The New York Times recently posted an article titled, “Thousands of Toddlers are Medicated for ADHD,” which mentions that around 10,000 2-3 year olds are on medication for ADHD outside of proper pediatric guidelines. The article was written by Alan Schwarz who has been writing about ADHD in the Times for a while now. He also happens to be biased and biased in the same direction as me. One of his earlier articles in 2013, titled, “The Selling of ADHD,” should make his bias evident. It is not exactly a neutral headline.
I am the chief editor for a mental health newsletter that promotes alternatives over medications for treating mental illness. I had a terrible experience on anti-depressants myself. I think medicating two to three year olds for any sort of mental condition is ludicrous, and on some days, you might even hear me call it child abuse. I do not believe there is a two or three year old crazier than the act of medicating a two or three year old with amphetamines, the drugs commonly prescribed for ADHD. So I side with Schwarz most of the time.
That said, I have been steadily working to keep my own bias in check when it comes to controversial topics like medicating children for mental disorders. Through my wellness endeavors I have met parents who have a child on medication and explain to me that it was a last resort, that they felt helpless and that their child is doing better on the medication. For example, I recently talked to a mom who had a defiant child with ADHD who was now on medication and doing a lot better. Now her child is able to sit still and do his homework and is no longer failing out of the first grade. I am Irish, extra stubborn and hotheaded, and let me tell ya: It is a humbling experience to recognize and muzzle your bias on tough issues you feel so strongly about. The reactive part of me wanted to yell at her, “How could you give your 6 year old an amphetamine? What about the long-term side effects? Maybe he is just being a kid? Kids go through a million and one awkward and weird phases, just let them be!”
I went away from that conversation thinking to myself, “There is no way she tried everything. There is now way medication was her last resort, she is just saying that.” So, yes. It is a struggle to muzzle your own bias. Recognizing that fact, however, and just being open and honest about it with myself and others, I think ( I hope) has made me a better scientific investigator. I am now better at investigating an issue and keeping my bias to a minimum before preemptively jumping in and calling someone an idiot. But, it is always a struggle, and I still may call them an idiot just for the heck of it.
Realizing I continually have to hear all sides of a story, I recently reached out to a psychologist, Dr. Russ Barkley of South Carolina, who is one of the premier researchers on a possible new pediatric mental disorder, Sluggish Cognitive Tempo. Sluggish Cognitive Tempo is still being defined, but it has been described as an attention-deficit disorder that is unique from ADHD. Barkley is a big believer in Sluggish Cognitive Tempo and has a large evidence base for it. He has also been criticized for being paid over 100,000 dollars by the drug company giant, Eli Lilly, for giving lectures on their behalf. Eli Lilly has funded research on Sluggish Cognitive Tempo, and specifically research that tests one of their drugs, Strattera, as a possible treatment.
I am biased against doctors like Barkley, but of course I would be: He is a doctor who is trying to create a new mental disorder for kids and he’s a doctor who gets paid by a massive drug company to speak on their behalf. Still, and always, a responsible and thoughtful investigator should hear all sides of an issue to have the best possible picture of a complicated, controversial issue, even if that means punching your punching bag a few times before sitting down to talk to him.
I found his email, wrote a thoughtful letter explaining who I was AND my bias, and asked him if he would be willing to do an interview on Sluggish Cognitive Tempo and how one could distinguish it from normal childhood behavior. He wrote me back the following email:
“Sorry but I am not available for such an interview. You can find all of the information on SCT that is known in the research literature in the Fact Sheet on this condition on my website under the Fact Sheets directory. Here is the article of mine that led the NYTimes sports journalist to contact me for an interview, which I and other clinical scientists working in this area refused to do given his past sensationalized articles on ADHD. I hope you find these informative.
Russell A. Barkley, Ph.D.