New York Times Magazine article questioning adhd commonplaces (including meds)

[Anonymous]

Anonymous wrote:

Anonymous wrote:The "changing the environment" argument is just a modern version of "the world needs ditchdiggers too".

They're saying some kids cant' concentrate in some environments, so instead of medicating them and giving them a chance to concentrate, we should put them in remedial classes and find jobs for them that don't require concentration. A small percentage will make it in unique jobs that value unstructured thought and don't penalize disorganization.

In my kids' case, switching from schools that used the workshop model, where there was a lot of humm and buzz and working in small groups and laptops insufficiently guarded to prevent kids from wandering off into the depths of the internet, to one where there was a lot more sitting in rows, listening to the teacher, and writing with pen and paper, significantly improved their learning experience. The work they're doing now doesn't seem at all remedial.

Same experience moving my child from Montessori to a public school!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:TLDR; ADHD meds keep teachers happier but don’t actually result in better learning outcomes for kids at school.

This is bull sh*t. For my kid and the other kids I know with a similar diagnosis it makes all the difference. I can't believe more parents aren't calling this out for the crap it is.

Calling out a very well reported news article based on … what exactly? The article doesn’t dispute that stimulants show an immediate impact on behavior for younger kids in the short term.

Dp. The article acts like the behavioral aspect is short term and therefore doesn't matter, or only matters because it causes less fighting at home.

In reality, kids face big consequences, at school and with friends, if they can't control impulsive behavior. Being labeled "the bad kid" is a big deal.

Thid is why many parents take med breaks, and/or the kid switches meds. These meds don't just have a short term affect. It's not Ritalin until the behavioral effect wears off and then there's no options for behavioral challenges. Doctors and parents are using an umbrella of meds to deal with these challenges over the course if many years, as needed, got these kids.

No, the article says that the research shows the impact of medication on behavior is short term. It probably could have gone more into depth on the relative severity of “ADHD” diagnoses though. There’s a big difference between a child that is so hyperactive they cannot sit to eat or learn to read; and a kid who is merely spacey.

The article discusses one study on Ritalin, saying:

"But by 36 months, that advantage had faded completely..."

I don't see anything further about trying other drugs after one stops being effective and that those other drugs are not effective.

I took ritalin for about 36 months, it seemed to fade in its effectiveness and then was put on another non-ritalin drug, took that for 20 years until it stopped becoming available, and moved around and eventually wound up on Concerta (a Ritalin-related drug) which has worked wonderfully for 5+ years.

In the process of switching drugs I found that Adderall was ineffective for me and the side effects were deeply unpleasant, even though it was in the same family as the drug I took after stopping Ritalin, and Concerta was amazing, despite Ritalin previously seeming to have lost its effectiveness. Not all drugs work in all people the same way, and that seems like a very basic error in the reporting.

Did you read the part in the article where they discussed how people believe that they are functioning better on stimulants, but actually are not?

That study was on neurotypical people and not people with ADHD! So giving a person who doesn’t have ADHD stimulants doesn’t help them. It does not mean giving kids with ADHD stimulants wouldn’t help them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The "changing the environment" argument is just a modern version of "the world needs ditchdiggers too".

They're saying some kids cant' concentrate in some environments, so instead of medicating them and giving them a chance to concentrate, we should put them in remedial classes and find jobs for them that don't require concentration. A small percentage will make it in unique jobs that value unstructured thought and don't penalize disorganization.

In my kids' case, switching from schools that used the workshop model, where there was a lot of humm and buzz and working in small groups and laptops insufficiently guarded to prevent kids from wandering off into the depths of the internet, to one where there was a lot more sitting in rows, listening to the teacher, and writing with pen and paper, significantly improved their learning experience. The work they're doing now doesn't seem at all remedial.

