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I suppose I should have said "Internet journalism." With "journalism" in very heavy air quotes. The problem is that people see Psychology Today, a known publication, and think they are getting something that has actually been fact-checked and edited for like, 5 seconds. Also, the proliferation of pay-for-publication fake-o Internet scientific journals is making this all even muddier. And nobody, but nobody ever actually goes to the source and reads the cited articles (most of which are behind a paywall anyway, unless they're the aforementioned fake-o type). My Facebook feed is full of people posting nutball junk about GMOs and vaccination from sites like naturalnews.com. These friends of mine have degrees and ought to know better, but the sites fake themselves up to look marginally science-y if you aren't really paying attention. This isn't even taking into account the fact that many real scientific articles are questionable.

I don't get it. If the child is smart and advanced according to the author, isn't it expected that she's not going to pay attention in the boring and slow paced class environment?

Here are some of the strikes I see against ADHD medication when not absolutely indicated:

-Something like a 50% higher ADHD diagnoses for children in the youngest quartile of their grade.

-A thinner frontal cortex in kids with ADHD compares disturbingly with the thinner frontal cortex of many highly gifted children, and perhaps often with the same symptoms. However the trajectory of the HG+ child is to rapidly gain cortical thickness until it is well above average in thickness around age 11 (if memory serves) then it thins back down some.

-Stunted or delayed average growth for ADHD kids on medication (~1" shorter after three years)

-The strongest outcomes pair cognitive therapies with medication. Taking a kid who has only had medication intervention off of the medication leaves them back at the starting line with no coping skills.

-Often brains grow resistant to psychotropic medications such as reducing the number of receptors for the given medication. Or a brain will cut back on producing its natural alternative. Or when the medication is a receptor blocker, the brain may ramp up production of the chemical for that receptor.

Bingo.

What's worse? Apparently some of those regulatory changes induced by psychotropics within the stimulant classes most commonly used to trial ADD/ADHD treatment cause permanent regulatory changes in receptors and transporters. They are profoundly addictive. Profoundly. In a small, but very real and very reproducible percentage of those who take them, they induce psychosis. Really. Rates vary by individual substance, but are well over 1%. It's not always reversible, incidentally.

The thing is, also, that stimulant meds increase focus for anyone taking them. This is why there is abuse on a positively horrifying scale in collegiate settings with these drugs. There is not really a 'paradoxical' effect that can be used to determine which people are actually in NEED of medication.

It's just like clinical depression-- everyone KNOWS it when they see it. It's just that there isn't a clear diagnostic picture which isn't ambiguous, and the line where medication becomes "the" treatment of choice also isn't clear.

If ADD/ADHD isn't fundamentally an asynchronous development problem for the vast majority of children, then why do so many of them "outgrow" the problem? (And they do, if left unmedicated-- far fewer than half of the children with ADHD retain symptoms into adulthood.)

I strongly suspect that there are multiple populations being lumped together into one classification based on behavioral constructs that probably don't reflect the same underlying mechanistic causes. Some of those people are probably just asynchronous in development, and we're only starting to tease apart who is MOST likely to be misdiagnosed.

Wouldn't it be awesome to get back to a place where people who truly NEED medication can get it without it being assumed that they are selling it for recreational use?

And the behavioral/cognitive therapy that works is hard to obtain for many (most) people. This is a serious failing of the medical establishment. I will not editorialize further, but ugh.

Important to note that behavioral/cognitive therapy alone doesn't necessarily work that well for most children with ADHD. In many cases, the child cannot really access the therapy without medication, which is why the combination is often the strongest choice for moderately to severely affected children (for people who actually have ADHD, not talking about misdiagnoses here).

The choice to medicate is not IME usually taken lightly; nobody's a huge fan of giving medications to kids in principle. In our community, I see it operating as a last-ditch thing that people try after having tried a number of other ways to make life workable for their children, and I see that it is typically associated with unjustly shaming the parents first for having an uncontrollable or out-to-lunch kid, and then for drugging the kid.

Unmedicated ADHD is associated with some other really undesirable things in young adults, like alcohol and drug abuse; if you let a person's frustration level climb sky-high over years by letting them feel like a failure for how their brain works, lots of really bad things can happen. This ought to be factored into decisions. I think families mostly try to do right by their kids; I do not think most families are trying to drug their children into submission and so on.

I would like so much of this public shouting and judgment to stop: the shaming, the overdiagnosis, the pressure to medicate or not medicate. I suppose that's unrealistic of me.

DeeDee

I think what I'd like is also unrealistic-- because it involves changing our expectations and dialing things back to a point where kids were allowed to be... well, children.

I think (and have had a lot of primary educators confirm) that the expectations placed on kids now in K-5 are way different than they were forty years ago. We expect children this age to be "self-regulating" and "self-directed" in ways that probably aren't really developmentally appropriate for about half of them.

DeeDee, I'm with you on this.

I'm a "non-medicator" (I could have written HowlerKarma's posts in this thread, I agree with them so strongly) BUT I feel like I'M judged for "not helping" DS for denying him meds.

The "why/why not" is a futile argument because each child is unique, and each decision made by parents is appropriate for their child ONLY. It is for this reason that I make an honest effort in supporting the people I know who medicate their kids. They know where I stand. My decision not to medicate my DS is not appropriate for my friend's 10 year old, or my other friend's 12 year old, etc etc.

There are so many things that factor into this decision that really shouldn't such as the media, peer pressure, guilt, stigma, overworked doctors who rush, school based teams with insufficient child specific information, etc.

My bottom line is that instinct is what guides me, for my DS8 only. I would never question the instinct of another parent who was guided down a different path, for their child.

Yes, I'll take that, too, while we are being unrealistic.

DeeDee

Zen Scanner, I agree with your post and your reading of the literature.

I still hate the piece about why French kids don't get ADHD because their parents feed them dinner on a schedule and spank them. Lordy.


I will say that I see medication being pushed as a first-line choice by doctors. This is consistent with the research, which shows that it's what dosctors say to do, regardless of the evidence that this isn't what should be tried first. I don't think PARENTS want to do it as a first-line defense, but doctors are often very, very insistent that it's necessary.

Oh, yes. To me, it isn't an MD versus psychologist issue, because both can be guilty of the same thing, which is, namely, failure to perform due diligence. My outrage at this sort of behavior stems from the fact that we both basically do the same thing for a living: troubleshoot complex systems. This is, incidentally, why I enjoy excellent health care personally... doctors and I share the same perspective and approach to the problem at hand.

If I did my job the way so many doctors do, the consequences would be the loss of a few billion dollars. No biggie. For them the stakes are much higher, and to see them failing so hard, so regularly, makes my blood boil. The problem is this: there are many doctors who are prescribing these meds based on a full evaluation and data-driven, evidence-based needs. And there are far more doctors who say, "I dunno... let's give this a try."

And... there are a great many parents who consent to medications as a last resort, and/or based on good information. There are a great many more parents who consent because an authority said so, and they don't know any better (critical thinking being a vanishing skill). There's also a significant subset of parents who view their child as a "thing", and anything unusual is a problem that must be diagnosed and treated... as opposed to, say, that the "problem" is that the kid is, in fact, a kid.

So yeah... lots of reasons to sympathize with the parents who are dealing with these things, and also reasons to be suspicious, too. This is why I tend to avoid the 2e section of this forum, because I'll likely read things that set off alarm bells on some of these behaviors, but honestly I'm in no position to judge based on a few paragraphs in a forum, and I don't want to offend.