Daniel Willingham--Science & Education
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Who is responsible for your child's health?

8/20/2012

 
In an op-ed piece in August 19th's New York Times, Bronwen Hruska tells of her experiences with her son, Will, between the 3rd and 5th grade. Will was misdiagnosed with ADHD.

Hruska and her husband were initially approached by Will's teacher, who thought his behavior indicated ADHD. Though they were doubtful, they took him to a psychiatrist who said that Will did indeed have ADHD and prescribed stimulant medication. Will took the medication for two years but stopped when he concluded that Aderall is dangerous. Now a happy high school sophomore, there is not much reason to think that the medication was ever necessary.

How did this happen?

The title of the piece--"Raising the Ritalin Generation"--provides a clue to the author's conclusion. Hruska suggests that our society is sick. Teachers are too quick to suggest medication for kids. Schools "want no part" of average kids; they expect kids to be exceptional, extraordinary. And we, as a society, are teaching kids that average is not good enough, and that if you're only average you should take a pill.

But there's an important piece missing from this picture--parents.

From what's written, it sure does sound like Will was misdiagnosed. But I can't help but wonder why his parents didn't know it at the time.

ADHD diagnosis requires that symptoms be present in at least two settings. So it's not enough that Will shows troubling symptoms in school: he would also need to show them at home, in social settings, or in some other context for him to be diagnosed. There's no indication of a problem outside of school.

It's also notable that the mere presence of symptoms is not enough: the symptoms must be clinically significant; in other words, they obstruct the child's ability to function well in that setting and Hruska maintains that Will seems like a typical kid to her.

This is where Hruska loses me. Why would she accept the diagnosis if symptoms were observed in just one context, and if she believed there was limited evidence that the symptoms were clinically significant in that context? Why wouldn't she challenge the physician who diagnosed him?

I'm led to wonder if she knew the diagnostic criteria. They aren't hard to find. Google "adhd diagnosis." The first link is the CDC site that offers a reader-friendly version of the DSM IV criteria.

Are our kids pill-happy? Are we raising a Ritalin generation? If so, the solution is not to lay all of the blame on schools and society or even on physicians who make mistakes, and to portray parents as powerless victims. The solution is for parents to make better use of the wealth of scientific information available to us, and to ask questions when a doctor or other authority makes claims that fly in the face of our experience.

Marianne K. link
8/20/2012 04:09:22 am

Thank you so much for being among those bringing increased attention to the issue of ADHD misdiagnosis. This is such an important topic, which is even witnessed at a significant degree among gifted children.

SENG (Supporting Emotional Needs of the Gifted), a nationally recognized nonprofit organization celebrating 30 years, began a public awareness effort in January 2012 about the issue of ADHD misdiagnosis & over-diagnosis. SENG also recently released in July 2012 a well-received informational brochure specifically for pediatric medical professionals about decreasing medical misdiagnosis in children - specifically in our constituency of gifted children. SENG is in the midst of distributing these educational materials nationwide. But it is undoubtedly clear that misdiagnosis occurs in all subgroups of children - all ability levels, genders, races, ethnicities, and in all socioeconomic groups.

Misdiagnosis not only may harm children without ADHD who are given the diagnosis of ADHD, but the increases in misdiagnosis also may harm those who truly suffer from this condition when limits are reached in schools in the ability to accommodate the increasing numbers of children. More research is needed in identification and treatment, as well as increased research which better illuminates the full range and full variability of normal neuro-development.

I hope the ADHD conversation further expands to include a more accurate and vocal addressing of the myriad of other conditions & even societal pressures that oftentimes mimic ADHD in untrained eyes. More understanding is desperately needed in these areas.

Thank you.

