More work by Robert Whitaker who alerted me to this post on Mad in America so that I might share it here:
On Wednesday, May 26, the New York Times website ran a question-and-answer interview with Dr. Harold Koplewicz, who is one of the most prominent child psychiatrists in the United States. The New York Times stated that, in this interview, Dr. Koplewicz would respond to readers’ questions about the “myths” surrounding psychiatric disorders in children and adolescents.
In other words, Dr. Koplewicz would dispel the “myths” and inform the readers of the “truth.”
Now during the Q & A, Dr. Koplewicz stated that “hundreds” of studies had shown stimulants to be a “safe and effective” treatment for ADD/ADHD. Once a child was properly diagnosed with the disorder, then drug treatment followed as a matter of course. “If your child had diabetes, would you say no to insulin? If your child had epilepsy, would you say no to anti-seizure medications?”
So let’s put those two statements to the test. Is this an instance of “myths” being dispelled, or is it an example of “myths”—and misinformation—being peddled?
In terms of the safety and efficacy of stimulants for ADHD, short-term studies do show that stimulants curb motor activity, and thus reduce the symptoms of “hyperactivity.” Medicated children may also focus more intently on a school assignment. But I’m quite certain that Dr. Koplewicz is also familiar with studies that have looked at the long-term efficacy of stimulants, such as the NIMH’s Multimodal Treatment Study of Children with ADHD.” While the medicated children in that study were doing slightly better than those treated with behavioral therapy at the end of 14 months, by the end of 14 end of three years, “medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-to-36 month period actually showed increased symptomatology during that interval relative to those not taking medication.” In addition, the medicated youth had higher delinquency scores and were also now shorter and weighed less than their non-medicated peers, evidence that the drugs suppressed growth.
At the end of six years, the results were the same. Medication use was “associated with worse hyperactivity-impulsivity and oppositional defiant disorders symptoms,” and with greater “overall functional impairment.”
Thus, the safety and efficacy picture has both a short-term component and a long-term component. Other studies that have focused on long-term results have also failed to document a benefit to the drug treatment, which was why, when the NIMH first mounted its MTA study, its investigators confessed that “the long-term efficacy of stimulant medication has not been demonstrated for any domain of child functioning.” Dr. Koplewicz omitted this long-term information, and thus, I think it’s fair to say, presented an inaccurate picture of what science has revealed about the safety and efficacy of stimulants as a treatment for ADHD.
As for Dr. Koplewicz’s comparing stimulants to “insulin for diabetes,” this is a metaphor that psychiatry has employed for decades to describe its drugs, and it is such a tired, old canard. That metaphor leads readers to believe that the drugs are antidotes to a known pathology, and that of course isn’t true. The biological causes of most mental disorders remain unknown. This is certainly the case for ADHD. As an expert panel convened by the National Institute of Health confessed in 1998, “after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains largely speculative.” Stimulants, which alter dopamine function in the brain, are not fixing any known “abnormality.”
This Q&A illustrates why our country can’t have a reasonable discussion about the merits of psychiatric medications for children. The New York Times presented it as a piece that would dispel “myths,” and yet, in the space of a few lines, readers were misled about the safety and efficacy record of stimulants, and they were encouraged to conceive of the drugs as antidotes to a known disease, which clearly they are not. And this, unfortunately, is the “news” that is fit to print.