Ritalin and ADD/ADHD have become so closely associated with each other that to mention the one is to imply the other. Indeed, at the end of last year, a mild panic arose over a shortage of drugs like Ritalin and Adderall. Three million children now take such medications, a 20-fold increase in the past 30 years. L. Alan Sroufe, professor emeritus of psychology at the University of Minnesota’s Institute of Child Development, says that the use of drugs in the name of helping children with attention issues is a case of “Ritalin gone wrong.” In a New York Times op-ed, Sroufe argues that based on his 40 years of studying the development of “troubled children,” the drugs are not effective in the long-term. Our overuse of them is a sign of insufficiently understanding of what ADD is and of not taking enough into account how experiences in early childhood can affect children’s development.
Drugs and ADD/ADHD
While stimulants like Ritalin and Adderall do increase attention in the short term, “when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems.” Furthermore children develop a tolerance for the drugs over time. A 2009 study that examined how four different treatments affected children with attention problems over a number of years yielded inconsistent results:
The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.
Despite a lack of evidence, many “well-meaning” parents, therapists and teachers have, says Sroufe, have come to believe that medication is necessary based on research linking ADD/ADHD to different neural functioning.
…findings in neuroscience are being used to prop up the argument for drugs to treat the hypothesized “inborn defect.” These studies show that children who receive an A.D.D. diagnosis have different patterns of neurotransmitters in their brains and other anomalies. While the technological sophistication of these studies may impress parents and nonprofessionals, they can be misleading. Of course the brains of children with behavior problems will show anomalies on brain scans. It could not be otherwise. Behavior and the brain are intertwined. Depression also waxes and wanes in many people, and as it does so, parallel changes in brain functioning occur, regardless of medication.
I do think it is necessary to continually reevaluate the use of medications for children, but Sroufe is too quickly dismissive of findings from neuroscience about ADD/ADHD, perhaps due to his emphasis on the social and interpersonal environment a child is raised in. His own research has involved a several-years study of 200 low-income children who are “therefore more vulnerable to behavior problems”; 50 percent of the children qualified for some sort of psychiatric diagnosis as adolescents and 14 percent for ADHD.
In affluent families, Sroufe writes that behavior problems can result too, from stresses including 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.”
ADD/ADHD and Being “Differently Wired”
Sroufe’s discounting of neuroscience findings and his emphasis on early childhood experience — on the interpersonal environment a child is raised in — may not sit so well with parents and others.
Parents too often find themselves deciding to give a child Ritalin or Adderall out of clear and present worries about a student’s performance in school and overall well-being. But there is a general sense among many that it is best to be wary about giving children too medications or even any at all, precisely due to the side effects that Sroufe expresses concerns about, and to worries about a child becoming over-dependent on little pills from a bottle. Parents, teachers and therapists are, indeed, ever on the lookout for other ways to help children focus. These include diet and exercise and also an understanding of the sensory problems that can accompany an ADD/ADHD diagnosis. Small innovations such as changing the lighting in a room or allowing students to stand up while studying can make a huge difference.
My teenage son Charlie is on the moderate to severe end of the autism spectrum and takes a number of medications. Autism is understood to be a neurodevelopmental disorder today but once parents were blamed for causing it, by withdrawing emotionally from their young children and not bonding with them. Accordingly, I am wary of Sroufe’s emphasis on experience and environment as at the root of attention disorders, and all the more so as my husband Jim has ADHD (he’s been diagnosed by a number of professionals and is actually lecturing soon on this very topic). In the course of taking care of Charlie (who is only minimally verbal) and getting a better understanding of how his brain functioning is tied to his behaviors (Charlie does not have seizures but anti-epileptic medication helps him a lot), Jim has gotten a better sense of how he himself is “wired differently.” Exercise has been especially helpful for him (and for Charlie), as well as the understanding that, even when he appears not to be paying attention, he really is.
Yes, we need better solutions for ADD and ADHD than Ritalin and Adderall. But also necessary is a better understanding that some of us are “neurologically wired” in different ways and that this can indeed affect your early childhood development and how people respond to you.
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Photo by Jeff Karpala