SENG news release: http://www.sengifted.org/news/press-releases-media-kits

Will May link
8/20/2012 06:12:38 am

It seems pretty obvious to me what's going on. The psychiatrist is perceived as an authority figure. It's not much different than the Stanley Milgram experiments.

http://www.youtube.com/watch?v=BcvSNg0HZwk

It strikes me as very odd that a psychologist would fret about where to place blame. Blame is subjective and unscientific. If we want to improve this problem, we need to alter the situation in some way so that parents feel more comfortable challenging psychiatric authorities. (Or change other aspects of the situation.)

Deciding to "blame" parents is basically pointless.

Jared Cosulich link
8/20/2012 11:59:01 am

Expecting parents to challenge two authority figures based on what they've read on the Internet is not an appropriate expectation. Sure, it would be great if every parent had the confidence to challenge both a teacher and a psychiatrist despite understanding the symptoms of ADHD less than either one, but expecting that as a solution to the problem of excessive ADHD diagnosis is extremely poor judgement in my opinion.

Why did the teacher and psychiatrist misdiagnosis? That is a far more important question then why did the parent not correct that diagnosis, challenging two clear authority figures.

If there is a pattern of misdiagnosis in either profession (teaching or psychiatry) then that problem must be addressed. You can't simply pass along the blame to parents for not properly challenging the people they are trusting to provide expert analysis.

Cal
8/20/2012 12:02:10 pm

While I agree with you, and would be willing to face-off teachers or shrinks who gave me a diagnosis I disagreed with, the reality is that life gets very, very tough for parents who disagree with a school who wants to medicate their kids. Every problem, minor or not, becomes more fuel for the argument. The parents are viewed as "problem" parents. The kids are, too.

Many times, that perspective is justified. Sometimes, it's not. But justified or not, that's what will happen. And many parents don't want the hassle.

Mike Thayer (@gfrblxt) link
8/20/2012 01:39:23 pm

If you are a parent, you can't help reading about how Ritalin and other drugs are so heavily prescribed and so <i>easily</i> prescribed. So, if your kid is "recommended" for it, and you don't think it's appropriate, then act like a doggone parent. Fight back. Be the problem parent. If you've really taught your kids manners, respect, appropriateness, and so on, and you're still approached with the "get them evaluated" suggestion, you should - you MUST - find out why that suggestion was made. Too often parents (and teachers, and psychiatrists, and...) want the easy way out - they don't want the hassle, as you say. But if you're a parent, I'm sorry, but you signed on to deal with those hassles.

As a teacher myself, I really wonder if many kids on meds have an organic issue that requires these drugs. My suspicion is more that they are either (a) bored with school, (b) have not learned self-discipline, or (c) are developmentally unready to be in the regulated classroom setting that they find themselves in. The drugs they could will cover the symptoms of all 3 - but at what cost?

Cal
8/20/2012 02:28:48 pm

I'm not sure why you think I would personally disagree. However, Dan was wondering why parents would consent when they were worried about a misdiagnosis. I was explaining why, not denouncing them for doing so.

Mike Thayer (@gfrblxt) link
8/21/2012 04:08:12 am

I didn't mean to imply that you yourself disagreed. The "you" above referred to the general public. As Dan says, when such a serious recommendation (to medicate one's child) seems to contradict what the parents know about their own child, and yet they act on the recommendation anyway without seeking other opinions, in my view they deserve to be called out on it.

Dan Willingham
8/20/2012 10:12:05 pm

@Will, @Jared I think we agree more than not. I agree that she listened to the doctor because of his authority. I also agree that most of us do so most of the time and that doing so usually makes sense. I actually used this example in my book. But I also encouraged people not to accept the judgment of an authority that flies in the face of your experience. And I encouraged people to capitalize on reliable scientific information that is available to them. I thought that in this case doing so would have been so remarkably easy that it's not unreasonable to expect the author to have asked the doctor some questions, or to seek another opinion. Instead, she used the experience to take a swipe at the teacher and society at large. I think that's a cop out.

