There are only two things you need to know about medicines and ADHD:
Some kids get medicine when they shouldn't. And some kids don't get medicine when they should.
The first of those is reported over and over and over again. The second is almost never mentioned.
The New York Times has run a series of stories, mostly on the front page, about the overuse of ADHD medications. You will rarely find it mention–even in passing–the tragedy of children with ADHD who are not getting treatment that would help them.
If it sounds as though I'm taking sides, it's only to fight back against the widespread prejudice among journalists that the problem with drugs and ADHD is solely a problem of overmedication. I don't know how to diagnose ADHD, I don't know what medicines to use to treat it, and I'm not advocating more use of medication or less.
I'm urging reporters to look at ADHD more carefully and consider that perhaps the most important problem with children and mental illness is not overmedication, but the sad fact that many of them get no treatment whatsoever.
[It takes only a few minutes to realize that reporters face a practical problem here: It's easy to track down kids on medication; you simply call a few doctors, or the American Psychiatric Association. It's hard to find kids who are not on medication but who should be. There is no easy way for reporters to get to them. It requires getting out of the office, talking to parents, and visiting people in their homes.]
The latest example of a story reporting the horrors of overmedication appears under the title "The Drugging of the American Boy" by Ryan D'Agostino in Esquire. It begins with the usual scare tactics:
If you have a son, you have a one-in-seven chance that he has been diagnosed with ADHD. If you have a son who has been diagnosed, it's more than likely that he has been prescribed a stimulant…
By the second sentence, we've already drifted into fuzzy math. More than likely? How much more than likely? We could look it up, but why should we have to?
D'Agostino then discusses the potential dangers of ADHD drugs using guilt-by-association. Stimulants used to treat ADHD are Schedule II drugs, he reports, a classification that includes "cocaine, methamphetamine, Demerol, and OxyContin." Are you frightened yet? Don't worry, you will be.
The ADHD drugs
…are associated with sudden death in children who have heart problems, whether those heart problems have been previously detected or not. They can bring on a bipolar condition in a child who didn't exhibit any symptoms of such a disorder before taking stimulants. They are associated with "new or worse aggressive behavior or hostility." They can cause "new psychotic symptoms (such as hearing voices and believing things that are not true) or new manic symptoms." They commonly cause noticeable weight loss and trouble sleeping. In some children, some stimulants can cause the paranoid feeling that bugs are crawling on them. Facial tics. They can cause children's eyes to glaze over, their spirits to dampen. One study reported fears of being harmed by other children and thoughts of suicide.
It might have been easier for D'Agostino to list the bad things the drugs don't do. And which drugs are we talking about here? Are they all the same? Do these disturbing side effects belong to all of them, or some of them, or some to one drug and some to another? D'Agostino doesn't say. But he's not trying to clarify or inform here; he's trying to generate visceral anger. And he's not done yet:
Imagine you have a six-year-old son. A little boy for whom you are responsible. A little boy you would take a bullet for, a little boy in whom you search for glimpses of yourself, and hope every day that he will turn out just like you, only better. A little boy who would do anything to make you happy. Now imagine that little boy—your little boy—alone in his bed in the night, eyes wide with fear, afraid to move, a frightening and unfamiliar voice echoing in his head, afraid to call for you. Imagine him shivering because he hasn't eaten all day because he isn't hungry. His head is pounding. He doesn't know why any of this is happening.
Now imagine that he is suffering like this because of a mistake. Because a doctor examined him for twelve minutes, looked at a questionnaire on which you had checked some boxes, listened to your brief and vague report that he seemed to have trouble sitting still in kindergarten, made a diagnosis for a disorder the boy doesn't have, and wrote a prescription for a powerful drug he doesn't need.
If you have a son in America, there is an alarming probability that this has happened or will happen to you.
I have four sons. I suppose the chance that this has happened to me would be four times "an alarming probability." It's tough to do the math without knowing what that probably is.
D'Agostino might be shocked to find out from me that despite the overwhelming odds–four times higher than his imaginary six-year-old–this hasn't happened to me.
And while I recognize that Esquire is a men's magazine and is therefore unconcerned with daughters unless they happen to grow up to be Women We Love, I have a daughter who likewise escaped D'Agostino's alarming probability.
And now, back to our regularly scheduled programming. Might we politely ask for something to back up D'Agostino's fear mongering?
Well, not quite yet. The next thing we get is a few numbers from the CDC. Here D'Agostino reports that "by high school, even more boys are diagnosed–nearly one in five." Up top he had said one in seven, but, hey–let's just say his copy editor failed him on this one.
"Everyone agrees" that "among those millions of diagnoses" there are 6.4 million "who are swallowing pills every day for a disorder they don't have." And I wait for the other shoe to fall–the number of kids who are suffering because of lack of treatment–and I wait and wait.
D'Agostino then takes a breath and moves into the body of the story with a history of psychiatric diagnosis beginning in 1840. He quotes a psychiatrist who complains about "a general girlification of elementary school," where any disruption is "sinful." (I like the fire-and-brimstone nod.)
We get an exhaustive and exhausting discussion of why ADHD is wrongly diagnosed and a walk through the problems with the psychiatric diagnostic manual known as the DSM-5.
And then D'Agostino's story coalesces around a "countercultural clinician," a family therapist named Howard Glasser, who was a "hyperactive, defiant" kid himself. He believes "wired, obstreperous, uncontrollable kids…are, beneath all that, good."
Why make this moral judgment on obstreperous kids? Who said they were bad? Why does Glasser need to assert that they are good? They are either sick, or they're not. This is not a story about Sunday school behavior; it's a story about ADHD.
D'Agostino's story goes on at enormous length–about 10,000 words–making it an example of verylongform journalism, I suppose. We hear from some families, and we hear much, much more from and about Glasser.
But we don't hear about the kids who don't get medicine when they should.
-Paul Raeburn
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