No Quick Fix

05.07.12

Dr. Harold Koplewicz: a New Poll That Trivializes ADHD Is Nonsense

Doctors and parents who medicate children with ADHD and other childhood disorders are not taking short cuts, writes Dr. Harold S. Koplewicz, but instead are trying to help those children enjoy life and learning as normally as possible. Plus, Koplewicz's 5 tips every parent should know.

It all started when I was getting my feet wet as a general psychiatry resident, on my first day at the hospital, almost 35 years ago.  Three brand-new residents, including me, were introduced to patients by the three residents who were leaving.

All of the patients were in a circle, along with the nurses and old and new residents, for their morning group-therapy session. As the patients talked and vented their anxiety, some of them delusional, I could feel how anxious I was too, along with a rising sensation that I might have made a mistake in my career choice. How could I possibly understand, let alone help, these intense, complex, and confusing human beings?

When the morning session ended, one of the patients assigned to me grabbed the leg of the departing resident who had been his doctor and begged him, "Please don't leave me with him" (meaning me). And it took all of my self-control not to grab the other leg and say, Please, I made a mistake, don't leave!

Of course, I got over my initial anxiety and learned a lot about treating adults with psychiatric disorders. But that day was the day I began to realize that I wanted to work with children. Because the patients in that ward already had decades of psychiatric illness behind them, decades of suffering, decades of maladaptive coping strategies, and often decades of dysfunctional behavior that tested and alienated those around them.

What did I realize that day? That it would be particularly rewarding and exciting to work with children, because there is such an important opportunity to have a positive impact, and to prevent them from becoming very disabled adults.

And in the nearly 35 years since then, our ability to alter the course of a life for the better has only improved. That's because the tools we use to treat kids are so much better now. We've made enormous strides in understanding children: how they think and develop, and how they're different from adults. We also have specialized, targeted behavioral therapies that really can transform young lives, as well as much more effective medications.

But the public perception of children's mental health hasn't changed along with the possibilities. Stigma and misinformation are still preventing kids from getting treatment that could really change the course of their lives.

Where we have areas of progress, like medications for ADHD, there's a backlash, and lots of people are blaming parents for using medication to help their children.

If you had seen as many kids with ADHD as I have, you'd know that there's no such thing as a ‘quick and easy fix.’

When Parents magazine and the Child Mind Institute surveyed Parents readers about ADHD, we found that a solid majority (62 percent) think ADHD is being overdiagnosed just because children have behavior issues. A whopping 72 percent said doctors are too quick to put kids on medication for ADHD rather than look for other solutions, and 74 percent said kids are being put on medication for a "quick and easy fix."

If you had seen as many kids with ADHD as I have, you'd know that there's no such thing as a "quick and easy fix," and that their parents go to extraordinary lengths to help them be happy and successful. Parents don't medicate kids because they are lazy parents and think the pills will rein in unruly kids. They use medication when kids are so impulsive and inattentive that they are failing in school and on a collision course with their friends and family.

I'm sure some misdiagnosis goes on, when the doctors doing the prescribing aren't well-enough informed, but kids who are not getting diagnosed and treated are a much bigger concern.

I am well aware of the charge that mental-health professionals are pathologizing normal behavior, treating symptoms that all children exhibit: distraction, hyperactivity, anxiety, impulsiveness, moodiness, and other forms of disruptive behavior.  But the children who need help are those who are chronically out of the normal range for these symptoms, and they are seriously impaired by them.

No one would tell the parents of a child with diabetes or leukemia that they shouldn't seek treatment, and no one should tell the parents of children with psychiatric or learning disorders that they're overreacting by getting help, whether it's medication or behavioral therapy or both.

This gulf between the reality and the perception of children's mental health is the reason we started Speak Up for Kids, our campaign during National Children's Mental Health Week (May 6-12) to raise awareness of the symptoms of psychiatric and learning disorders, and the evidence-based treatments available to help them.

Obviously, we need a national conversation about children's mental health, to force into the open the parent-bashing and misinformation that is being promulgated. We need all our kids to have the opportunity to fulfill their potential, and to get there we need everyone to help spread the word about early and effective intervention.

The message we want to send is that kids who are struggling should get help before their impulsivity becomes dangerous, before their anxiety becomes crippling, before their frustration in school makes them give up, and before their disruptive behavior gets them into serious trouble.

Childhood disorders should be treated before they become adult disorders, which are much tougher to deal with. And kids should get help before they miss out on the main task of childhood and adolescence—learning—because they're too anxious to try new things, too distracted to pay attention, too despondent to be engaged, too hyperactive to concentrate.

This week people all over the country (and the world) will be speaking up for kids who are struggling and the parents who are trying to help them. They will be telling the world that childhood psychiatric and learning disorders are real, common, and treatable.

Go to childmind.org/speakup and add your voice to this important cause.