We had the opposite effect. The boredom of sitting in rows and having information pushed on them (instead of engaged and active in learning) has been detrimental

Thank goodness we have successfully avoided school choice, so we can instead engage in winner take all fights over the county school system in regards to classroom style. Loser's children flunk miserabley. Dire consequences make the struggle so much more entertaining!

Not sure if you noticed but this is DC Urban Moms. we have school choice in DC. Apart from some really great curriculum for learning to read, the schools are all pretty cr*p for neurodivergent kids.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:TLDR; ADHD meds keep teachers happier but don’t actually result in better learning outcomes for kids at school.

This is bull sh*t. For my kid and the other kids I know with a similar diagnosis it makes all the difference. I can't believe more parents aren't calling this out for the crap it is.

Calling out a very well reported news article based on … what exactly? The article doesn’t dispute that stimulants show an immediate impact on behavior for younger kids in the short term.

Dp. The article acts like the behavioral aspect is short term and therefore doesn't matter, or only matters because it causes less fighting at home.

In reality, kids face big consequences, at school and with friends, if they can't control impulsive behavior. Being labeled "the bad kid" is a big deal.

Thid is why many parents take med breaks, and/or the kid switches meds. These meds don't just have a short term affect. It's not Ritalin until the behavioral effect wears off and then there's no options for behavioral challenges. Doctors and parents are using an umbrella of meds to deal with these challenges over the course if many years, as needed, got these kids.

No, the article says that the research shows the impact of medication on behavior is short term. It probably could have gone more into depth on the relative severity of “ADHD” diagnoses though. There’s a big difference between a child that is so hyperactive they cannot sit to eat or learn to read; and a kid who is merely spacey.

The article discusses one study on Ritalin, saying:

"But by 36 months, that advantage had faded completely..."

I don't see anything further about trying other drugs after one stops being effective and that those other drugs are not effective.

I took ritalin for about 36 months, it seemed to fade in its effectiveness and then was put on another non-ritalin drug, took that for 20 years until it stopped becoming available, and moved around and eventually wound up on Concerta (a Ritalin-related drug) which has worked wonderfully for 5+ years.

In the process of switching drugs I found that Adderall was ineffective for me and the side effects were deeply unpleasant, even though it was in the same family as the drug I took after stopping Ritalin, and Concerta was amazing, despite Ritalin previously seeming to have lost its effectiveness. Not all drugs work in all people the same way, and that seems like a very basic error in the reporting.

Did you read the part in the article where they discussed how people believe that they are functioning better on stimulants, but actually are not?

That study was on neurotypical people and not people with ADHD! So giving a person who doesn’t have ADHD stimulants doesn’t help them. It does not mean giving kids with ADHD stimulants wouldn’t help them.

I’m not sure that’s true but in any event there were also studies of kids that showed no increase in academic acheivement.

[Anonymous]

I haven’t read all the posts so apologies if it’s been asked and answered, but for those of you who did parent training, can you recommend the practice you went with?

[Anonymous]

Anonymous wrote:I haven’t read all the posts so apologies if it’s been asked and answered, but for those of you who did parent training, can you recommend the practice you went with?

Parent-Child Journey with Dr. Dan in Bethesda is good. Works better if both parents participate but my spouse would not so best of luck with that.

[Anonymous]

Anonymous wrote:The fact that the medication does not help academic outcomes is mind blowing to me. Why take it especially with all the side effects?

I don't think we can call that a "fact." Maybe it will vary person to person (or incorporate the way teachers inflate grades in some places). It absolutely changed academic outcomes for our kid.

We didn't get a diagnosis for our inattentive ADHD kid until late middle school, when innate intelligence and behavior cues could no longer cover for what turned out to be a 3rd percentile attention score (!!). This inattentive kid in elementary school (who could read and do basic math by kindergarten) was deemed well behaved and maybe just of average intelligence. Grades, such as the are in elementary school, were fine, but nothing was really being learned -- it's elementary school and the bar is low for a really bright kid.

