L. Alan Sroufe drew a hailstorm of comment last week with his New York Times essay that criticized medication for Attention-Deficit/Hyperactivity Disorder. Plenty of bloggers focused on his claim that parents can cause AD/HD by putting a baby in the bath too fast. Others barraged his claim that meds are a waste of time, because they aren’t a cure. Appropriate treatment of AD/HD is a critical issue. Let’s ask some critical-thinking questions:
1. Is the author an expert in the field?
Prof. Sroufe is an eminent psychologist who has studied behaviorally-disturbed children for more than forty years. What he is not is a psychiatrist, neurologist, neuropsychologist or AD/HD researcher. Time Magazine columnist Judith Warner points out that Sroufe last studied medication’s effects on behavior in 1973. Over at PsychCentral, John M. Grohol, PsyD notes Sroufe cites only one other study completed since. You can dismiss Warner’s quasi-Freudian speculations on Sroufe’s motivations, and still suspect his assumptions are as dated as Ziggy Stardust’s leotard.
2. Does the author back up what they say?
He states: “… the large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill.” Is this society’s view? Sroufe cites no evidence that it is. Patently offensive but zeitgeist-y cartoons suggest the reverse. A Google search on “drug free”+ADHD+treatment yields 5,840,000 hits as of this writing. Ned Hallowell, MD, a former Harvard Medical School faculty member who runs clinics in New York, NY and Sudbury, MA states,
“…19 out of 20 people who come to me for help for themselves or their child adamantly oppose the use of medication. Only when they fully understand the medical facts do many of them change their minds. Far being predisposed to the use of medication, the people who come to see me are predisposed in precisely the opposite direction.”
According to the Centers for Disease Control, 5.4 million American children aged 4 to 17 have been diagnosed with AD/HD. Per the same study, 2.7 million of those children are prescribed medication. If we, as a nation, ram pills down innocent throats, we’re slacking on the job. We haven’t even inflicted meds on all the kids who meet AD/HD criteria yet.
3. Do the examples fit the argument?
Sroufe says children’s behavior can worsen after they are taken off stimulants. He states, “Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking. ” Nicotine withdrawal lasts four weeks max, and caffeine withdrawal is over in a couple of days. Does that make it a mistake to perk yourself up with a daily cup of joe in the first place? If there’s a reason someone with AD/HD needs to stop the meds, a week or two of adjustment seems a mild price to pay for the improvements stimulants bring. Sroufe also notes (correctly):
Behavior problems in children have many possible sources. Among them are family stresses like 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.
He’s gotten a lot of heat for the comments about parental intrusiveness. No one seems to have noticed the bait-and-switch from ’causes of AD/HD’ to ’causes of behavior problems in general’. Airplanes and motorcycles are both motor vehicles. That doesn’t mean 747’s come from the Harley-Davidson factory.
4. Do important points get obscured in controversy?
Criticism of Sroufe’s column has slammed the parts where he seems to say that parents are to blame, or that effective medications are a bad idea because … well, because they’re medications. Much less attention has focused on propositions like this:
Putting children on drugs does nothing to change the conditions that derail their development in the first place. 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 A.D.D. 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.
You could knock Sroufe for a syllogistic fallacy here (“We need to spend more to research causes of AD/HD that haven’t been demonstrated to cause AD/HD”), but you’d miss his larger point. We don’t know enough about how and when environment influences behavior. Research dollars are funneled to well-researched topics, instead of to open questions. If too many children are receiving meds without therapy or behavior management skills, that’s a failing to address immediately.
My criticism of Sroufe? He blew it. He had national commentary’s version of a Super Bowl ad to advocate for more comprehensive treatments and research. He distracted everyone by arguing, “Let’s quit using the most effective individual tool we have.”
@ 2012 Jonathan Miller All Rights Reserved