3/18/14.
Michigan Psychological Association Newsletter
Winter 2014
Notes of a Psychology Watcher
Steven J. Ceresnie, Ph.D.
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:
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.
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.
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:
Ensure
that ADHD is recognized as both biological and cultural and contextual in
nature.
Demand
that ADHD be diagnosed carefully by professionals who know their business.
Ensure
that ADHD be treated by clinicians (and paraprofessionals) who are versed in
evidence-based interventions.
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.
Alter
educational practices to promote more individualized approaches.
Facilitate
partnered systems of cure, and coordinated payment mechanisms, across insurers,
schools, and employers.
Convey
a different set of media images about ADHD, emphasizing the reality of daily
struggles and triumphs.
Encourage
information exchange across scientists and clinicians internationally.
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.
Wright, Lawrence.
Going Clear. Scientology, Hollywood, and
the Prison of Belief. New York:
Alfred A. Knopf, 2013.
