In a provocative essay in Sunday’s New York Times, L. Alan Sroufe, an emeritus professor of psychology at the University of Minnesota and an expert in child development, argues that recent parental concern about a shortage of Ritalin, Adderall and other drugs used to treat children with attention problems is misplaced.
Instead, he says, parents — and the rest of us — should be concerned about why we’re so heavily invested in giving these drugs to our kids.
For, as Sroufe points out, although there’s been a 20-fold increase in the use of stimulant drugs for attention deficit hyperactivity disorder (ADHD) during the past three decades, there’s no good evidence that these drugs offer long-term help to children.
“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams,” he writes. “But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth. Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.”
Drugs like Ritalin and Adderall become less effective over time because children (like adults) build up a tolerance to them — a factor that, ironically, causes parents to strengthen their belief in the drugs’ usefulness, says Sroufe.
“Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work,” Sroufe explains. “But the behavior worsens because the children’s bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.”
Environmental factors are overlooked
The prevailing belief about the cause of ADHD — that it’s “a brain problem of genetic or otherwise inborn origin” — is itself built on sand, Sroufe argues. Large-scale epidemiological studies, including those he and his colleagues at the U of M’s Institute of Child Development have conducted over the past 40 years, suggest that the child’s environment is a much greater factor than any inborn chemical imbalance.
“Putting children on drugs does nothing to change the conditions that derail their development in the first place,” he writes. “Yet those conditions are receiving scant attention. Policy makers are so convinced that children with attention deficits have an organic disease that they have all but called off the search for a comprehensive understanding of the condition. The National Institute of Mental Health finances research aimed largely at physiological and brain components of [ADHD]. While there is some research on other treatment approaches, very little is studied regarding the role of experience. Scientists, aware of this orientation, tend to submit only grants aimed at elucidating the biochemistry.”
Sroufe believes that neurological studies are unwisely being used to “prop up the argument for drugs to treat the hypothesized ‘inborn defect.'”
“While the technological sophistication of these studies may impress parents and nonprofessionals, they can be misleading,” he writes. “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. … [But] these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience.”
If we don’t change course
Our present way of thinking about ADHD, Sroufe concludes, poses several risks:
First, there will never be a single solution for all children with learning and behavior problems. While some smaller number may benefit from short-term drug treatment, large-scale, long-term treatment for millions of children is not the answer.
Second, the large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them.
Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone — politicians, scientists, teachers and parents — off the hook. Everyone except the children, that is.