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We’re in my office, which like any child psychologist’s office, is stuffed with toys, books, and more than a little unfinished paperwork. I’m meeting with Alex and his parents for their first session. Alex is fifteen and already taller than his father, but his problems, they explain, began in preschool.
The problem was this: there was always a problem.
Every kid gets in trouble now and then, but Alex was always in trouble. Always. In primary school, he would daydream so much and so intensely that he would get up in the middle of class and make robot noises while walking around his desk. He was found climbing on a dinosaur fossil during a field trip in the third grade and was banned from field trips for the rest of the year. He was great about doing his homework, but would always forget it at home. He still does.
For more than a decade he was constantly on the receiving end of scoldings, “don’t go there” looks from adults, and teasing and bullying from his classmates. His parents thought that everyone was too hard on him. His teacher thought that his parents were too easy on him. And secretly, Alex thought he was just a “bad kid.”
But they are all wrong. Alex has ADHD.
Luckily, Alex’s pediatrician was sharp and told the parents about ADHD as far back as the first grade. But Alex’s uncle George was living with the family at the time, and he was horrified. He explained that ADHD was not real, that Big Pharma was conspiring with doctors to turn high-spirited kids into zombified conformists, and teachers were in on it because they were too lazy to handle creative types that don’t follow rules.
Like gamblers who have lost too much to quit, parents who go down this road often wake up years later having sunk many thousands of dollars into ineffective treatments
Uncle George sounded like a kook, but he provided evidence to back up his claim, and it looked convincing. Prominent scientists were debating whether the diagnostic criteria were accurate and whether medicine was over prescribed. Articles with shocking headlines about the controversy were appearing in mainstream magazines and even in papers like the New York Times. Dozens of books touted ADHD as scheme. Soon the parents were shopping around for a new pediatrician and were dead set against ADHD. “We thought it was a scam” his mother explained.
Alex’s family is not alone. Attention Deficit Hyperactivity Disorder has been a big topic in the popular press, and it seems as though most of the press about it is geared to do one thing: scare the hell out of parents.
There are good reasons for journalists and authors to do this. If you are a trying to sell copy, scary headlines draw eyes to your story. And, when it comes to readers, no one scares quite as easily, and buys as many books, as parents. A recent book illustrates this point perfectly. With the provoking title, ADHD is Not Real, and written by a medical doctor, it achieves the dumbfounding feat of both denying the existence of ADHD while inventing an entirely new syndrome that looks exactly like it. It very conveniently sets the audience up for potential new treatments and cures. And this speaks to another problem. In the long shadow cast by the scare journalism, a cottage industry of snake-oil cures has flourished. This intersection of scare journalism and pseudoscience should rightly be called an “industry” because while no one that I know of has added up the financial take of those who deny ADHD while providing alternative cures to it, I would suspect it is in the many millions of dollars.
Take Alex and his parents as an example. They discovered the alternative medicine side of the denial industry shortly after uncle George moved out.
They tried special diets, mega-vitamins, magnet therapy, special mattresses, dolphin-assisted therapy (a particularly Hawaiian luxury), chiropractors who claimed they could treat it with spine alignments, aromatherapy, herbal supplements, biofeedback machines, and a host of other pseudoscientific products that claimed, like Uncle George, that Big Pharma was a scam and they had the real answer. Alex’s dad explained that he once did the math on how much they had spent on alternative treatments for ADHD. “I won’t tell you how much it was. Let’s just say it could have paid for a big chunk of his college.” Years rolled by, with failing grades, constant punishments, and bullying from peers, Alex’s self-esteem crashed.
There is a pattern to a family’s journey into alternative treatments that is illustrated by what happened to Alex’s family. At first, the “cure” seems to work and everyone is convinced and exuberant about the effects, but it mysteriously wears off, so something else is tried, and it seems to work wonderfully for a little while, but also wears off. Chasing the relief and joy of the first discovery, the family tries something else. It is a potent combination of placebo effect and confirmation bias rolled together. And like gamblers who have lost too much to quit, parents who go down this road often wake up years later having sunk many thousands of dollars into ineffective treatments. Meanwhile, the child has been through difficulties that are hard to imagine for those without ADHD.
The best way to not fall for the scare journalism and pseudoscience is to study the research and learn the facts. Here are some of the key the facts about ADHD: It is real. It is not willful. It is not just being a boy, being eccentric, being bad, being creative, or being a free spirit. It is a disorder with a biological basis, just like asthma or diabetes, but rather than disrupting breathing or metabolism it disrupts the brain’s ability to pay effortful attention and prioritize activities.
First, here is what we know does not work to effectively treat ADHD:
special diets (the research is still ongoing but well-controlled studies have not supported them)
therapy with magnets
“talk therapy” or psychoanalysis
sensory integration training
social skills training alone
most forms of biofeedback (the research is ongoing for neurofeedback and looks very interesting)
strict punishments for inattention and forgetfulness
Here is what we know actually works:
education for parents and teachers about ADHD
parent praise for effortful, attentive and organized behaviors
parent training for general behavior management
clear and consistent limit-setting
tangible rewards and response-cost for specific behaviors that the child can name
ignoring inappropriate behavior (within reason)
and….medication (yes, it is often over-prescribed, and no it should not be the first treatment choice, but for many kids it does work when prescribed correctly)
Research also suggests that the best approach is to create a tailor-made combination of evidence-based treatments (a “treatment plan”) that address the specific needs of that child rather than relying on one type alone or a cookie-cutter approach. It is also better if the treatment is integrated across environments (a single behavior management system for both home and school).
There is a lot of hype about ADHD, but, fortunately, there is also a lot of solid science. Sifting through the two is not easy, but there are reputable places to go to avoid the pseudoscience and scare journalism. I recommend starting with the National Institute of Mental Health’s website on ADHD and with the websites for CHADD and ADHD Aware, nonprofit advocacy groups for people with ADHD. But most of all, please don’t listen to the uncle Georges of the world. Instead, give your precious time and attention to those who have made it their life’s work to actually study and understand ADHD. After all, the long-term cost of ADHD are well understood and include low self-esteem, poor social skills, and increased risk of depression and anxiety.
By Dr. Ronald Crouch, originally posted here.