A Response to New York Times Opinion Pages piece “Ritalin Gone Wrong”

 

The one fact I know that’s consistent among children with Attention Deficit Hyperactivity Disorder (ADHD) is that they are individuals and react differently to treatment and medication therapy.

L. Alan Sroufe, Ph.D
mentions in the Sunday, January 28, 2012 edition of the New York Times Opinion Pages editorial that there has been “a twentyfold increase in the consumption of drugs for attention-deficit disorder.” I’m sure this correlates with our improved ability to diagnose children with ADHD, a medical as well as at times a very invisible disorder. Let me further elaborate on some of his comments.

Although Dr. Sroufe in the 60’s used to believe that there was a “brain problem”, he now says that there is little to no evidence to support this. What about the fact that the frontal cortex is under active as a result of biochemical imbalances with neurotransmitters like dopamine? This would be where the stimulants do their work. In 2007, The National Institute of Mental Health had done one of many imaging studies that indicated brain maturation in some regions were delayed by three years.

According to literature that he reviewed in 1990, “all children, whether they had attention problems or not, responded to stimulant drugs the same way.” Every child is an individual and every child with ADHD is affected by impairments and co-existing conditions differently. It is often a journey to find the right medication that will allow for the most success and healthy self-esteem. For instance, I know of a child on focalin doing very well but his sister, also diagnosed with ADHD, tried it with results of anxiety and hyperactivity, reactions that did not allow for study.

Dr. Sroufe relates behavior to the consumption of stimulant medication. It is not thought that these drugs promote good behavior. They merely allow the child to be in a position to learn better and appropriate behavior. He says, “while the drugs helped children settle down in class, they actually increased activity in the playground.” This actually proves my point. We know that changes in environment definitely impact the behavior of children with ADHD. How can anyone say and prove that the drug itself increased activity? Knowledge of ADHD tells us that behavior will change based on lack of boundaries, chaos, interest, and general state of health.

Dr. Sroufe refers to a study that consisted of four treatment groups, randomly assigned. He indicates that “after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.” The treatments of the study were provided for the first 14 months of the study. By the end of the 14 months, the group that was provided medication and behavioral therapy showed the most improvement in ADHD symptoms. Later assessment shows many variable results of success. Again, showing that children respond differently to therapy.

Parents have the right and obligation to treat their children with the available medications and behavioral treatments based on what we know today. Without effective treatment, poor self-esteem, a lack of self-advocacy, and academic failure occur. Stimulant medication as well as behavioral therapy allows a child with ADHD the chance to be successful. Since at least 40% of children with ADHD have learning differences, having the chance at more focus will allow them to achieve their goals in their modified programs.

I certainly can’t prove that medication will maintain the same focus throughout time for every child. I know from personal experience the importance of self-esteem. If the medications are allowing for sustained focus as the child matures, he will feel good about his or her achievement, self-advocate, and reach his or her goals. I believe this will sustain the child over time, despite future medication.

Karen K Lowry,R.N.,M.S.N.
Parent2Parent ADHD Family Trainer for CHADD
ADHD Coach
Facilitator for CHADD support Group
Author, The Seventh Inning Sit: A Journey of ADHD
www.7thinningsit.com