By the time academics becomes heavy reading an lecture based, an inattentive kid starts falling behind because inattentive ADHD (if you ask someone who has it) is like being rendered temporarily blind and/or deaf randomly and without warning or even knowing it happened half the time. It makes me wonder if there is a link between inattentive ADHD and absence seizures. It can be for a stretch, where you zone out for half a class, or an instant, where you miss key words in a discussion or every other sentence or half of the point being made (and so you misunderstand, miss key words or actually learn things incorrectly because you only registered half of the explanation). It's like your brain was turned off and time moved on, and when your brain turns on again, sometime you realize it happened and sometimes you don't, but you certainly missed half the class lecture and are certainly behind in whatever you were reading and probably have to start over. How can that NOT affect academic outcomes?

Medication for our kid decreased the frequency of these episodes and also improved awareness of when it was happening, so he more often knew when he missed something and could go get help. In the past, his notes would be half a page compared to other kids with 4-5 pages from the same class, but he didn't think he'd missed anything! Now he either doesn't miss it or catches himself when he does. Grades aside, he is clearly learning more, and homework takes half the time it used to because he isn't constantly losing his place and rereading - it still happens, but less frequently. And it does show in grades that went from Cs and Bs to As and Bs. This is a kid who scored over 700 on both sections of the SAT (so no dummy), but in class before medication would either fail a test he had studied for for hours or get an A -- depended on the day! Teachers and tutors and our son were flummoxed because even when he obviously knew the material he would fail. Medication changed that - not to perfection, but so much better.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:TLDR; ADHD meds keep teachers happier but don’t actually result in better learning outcomes for kids at school.

This is bull sh*t. For my kid and the other kids I know with a similar diagnosis it makes all the difference. I can't believe more parents aren't calling this out for the crap it is.

Calling out a very well reported news article based on … what exactly? The article doesn’t dispute that stimulants show an immediate impact on behavior for younger kids in the short term.

Dp. The article acts like the behavioral aspect is short term and therefore doesn't matter, or only matters because it causes less fighting at home.

In reality, kids face big consequences, at school and with friends, if they can't control impulsive behavior. Being labeled "the bad kid" is a big deal.

Thid is why many parents take med breaks, and/or the kid switches meds. These meds don't just have a short term affect. It's not Ritalin until the behavioral effect wears off and then there's no options for behavioral challenges. Doctors and parents are using an umbrella of meds to deal with these challenges over the course if many years, as needed, got these kids.

No, the article says that the research shows the impact of medication on behavior is short term. It probably could have gone more into depth on the relative severity of “ADHD” diagnoses though. There’s a big difference between a child that is so hyperactive they cannot sit to eat or learn to read; and a kid who is merely spacey.

The article discusses one study on Ritalin, saying:

"But by 36 months, that advantage had faded completely..."

I don't see anything further about trying other drugs after one stops being effective and that those other drugs are not effective.

I took ritalin for about 36 months, it seemed to fade in its effectiveness and then was put on another non-ritalin drug, took that for 20 years until it stopped becoming available, and moved around and eventually wound up on Concerta (a Ritalin-related drug) which has worked wonderfully for 5+ years.

In the process of switching drugs I found that Adderall was ineffective for me and the side effects were deeply unpleasant, even though it was in the same family as the drug I took after stopping Ritalin, and Concerta was amazing, despite Ritalin previously seeming to have lost its effectiveness. Not all drugs work in all people the same way, and that seems like a very basic error in the reporting.

Did you read the part in the article where they discussed how people believe that they are functioning better on stimulants, but actually are not?

That study was on neurotypical people and not people with ADHD! So giving a person who doesn’t have ADHD stimulants doesn’t help them. It does not mean giving kids with ADHD stimulants wouldn’t help them.

I’m not sure that’s true but in any event there were also studies of kids that showed no increase in academic acheivement.

Frankly, based on personal experience, that is obvious BS.

