Originally published February 8, 2012, Donna's response to L. Alan Sroufe’s polarizing Times' article was one of our most-read missives of 2012. The ADHD medication argument has only intensified. While concerned parents actively continue to try to find what will work best for their children, there can be no doubt that children are medicating themselves. Below, we get shades of the complexity in not only this issue, but substance abuse treatment as well. Our culture wants things compartmentalized in black and white. We answer by encouraging people to tolerate the gray.
L. Alan Sroufe’s recent article in the New York Times, Ritalin Gone Wrong, has ignited a maelstrom about the use of “stimulant” drugs in treating ADD and ADHD. Specifically, Sroufe, a noted attachment researcher at the University of Minnesota, stated that his research demonstrates that medication for ADD/HD is not effective after two years. Even more provocatively, Sroufe questioned if ADD/HD was actually a core neurological deficit at all. In his view, ADD/HD is more likely the result of “experiences in early childhood” and “over-intrusive parenting.” Not surprisingly, these statements precipitated a flood of outraged responses to Sroufe, much of it centered on the tone of “parental blaming” in the article. (For two excellent point-by-point rebuttals to Sroufe’s argument, see Righting the Record on Ritalin from the Child Mind Institute, and Dr. Hallowell’s Response from Ned Hallowell’s blog.)
I am not an expert on the subject, but Sroufe’s claim that stimulant drugs are not effective for the treatment of ADD/HD is counter to everything I’ve learned about ADD/HD. As the Executive Director of Freedom Institute, I am primarily concerned with the ways in which ADD/HD interacts with addiction. There is considerable research indicating that 1) children and adolescents with ADD/HD have an increased risk for substance abuse, and 2) that treatment with “stimulant drugs” is a protective factor for these children (Biederman (2003), Wilkes (2003)). In other words, children and adolescents with ADD/HD are less likely to engage in substance abuse and other high risk behavior when they are taking the appropriate medication.
This may seem paradoxical, but should be considered in light of research indicating that children with ADD/HD are more likely to engage in all forms of risk taking behavior. ADD/HD is a thought process characterized by impulsivity and a lessened ability to perceive consequences. In addition, some children and adults with ADD/HD find that high-risk endeavors help organize their thoughts; they can focus more easily when engaged in behavior that requires additional adrenaline. As a result, all children and adolescents with ADD/HD are at increased risk for engaging in dangerous experimentation with drugs and alcohol because they are likely to perceive and respond to risk differently than children without ADD/HD.
When risky experimentation develops into substance abuse, it’s likely that unmedicated adolescents are self-medicating, for either the primary effects of ADD/HD, or the secondary effects that are often a result; low self-esteem, poor peer relationships, and academic or parental pressure to achieve more. This is not to suggest that medication is a magic bullet that will always protect children with ADD/HD from self-medicating with other substances. Some adolescents will end up abusing the stimulant drugs prescribed for their ADD/HD, mostly commonly Adderrall. (See Jimmy's testimonial Righting My Wrong Perception). Unfortunately, parents and psychiatrists have no way knowing when medication treatment begins if their child or patient will be one of the unlucky ones ensnared by substance abuse. It’s a leap of faith, but in my view, it is far less risky to be taking legal, prescribed drugs under the close supervision of a qualified psychiatrist than to self-medicate as the result of a condition for which there is appropriate medication.
That’s the decision my husband and I made several years ago for our daughter who has ADD. At the time, we were not focused on the link between ADD/HD and substance abuse. We just wanted to make her academic life easier. And for her, the drugs worked. She didn’t abuse other substances, she avoided drugs that would interact with her Adderrall, and she never abused her ADD medication. As she tells me, I don’t have to worry, because she doesn’t “like it enough” to do so. She feels like it flattens her out.
So my personal story has been a lucky one. Parents have to make their own choices about stimulant medication for their child. But in my professional capacity at Freedom Institute, I would be remiss if I didn’t draw parents’ attention to the correlation between ADD/HD and substance abuse, as well as the studies that indicate that stimulant medication is a protective factor.