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The Case Against Ritalin: How Strong Is It?

Parents with children who’ve been diagnosed with ADD or ADHD have a difficult choice to face: should we medicate?

Therapy in combination with medication is widely believed to produce the best results in terms of behavior and academic achievement. Side effects can be an issue, though, and many parents dislike the idea of putting their child on a psychiatric medication.

Now a larger question looms: do the medications currently used to treat ADHD even work?

The New York Times this weekend ran a major article critiquing the use of medication for ADHD in kids. It’s an opinion piece, but one written from the vantage point of considerable authority by a therapist who has been researching children with ADHD for 40 years.

His assessment of the current state of ADHD treatments is frightening. Especially if, like me, you take Ritalin every day to manage your own attention problems.

I’ve been on and off Ritalin since I was 6. Like the parents in Dr. Sroufe’s studies, I’ve grown up believing that ADHD is a biological disorder that requires medication to treat. Ritalin isn’t a magic bullet, but my personal experience tells me there are things I can’t do without it. Normal human things like get through a stack of paperwork or keep my appointment calendar straight.

Dr. Sroufe sums up the common wisdom about ADHD this way:

Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.

In a nutshell, Dr. Sroufe dismisses the idea that drugs help with ADD by pointing to one long term study that shows early benefits from medication but no long term improvement to behavior or academic performance. The issue, he claims, is that our bodies become inured to the medications we take, and the beneficial effects wear off.

Moreover, he challenges the entire premise that ADHD is a biological disorder. Instead, he’s eager to blame it on the parents and early childhood environments. Yes, there’s ample evidence that ADHD brains respond differently to neurological testing than neurotypical brains do. But Sroufe points out that our brains change in response to stimulus. Just because a child is struggling with attention issues that show up on a brain scan doesn’t mean the kid was born that way.

Instead, Sroufe stresses the importance of looking at a child’s environment and parental involvement. His theories sound eerily like the old story that autism was caused by “refrigerator mothers” who didn’t love their kids enough. He writes:

Behavior problems in children have many possible sources. Among them are family stresses like domestic violence, lack of social support from friends or relatives, chaotic living situations, including frequent moves, and, especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared. For example, a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath. Or a 3-year-old is becoming frustrated in solving a problem, and a parent taunts or ridicules. Such practices excessively stimulate and also compromise the child’s developing capacity for self-regulation.

Sroufe is ignoring or blithely dismissing as irrelevant decades of research that show brain chemistry being a huge factor in ADHD. He’s also ignoring the substantial evidence that ADHD is heritable, which further points to it’s biological roots.

As one mom  said after reading this article, “Oh, goody. An opinion piece from another psychologist who thinks kids with ADHD have “behavior problems” caused by “family stresses”?”

The thing is, I can’t quite dismiss Sroufe entirely. I’ve been on Ritalin most of my life, and I know it’s effectiveness waxes and wanes. Stress makes me respond less well to it; sleeping well and exercising enough do almost as much to combat my ADD symptoms as Ritalin does. I wouldn’t want to live without it, but it’s only one piece of a system that helps me manage my funky brain.

This is the thing Sroufe ignores that most bothers me: ADHD folks, and their parents, know that Ritalin and Adderall aren’t the only thing an ADD kid needs. We’re not, as his article suggests, looking to be let off the hook. We’re using all the tools available to us. If Ritalin works for awhile and then you need a medication vacation to reset your metabolism because you’ve developed a tolerance to it, then that’s what you do. That doesn’t make it a worthless tool, just one that needs to be managed carefully.

Dr. Sroufe may have decades of experience treating and studying ADHD. He clearly has compassion for the kids he’s writing about. But I don’t think he really understands the choice facing parents and kids when an ADHD diagnosis is given.

More importantly, while environmental factors clearly affect children, it seems irresponsible to lay the blame for a learning disorder entirely at the feet of parents who may have had poor timing about when to give their baby a bath.

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