The heated debate set off by psychologist Alan Sroufe's New York Times article (with responses in the Huffington Post by Dr. Harold Koplewicz and Jessica Samakow) misses a critical point implicit in Dr. Sroufe's discussion. The fact that the child's social context may play a part in causing the attention, focusing and behavior problems that we call ADHD can actually be interpreted as good news for parents.
Family stress is not synonymous with bad parenting. Far from heaping shame and blame on parents or firing a shot across the bow of parents, as Dr. Koplewicz interprets Sroufe's position, the news about the relevance of the nurturing environment actually empowers parents. It means that kids, like adults, respond to environmental stresses and may have striking personality changes as a result. The reason that this is good news for parents and kids is that changing the social context factors that are stressing their child is very frequently under parents' control.
To best help our country's children, we, as parents and professionals, need to look beyond the increasing polarization on the "to drug or not to drug" issue. We need to recognize the deeper both/and message that underlies the increasingly fervent debate about whether kids should be medicated for ADHD. Even Dr. Koplewicz admits that that serious stress in a child's environment -- ranging from abuse and neglect, to inconsistent discipline, marital problems, and financial issues -- can result in a child's having problems. And Dr. Sroufe, for his part, does not dispute that stimulant medications like Ritalin enhance most people's ability to concentrate. He points out that versions of the drug helped World War II radar operators stay awake and focus on boring and repetitive tasks. Stimulants certainly can help children focus.
But to choose one side or another of the debate is to throw out the baby with the bath water. I think that we can recognize both that stimulants do work to help kids focus and also that modifying the child's environment can help him become calmer and more focused. And, most importantly, we can recognize the latter without blaming or shaming parents. I have seen stimulants medications help many children behave and focus better, even over the course of many years. But many parents come into my office dead set against medicating their child because they have read the research about the possible long-term side effects of psychotropic medications that are now prescribed for children. These parents are looking for a behavioral rather than a pharmaceutical solution. And because there is a huge difference between blaming parents and counseling them in a spirit of support and caring, I, like many other family therapists, can usually provide them with that solution.
Dr. Koplewicz points out that kids may get prescribed drugs because it's easier than figuring out what's causing the behavior. I believe that that depends entirely on who is doing the figuring. But he is certainly correct in saying that stimulants medications are quicker in helping. Ritalin and similar drugs can take effect almost immediately, whereas for parents to change their behavior consistently can take up to take several weeks. Making changes in parenting takes more work and more time -- and perhaps more courage -- but that doesn't mean that this kind of solution cannot be effective for many ADHD children.
I truly appreciate Dr. Sroufe's bringing to light research that shows that the social context of a child can play a role in causing ADHD-type problems, and his insistence that we search for more complex solutions for what is a complex problem. But I do not agree with his view that the social context factors are mainly to be found in in early childhood. From my experience as a therapist, I know that stress in the child's present environment can play a large part in causing focusing and attention problems. That is why a child can have a personality change seemingly overnight and "become" ADHD. And this focus on factors that may be stressful in a child's present environment -- whether at school or at home -- is empowering. While parents do not have the power to change the past, they do have the power to change the present.