[Anonymous]

Anonymous wrote:Can we go back to the fact that 25% of boys get ADHD diagnoses??

If it is over diagnosed, it is the hyperactive type. They want to control behavior in over crowded classrooms.
Inattentive is grossly under diagnosed. Every teacher loves the quiet kid (who is zoned out but no one realizes that). They will ignore that kid unless they fail (hard to do in elementary school) to avoid having another student with an IEP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:TLDR; ADHD meds keep teachers happier but don’t actually result in better learning outcomes for kids at school.

This is bull sh*t. For my kid and the other kids I know with a similar diagnosis it makes all the difference. I can't believe more parents aren't calling this out for the crap it is.

Calling out a very well reported news article based on … what exactly? The article doesn’t dispute that stimulants show an immediate impact on behavior for younger kids in the short term.

Dp. The article acts like the behavioral aspect is short term and therefore doesn't matter, or only matters because it causes less fighting at home.

In reality, kids face big consequences, at school and with friends, if they can't control impulsive behavior. Being labeled "the bad kid" is a big deal.

Thid is why many parents take med breaks, and/or the kid switches meds. These meds don't just have a short term affect. It's not Ritalin until the behavioral effect wears off and then there's no options for behavioral challenges. Doctors and parents are using an umbrella of meds to deal with these challenges over the course if many years, as needed, got these kids.

No, the article says that the research shows the impact of medication on behavior is short term. It probably could have gone more into depth on the relative severity of “ADHD” diagnoses though. There’s a big difference between a child that is so hyperactive they cannot sit to eat or learn to read; and a kid who is merely spacey.

The article discusses one study on Ritalin, saying:

"But by 36 months, that advantage had faded completely..."

I don't see anything further about trying other drugs after one stops being effective and that those other drugs are not effective.

I took ritalin for about 36 months, it seemed to fade in its effectiveness and then was put on another non-ritalin drug, took that for 20 years until it stopped becoming available, and moved around and eventually wound up on Concerta (a Ritalin-related drug) which has worked wonderfully for 5+ years.

In the process of switching drugs I found that Adderall was ineffective for me and the side effects were deeply unpleasant, even though it was in the same family as the drug I took after stopping Ritalin, and Concerta was amazing, despite Ritalin previously seeming to have lost its effectiveness. Not all drugs work in all people the same way, and that seems like a very basic error in the reporting.

Did you read the part in the article where they discussed how people believe that they are functioning better on stimulants, but actually are not?

That study was on neurotypical people and not people with ADHD! So giving a person who doesn’t have ADHD stimulants doesn’t help them. It does not mean giving kids with ADHD stimulants wouldn’t help them.

I’m not sure that’s true but in any event there were also studies of kids that showed no increase in academic acheivement.

Frankly, based on personal experience, that is obvious BS.

personal experience vs RCT. Ok!

[Anonymous]

Anonymous wrote:

Anonymous wrote:Can we go back to the fact that 25% of boys get ADHD diagnoses??

If it is over diagnosed, it is the hyperactive type. They want to control behavior in over crowded classrooms.
Inattentive is grossly under diagnosed. Every teacher loves the quiet kid (who is zoned out but no one realizes that). They will ignore that kid unless they fail (hard to do in elementary school) to avoid having another student with an IEP.

I’m not totally sure that’s true. I do think a lot of parents are hyper-attuned to any academic struggle or difference. A kid missing a few assignments in MS will snowball into an ADHD diagnosis.

[Anonymous]

Anonymous wrote:Really interesting read, OP. Thank you for the gift link.

We are right in the thick of this in my household right now, with a child recently diagnosed with ADHD at age 7 and debating the benefits of medication versus parent coaching (which I'm currently doing) and environmental changes. I am not opposed to medication in general (pro-vaccine, have been on SSRIs before, not anti Pharma) but something about putting my 7 year old on ADHD meds has really given me pause.

