Misunderstandings about ADHD: Eyes Wide Shut

3/18/14.

Michigan Psychological Association Newsletter

Winter 2014

 

Notes of a Psychology Watcher

 

Steven J. Ceresnie, Ph.D.

Dr.Ceresnie@sjcpsych.com

 

Misunderstandings about ADHD:  Eyes Wide Shut

 

Book Review:  Hinshaw, Stephen P., and Scheffler, Richard M. The ADHD Explosion. Myths, Medication, Money, and Today’s Push for Performance.  New York:  Oxford University Press, 2014.

 

Myths about ADHD persist. Too many people continue to believe it’s a cop out, an unvalidated condition related to society’s penchant for overmedicalizing defiance or a convenient label intended to cover over social problems. These myths destroy any hope of providing systematic educational, behavioral, and medical care for the youth, families, and adults who desperately need help. Medications are still viewed suspiciously for behavioral and psychiatric conditions, a position unfortunately fostered by the ease of getting an ADHD diagnosis and securing pills for performance enhancement in too many quarters of society – and by overreliance on medication as the only treatment worth pursuing. To deal with ADHD better than we do now, we must alter our attitudes as well as our educational and healthcare practices (Hinshaw & Scheffler, page 168).

 

            This book, written by Stephen P. Hinshaw, Ph.D., Professor of Psychology at the University of California, Berkeley, and Richard M. Scheffler, Ph.D., Distinguished Professor of Health Economics and Public Policy in the School of Public Health and the Goldman School of Public Policy at the University of California, Berkeley, could not have come at better time.

 

            For the past two years, the media --- the New York Times, the Wall Street Journal --- have been awash with articles attacking the validity of ADHD, and slamming the medication treatment for this serious psychiatric disorder. The following are some headlines of these stories:

 

“Ritalin Gone Wrong.” Sroufe, L. Alan. The New York Times, January 28, 2012.

 

“Risky Rise of the Good-Grade Pill.”  Schwarz, Alan. The New York Times, June 9, 2012.

 

 “Drowned in a Stream of Prescriptions.” Schwarz, Alan. The New York Times, February 2, 2013.

 

“A Nation of Kids on Speed.” Cohen, Pieter. Rasmussen, Nicholas. The Wall Street Journal, June 16, 2013.

 

            Now these exposes about ADHD are nothing new. Some of these reports are critically examined in “The ADHD Explosion,” with some surprising results.    

 

Scientologists, where their founder L. Ron Hubbard lectures us about the between-lives period, when thetans are transported to Venus to have their memories erased, have waged a 40 year war against Ritalin – and against psychology and psychiatry, along with sympathetic mental health clinicians through the Citizens Commission on Human Rights, a Los-Angeles based nonprofit organization formed by the church in 1969 to investigate mental health abuses. Scientologists have used their considerable fortune to sue drug companies and the American Academy of Child and Adolescent Psychiatry, among others. When Scientologists announce their legal challenges to protect children, the media shines a bright light on these efforts. When all the lawsuits are dropped because of no merit, not a word their dismissals reach the public. (1)

 

            Hinshaw and Scheffler’s book has four fundamental messages:

1. Although often ridiculed, ADHD represents a genuine medical condition that robs people of major life chances. Its economic consequences are huge, totaling hundreds of billions of dollars annually in terms of special education services, juvenile justice and substance abuse costs, plus low work productivity and employment lapses in adults.
    
2. Only diligent and thorough assessment can distinguish ADHD from other mental health conditions, chaotic home environments, or the aftereffects of maltreatment. Yet, ADHD is too often diagnosed in extremely cursory fashion. This lack of careful evaluation, fueling both overdiagnosis and underdiagnosis contributes to a national crisis.
    
3. ADHD medications are effective in reducing the condition’s core symptoms, at least in the short run, but the most genuine gains are achieved by combining medication with skill-building approaches.

    4. Rates of ADHD and medication treatment vary dramatically across states (and, for treatment,         across the world), related to family and cultural values, health care systems, medical         portrayals  and advertisements, and, in particular, variations in school policies linked to demands for achievement and performance.

 

The authors list ten major goals for improving the science and practice related to ADHD in the future. Each of these goals roughly corresponds to a chapter in the book:

1. Ensure that ADHD is recognized as both biological and cultural and contextual in nature.
2. Demand that ADHD be diagnosed carefully by professionals who know their business.
3. Ensure that ADHD be treated by clinicians (and paraprofessionals) who are versed in evidence-based interventions.
4. Set realistic national quotas for stimulants, balancing the need for prescriptions for legitimate cases of ADHD with the reality of ever-greater diversion of the medications for neuro-enhancement or pleasure.
5. Alter educational practices to promote more individualized approaches.
6. Facilitate partnered systems of cure, and coordinated payment mechanisms, across insurers, schools, and employers.
7. Convey a different set of media images about ADHD, emphasizing the reality of daily struggles and triumphs.
8. Encourage information exchange across scientists and clinicians internationally.
9. Continue to recognize that ADHD exists well beyond white, middle-class boys, revealing itself across gender, race and ethnicity, and the age span.

(10)Recognize that fostering human potential, reducing stigma and enhancing economic   productivity go hand in hand.

            This book provides a corrective emotional and cognitive experience through an even-handed discussion about the controversies surrounding ADHD. The authors make clear what is known about ADHD, and distill the complexities about the personal and social costs of people who suffer with the chronic and pervasive problems of ADHD.

 

1. Wright, Lawrence. Going Clear. Scientology, Hollywood, and the Prison of Belief. New York:  Alfred A. Knopf, 2013.