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.
Photo by Jeff Karpala
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