We wound up going another route for now. Not ruling medication out but opting for a school change to see if things improve. We are fortunate because DC has no academic issues associated with ADHD (on the contrary, the hyper focus element has resulted in a strong reader who loves doing math problems for fun). So we hope changing the school environment to a school with more outdoor time, a more joyous vibe, and fewer behavioral problems overall, might eliminate the need for meds. If it doesn't, we'll probably medicate.

Anyway, I've been reading TONS of literature on ADHD and medication over the last few months, including literally every study mentioned in this article. So it was validating to read the nuance here and made me feel like we reached the right conclusion. The article is not anti-meds. It's just much more nuanced about what ADHD is and how meds can help (and how sometimes they don't). It's very needed as a counterbalance to what I have heard other places: that I'm stupid for having any reticence in medicating my kid, that environmental shifts can't possibly help with ADHD because "either you have it or you don't", that medicating early is beneficial because the meds will help to "rewire your kid's brain" (a very popular argument these days), and so on. The level of pressure I've felt to medicate is probably one of the reasons I've pushed back so hard, so I just really appreciate a balanced, deeply reported take on this that doesn't vilify medication but also doesn't gloss over the ways in which it can be complicated.

I love what you wrote. We are waiting on some neuropsych results for our 13 yo DS. I'm fairly certain there will be an ADHD (inattentive) thrown in there, because how could there not be. My main "fear" with the dx is having to seriously consider medicating. I'm shocked how so few people (at least many online forums, so perhaps not reliable) seem to even think about not-medicating. It almost seems akin to being anti-vax. I've also seen the comment often "would you deny your child glasses" often.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The fact that the medication does not help academic outcomes is mind blowing to me. Why take it especially with all the side effects?

I don't think we can call that a "fact." Maybe it will vary person to person (or incorporate the way teachers inflate grades in some places). It absolutely changed academic outcomes for our kid.

We didn't get a diagnosis for our inattentive ADHD kid until late middle school, when innate intelligence and behavior cues could no longer cover for what turned out to be a 3rd percentile attention score (!!). This inattentive kid in elementary school (who could read and do basic math by kindergarten) was deemed well behaved and maybe just of average intelligence. Grades, such as the are in elementary school, were fine, but nothing was really being learned -- it's elementary school and the bar is low for a really bright kid.

By the time academics becomes heavy reading an lecture based, an inattentive kid starts falling behind because inattentive ADHD (if you ask someone who has it) is like being rendered temporarily blind and/or deaf randomly and without warning or even knowing it happened half the time. It makes me wonder if there is a link between inattentive ADHD and absence seizures. It can be for a stretch, where you zone out for half a class, or an instant, where you miss key words in a discussion or every other sentence or half of the point being made (and so you misunderstand, miss key words or actually learn things incorrectly because you only registered half of the explanation). It's like your brain was turned off and time moved on, and when your brain turns on again, sometime you realize it happened and sometimes you don't, but you certainly missed half the class lecture and are certainly behind in whatever you were reading and probably have to start over. How can that NOT affect academic outcomes?

Medication for our kid decreased the frequency of these episodes and also improved awareness of when it was happening, so he more often knew when he missed something and could go get help. In the past, his notes would be half a page compared to other kids with 4-5 pages from the same class, but he didn't think he'd missed anything! Now he either doesn't miss it or catches himself when he does. Grades aside, he is clearly learning more, and homework takes half the time it used to because he isn't constantly losing his place and rereading - it still happens, but less frequently. And it does show in grades that went from Cs and Bs to As and Bs. This is a kid who scored over 700 on both sections of the SAT (so no dummy), but in class before medication would either fail a test he had studied for for hours or get an A -- depended on the day! Teachers and tutors and our son were flummoxed because even when he obviously knew the material he would fail. Medication changed that - not to perfection, but so much better.

May I ask what medication? Did it take a lot of trial and error to get there?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Can we go back to the fact that 25% of boys get ADHD diagnoses??