Jared Cosulich link
8/21/2012 03:43:08 am

I completely agree that people should be more wary of experts than they currently are, and at the end of the day parents are responsible for their children, but I actually think it's a cop out to blame the parents in this situation.

If educators and psychiatrists are recommending a path that involves drugs then they should be very confident of that path. Why didn't the teacher or the psychiatrist ask the parent how the child was acting at home or in another environment before recommending such a drastic path.

Parent are not professionals. I would love to provide the kind of resources necessary to give all parents the confidence and know-how to combat situations like this as I don't think you're ever going to be able to "solve" this issue and parents are the last and most important line of defense when it comes to children, but I don't think it's a cop out at all for a parent to complain about two professionals advising them to give their child drugs without proper due-diligence.

Was her attitude in the article perfect? No, I don't think so, but does that mean there wasn't an egregious error in a professional field? No, and those errors appear to be rampant.

Personally if I had limited resources to address this issue I would focus most of the attention on the psychiatrists who are prescribing these drugs without due-diligence. Second I would try to educate teachers on how best to advise parents so that parents can seek the opinion of a psychiatrist armed with the information they need to make better decisions themselves.

The fact of the matter is that the system failed these parents. Should they have been able to combat that failure. Ideally yes, but that doesn't mean the system didn't fail or doesn't deserve criticism.

Mike Thayer (@gfrblxt) link
8/21/2012 04:11:34 am

The last paragraph here is critical - we have a failure in the system, but it's of all parties, not just that of the teacher and the psychiatrist. The system can be criticized, but parents need to recognize that they are a part of it (arguably, the most important part) as well. And the New York Times article did not acknowledge that.

Will May link
8/25/2012 06:57:47 pm

I haven't read your newer book yet (though I enjoyed "Why Don't Students Like School?").

What you're saying makes more sense to me in that context.

Kathy Albertson
8/23/2012 12:57:27 am

When we lived in Northern Virginia, there were kindergarteners celebrating their SEVENTH BIRTHDAYS in my son's class. When your 'just turned five' gets compared to a seven year old, not surprisingly, he's going to be found deficient. THe problem for us was that we couldn't afford to send our child to another year of preschool (known as junior kindergarten in that area) because he had two siblings and we couldn't afford preschool for 3 kids. There literally was no other program to send him to, no other public school that thought differently about kids, about kindergarten, about childhood. Instead, he was compared to kids who were 7, some of whom had already been going to Kumon and other learning factories since they were 3. And we were told either to medicate him or take him home.

laser eye surgery link
8/23/2012 01:47:23 am

This is a good post.Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children.Although adult diseases in children can also occur due to genetic and environmental reasons,

Tracy W
9/3/2012 12:09:46 am

Heaven knows how pregnancy is an opportunity to prevent future health problems, particularly in women. Everything I've read is that you can slightly reduce the odds of some health problems for the kids, but most damage is done before many women know they're pregnant (eg fetal alcohol syndrome), other health problems are very low risk (eg the odds of getting listeria in pregnancy are low, and even if you do, odds are the baby will be fine), and many health problems are independent of pregnancy.

Mike G
8/23/2012 04:59:08 am

I agree that parents are not powerless.

But I couldn't tell from your post -- do you think that teachers and psychiatrists tend to over-identify ADHD in particular? Ie, does this diagnosis stick out to you as one that the experts frequently get wrong?

My opinion: yes.

The DSM IV says "3%-7% of school-aged children have ADHD."

But it seems like many states diagnose at a higher rate, with North Carolina at 15%.

man boobs melbourne link
8/28/2012 12:47:40 am

Interesting post and thanks for sharing. I liked the posts and cool layout you have here..Keep updating the blog,looking forward for more contents...Great job, keep it up..

Tammie Grey link
9/5/2012 03:40:17 pm

The parents are the first ones who are responsible for their child's health. Our very first doctors are our parents. If the situation is out of hand, then as a parent, it is our responsibility to bring our child to a reliable doctor.


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