"ADHD Medications Have Potential Benefits -- But Can Be Misused"
"I Have My Child Back -- A Story of Successful ADHD Treatment"
"Refining Clinical ADHD Diagnosis -- Clarifying an Imperfect Science"
The headline "ADHD Treatments Don't Reduce Symptoms in Most Children" (or similar ones posted on various sites last week) probably is far catchier than any of the above. It is also inaccurate and unfair to both parents and children. It's not what the related study meant to say. While there are many issues to sort out about accurate ADHD diagnosis and appropriate treatment, the endless stream of disturbing headlines about the disorder increases the burden on families working to live with it day to day.
Breaking News: ADHD Stressful For Parents, Children Alike
The major issue around this preschool study is not the report itself, but how it was covered in the media: "Medication Not Helping Kids with ADHD" is a snappy headline but also entirely misleading. This time around, the study was of high quality, but coverage was twisted to make an impression with the public. In other places (such as the New York Times), evidence from less-credible studies (or no study at all) has been presented as fact suggesting, for example, that medications are often prescribed inappropriately or are inherently dangerous. Articles stir up fear and sell newspapers (or increase the number of views online) while fanning the flames around ADHD.
Skewed coverage of ADHD undermines care and amplifies the difficulties for parents. There is still much to refine about how best to diagnose and treat ADHD. There are significant concerns to address about the potential for misuse of the medications as well as their limitations; comprehensive care goes far beyond a prescription. Yet we leave families hanging when we falsely suggest that ADHD is an artifact of a busy society or caused by ineffective parenting, or that treatment is unlikely to help or is unsafe. In fact, ADHD treatment can be remarkably effective -- "I Have My Child Back" is an actual quote I've heard in my office more than once.
Today's Top Story: ADHD Treatment Is Complicated, Often Successful
The paper referred to in the above headline is perfectly well-written. In case anyone out there was discouraged by how the study was reported, here is another interpretation of the actual results:
• ADHD is a chronic medical disorder, so we can't expect resolution of symptoms over time (although a minority of children will outgrow it). As expected, children with preschool ADHD in the study continued to show symptoms as they got older.
• As they are commonly used today, ADHD medications do not always work well. This isn't the first study to suggest that everyday ADHD management by non-experts may be less than ideally effective. One issue is that children are often prescribed specific medications or doses that do not fully address their ADHD or cause side effects that otherwise may be avoidable. Since for any individual, the pluses and minuses of any particular medication are apparent almost immediately, both the formulation and the dose can (and should) be adjusted rapidly if the results are off. That's not what always happens when people are treated in the general community.
In addition, parents and their physicians in the long-term follow up (having left the initial study) were free to do whatever they felt best with the medication over time. Children might have remained on wrong doses or poor fits of medications (for example, continuing to use a type that caused side effects) without even seeing a doctor, or they might not have taken their medication consistently. While the study could turn out to reflect something significant about general ADHD care that would only be the case if follow-up studies tracked appropriately managed medication; specific information about how the families in the study used the medication wasn't available.
• The authors also discussed the need for more research into behavioral therapy, both with parents and in schools. Medication alone is not typically the answer for ADHD, but effective behavioral intervention can be demanding and expensive. It also requires consistent follow-up and long-term maintenance of various plans that must be adapted over time. Behavioral change itself requires observing and adjusting often entrenched cognitive habits for parents and children alike, a feat that is challenging for any of us. Between limited health insurance and the simple reality of a busy life (or classroom), behavioral interventions are therefore hard to implement in a way that addresses all the details.
Clearly, headlines create a buzz when they stir up fear around ADHD. They also lead people to avoid ADHD evaluation, even though it could be helpful in sorting out the "why" of a child's difficulties... separate from making any treatment decisions. Negative headlines also increase stress around an already-challenging choice, without reflecting the reality that while all medications have potential side effects, so does untreated or undertreated ADHD. ADHD impacts individuals, families, schools, and the health care system as a whole. We would all benefit from far more objective and compassionate coverage of ADHD in our modern world.
For more by Mark Bertin, M.D., click here.
For more on ADHD, click here.