If it is over diagnosed, it is the hyperactive type. They want to control behavior in over crowded classrooms.
Inattentive is grossly under diagnosed. Every teacher loves the quiet kid (who is zoned out but no one realizes that). They will ignore that kid unless they fail (hard to do in elementary school) to avoid having another student with an IEP.

I’m not totally sure that’s true. I do think a lot of parents are hyper-attuned to any academic struggle or difference. A kid missing a few assignments in MS will snowball into an ADHD diagnosis.

This, and also I don't know if this has been discussed in the thread (I know it is not mentioned in the article) but changing expectations for kids, especially in early elementary, can also contribute to over diagnosis because age appropriate behavior gets identified as an issue. You get 5 yr olds in kindergarten who can't sit still for long periods or f time and need outdoor time, playtime, really engaging instruction in the form of songs and activities (which is what kindergarten was originally conceived to be) and then you ask them to sit in chairs and do worksheets for several hours a day. Half of their instruction is done via screens. And then when those kids struggle, it's like, well maybe he (or she) has ADHD? No! That's a normal 5 yr old.

And sometimes you see this moving down to PK. It's ridiculous. And it doesn't even result, long term, in higher test scores or literacy rates. There's a bump but it's temporary, and kids who get to play and have less academics early catch up in middle and upper elementary.

All kids NEED play, exercise, unscheduled time. But now we pathologist the kids who struggle more without it. In reality most of the kids who aren't struggling are just better at suppressing it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Really interesting read, OP. Thank you for the gift link.

We are right in the thick of this in my household right now, with a child recently diagnosed with ADHD at age 7 and debating the benefits of medication versus parent coaching (which I'm currently doing) and environmental changes. I am not opposed to medication in general (pro-vaccine, have been on SSRIs before, not anti Pharma) but something about putting my 7 year old on ADHD meds has really given me pause.

We wound up going another route for now. Not ruling medication out but opting for a school change to see if things improve. We are fortunate because DC has no academic issues associated with ADHD (on the contrary, the hyper focus element has resulted in a strong reader who loves doing math problems for fun). So we hope changing the school environment to a school with more outdoor time, a more joyous vibe, and fewer behavioral problems overall, might eliminate the need for meds. If it doesn't, we'll probably medicate.

Anyway, I've been reading TONS of literature on ADHD and medication over the last few months, including literally every study mentioned in this article. So it was validating to read the nuance here and made me feel like we reached the right conclusion. The article is not anti-meds. It's just much more nuanced about what ADHD is and how meds can help (and how sometimes they don't). It's very needed as a counterbalance to what I have heard other places: that I'm stupid for having any reticence in medicating my kid, that environmental shifts can't possibly help with ADHD because "either you have it or you don't", that medicating early is beneficial because the meds will help to "rewire your kid's brain" (a very popular argument these days), and so on. The level of pressure I've felt to medicate is probably one of the reasons I've pushed back so hard, so I just really appreciate a balanced, deeply reported take on this that doesn't vilify medication but also doesn't gloss over the ways in which it can be complicated.

I love what you wrote. We are waiting on some neuropsych results for our 13 yo DS. I'm fairly certain there will be an ADHD (inattentive) thrown in there, because how could there not be. My main "fear" with the dx is having to seriously consider medicating. I'm shocked how so few people (at least many online forums, so perhaps not reliable) seem to even think about not-medicating. It almost seems akin to being anti-vax. I've also seen the comment often "would you deny your child glasses" often.

Yes, the pressure to medicate can be intense. I was in a support group for parents of kids with ADHD and had to leave because there was NO nuance on medication. I decided to postpone medication for a kindergartener, figuring we can always add medication later but at this age the stakes are low enough for us to try other stuff first. This was viewed as an anti-science position in the group (even though our plan has the support of several doctors) and I wound up quitting the group rather than feel like an outcast for not believing that all cases of ADHD must be medicated or you are neglecting your child.