opinion” or any more prudent suggestions. He told viewers in the Fox audience to abruptly stop medications—and assures this will bring no side effects. “Love your children,” he admonished.
Let’s Unpack This
According to Hallowell, parents of young children with severe ADHD simply need to pay attention to them. Love them! Do that and poof! The medical condition called ADHD, with its far-reaching impact on the body and brain, is gone.
Furthermore, parents giving their children medications for ADHD are seeking a “quick solution”? It sounds straight from the anti-ADHD wingnuttery playbook, doesn’t it? Yet, it comes from a self-proclaimed ADHD expert—albeit one who says he eschews medication himself. He used to say at every opportunity that stimulants were “safer than aspirin.”
[As an aside, Hallowell has also sold his name to certifying chiropractors for treating ADHD. Yes, chiropractors. You can read about it at American Chiropractor: ADHD Treatment Through the Shine Protocol]
This is very dangerous: An MD who has made himself synonymous with ADHD. Takes to the national airwaves telling parents that he’s never met, to stop giving to children he’s never examined, medication prescribed by a physician he’s never consulted with.
I realize this will not sit well with some who consider Hallowell a sanctified figure. But simply consider the facts. It’s all there in black and white—and Fox News video: Shocking Numbers of Toddlers are Medicated for ADHD.
Actions have consequences. Where is forethought or compassion—or even basic medical expertise—for the people he risked damaging?
These Children Are Individuals, Their Cases Complex
No legitimate expert will rush in and medicate a young child when behavioral strategies are in order—or possible. That’s especially true for a child under four.
Each child’s case involves many factors and much deliberation. But it should not involve hysteria, fueled by ignorant hucksterish physicians, sharp-elbowed reporters, and concocted numbers.
Real children’s lives are at stake.
With this latest hit piece from The New York Times and Alan Schwarz, the Internet today finds itself 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. [Sadly, I was right. See updated note above.]
Please speak out against this co-option of rational discourse. Avoid the hits-hungry media and hucksters 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. — Gina Pera
24 thoughts on “10,000 Toddlers Medicated for ADHD? Part 2”
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I don’t think you are right either. You are too selling a book and benefiting from it.
Rise in ADHD cases is ‘due to marketing, not medicine’: Study blames increase on drug companies, pushy support groups, and people self-diagnosing online
ADHD is ‘an economic and cultural plague than a medical one’
Diagnosis and treatment rates are soaring compared to five years ago
Experts said five key trends have contributed to ADHD growth
Pharmaceutical companies lobby for drug treatment for the condition
Support groups often work with pharmaceutical companies
Treatment of ADHD with talking therapies has eroded in favour of drugs
U.S. guidelines with low thresholds for ADHD diagnosis has been adopted
Web use makes self-diagnosis easy and people pester doctor for drugs.
The global surge in ADHD diagnosis and treatment with drugs has more to do with marketing than medicine, and in years to come we may regret treating children with drug, experts warn in a paper
They blame the rise on lobbying from drug companies, who have spurred some countries to relax the restrictions put on stimulants like Ritalin, the most well-known drug used to treat ADHD.Psychoanalytic treatment of the condition, usually with talking therapies, is slowly being eroded in favour of treating the problem with drugs, they said.More psychologists and psychiatrists are now adopting the American Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD, they added.
There has also been a rise in vocal advocacy and support groups for the condition, who often work closely with pharmaceutical companies to promote treatment with drugs.
Lastly, the rise in internet use makes finding information on the condition, and diagnosing oneself, easy. This prompts people to ask their doctor for drug treatment, they said.
ADHD is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
HOW TAKING RITALIN CAN CAUSE LONG-LASTING DANGEROUS ERECTION (EVEN IN KIDS)
Use of the extremely common ADHD medication Ritalin can cause dangerously long-lasting, unwanted erections with long-term use.
The Food and Drug Administration said it has updated its advice on Ritalin to include a warning about priapism, a condition that can permanently damage a patient’s penis.
The stimulant drug in Ritalin, methylphenidate, is also found in the brand names Daytrana and Concerta–an extended release version often prescribed to adutls–among many others.
The agency warned people to talk to their doctors before halting the drugs and said priapism has only occurred from use of methylphenidate in rare cases.
It has come under much controversy in recent years, with some health professionals voicing concerns that diagnosing such a cluster of symptoms as one overarching disease means we are medicalising normal human behaviour.
In the paper, researchers cited websites promoting ADHD drugs, offering checklists with questions like ‘Do you fidget a lot?’ , ‘Is it hard for you to concentrate?’, ‘Are you disorganised at work and home?’ and ‘Do you start projects and then abandon them?’
Writing in the report, Professor Peter Conrad, of Brandeis University, U.S. said: ‘These checklists turn all kinds of different behaviors into medical problems.’
‘The checklists don’t distinguish what is part of the human condition and what is a disease.’
The researchers said in the U.K., diagnosis of ADHD in school-age children grew from less than one percent in the 1990s to about five per cent today.
In Germany, prescription ADHD drugs rose from 10 million daily doses in 1998 to 53 million in 2008.
Growth in Italy and France has been slower, in part due to those countries’ more restrictive pharmaceutical drug laws. However, researchers said even those nations are now becoming more lax.
In Brazil, a rising number of ADHD advocacy groups, many with close ties to the pharmaceutical industry, are raising awareness of the disorder.
Professor Conrad voiced concerns about the rise of prescription treatment for ADHD, which he believes may be socially constructed.
‘Call it an economic and cultural plague, but not necessarily a medical one.’
There is no pharmacological magic bullet. No drug can account for non-medical factors that may contribute to behavior.
A fidgety student may be responding to the one-size-fits-all compulsory education system, he said, not a flaw in his brain chemistry.
ADHD continues a long history of medicalising behaviors, especially in the U.S., he added.
One example he cited was masturbation, which was considered a disease a century ago. Men and women diagnosed with masturbatory insanity were institutionalised or subjected to surgical treatment.
‘I think we may look back on this time in 50 years and ask, what did we do to these kids?’ Professor Conrad concluded.
The paper was published in the journal Social Science and Medicine.
No better place to gotter real information for me then.
Hi Linda,
Unfortunately, you are woefully misinformed. About so many things.
For example, you really think I’d work almost full-time for 20 years to advocate on an issue for….book-sales profits? You obviously don’t know the book business.
It’s the anti-ADHD fearmongers who really make out, because they have gimmicks to sell. And they don’t care how many lies they have to tell or how much suffering they cause.
Peter Conrad. Seriously? You offer him as some kind of expert? The man is locked in his little ivory tower, spinning tales that feed the anti-science ignorance of the pot-addicted uber-liberal.
His entire career depends on this line of propaganda, because has so little else. No science degree, no medical degree. I wonder if he even took a biology class.
Certainly, he is empathy-impaired, given that he is willing to further stigmatize ADHD and limit the treatment options for people who have it, for the sake of his own grandstanding.
Good luck in finding more solid sources of information.
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I climbed the dinner table myself and fell. I broke my arm. I was 2. Who is Hallowell to say uncontrolled ADHD in toddlers is are better left unmedicated…? How can he call himself a professional?
Excellent question, Jessica. I’ve had the same question myself. To me, going on Fox news and telling parents to “stop giving your toddlers medication” should have revoked his medical license. It’s the height of self-promotional irresponsibility.
I recently met a physician — a pediatric oncologist — who says that up to 75 percent of her patients (children with cancer) have ADHD. And it is she who is diagnosing them! Many poor children in this country never see pediatricians; they receive medical care only when they go to Urgent Care, and that’s not the place to monitor or diagnose mental-health conditions.
Many of these 10,000 toddlers are in the Medicaid system, and there are some very sick children.
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.
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
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).
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.
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
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.
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
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.
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.
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.
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!)
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.
And there you have it, folks: “Lazy” parenting. 🙂
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.
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.
People love hyperbole and confirmation bias. People who provide them with that make money. Ergo, they must be right.
Bingo, Alison! Still shameful. Even sociopathic, in my estimation.