CADDAC responds to CBC's: Are we overdiagnosing ADHD?

CADDAC's President, Heidi Bernhardt, responds to: CBC's: Are we overdiagnosing ADHD?

On January 16^th 2014, Jian Ghomeshi interviewed Alan Swartz who wrote the New York Times article “The Selling of ADHD” and Dr. Gabor Mate in a segment entitled “Are we over diagnosing ADHD?”

I was extremely frustrated with this media interview on CBC and this is not the first time that CADDAC has called CBC on their lack of Canadian ADHD content.  As with other interviews in the past, no Canadian ADHD expert researcher or clinician was included in the interview to balance out the points that Alan Swartz made about the supposed US situation. CBC then compounded their error by using Gabor Mate to further sensationalize the issue.

You might surmise that no other Canadian expert was available, but it seems that responsible journalism was not the aim here. Neither CADDRA nor CADDAC was approached requesting a possible Canadian expert to add a clinical Canadian perspective to the interview. Several misleading statements were made during the interview but no reputable Canadian expert was there to correct them.

Particularly inaccurate were Mr. Swartz’s comments about parents of ADHD children.  He stated that pharmaceutical companies targeted parents, mothers in particular as being the “impressionable ones,” in their quest to sell more medication.  He describes his theory thusly: if these mothers are made to think that their children have a “real” medical problem that a pill can fix, it relieves the pressure of having to look at their own parenting or agonizing about being at fault for their child’s difficulties.

In the 20 years that I have been interacting with parents about ADHD I never have come across one that is thrilled with the prospect of putting their child on medication. Parents may be relieved that a reason for the disabling symptoms has been found, and that there may be help; but thrilled about giving their child medication, never. For the vast majority of parents this is an agonizing decision, and not lightly made. I have also met very few mothers of children with ADHD who do not, for at least  a period of time, worry that they were inadequate in their role and caused their child’s impairments, or made them worse, including myself.

Alan Swartz does admit that there are some legitimate cases of ADHD that may need treatment, and some of the parents may actually mean well; but he also states that only the most extreme cases on inattention, hyperactivity, and impulsivity were ever meant to be diagnosed and treated.  My own three children were never on the severe end of the ADHD spectrum, but were still impacted by their ADHD, as was our entire family. Our journey began thirty years ago, when there was little awareness surrounding ADHD and many medical professionals knew little about the disorder. It took several years and many professionals to finally get the diagnosis correct, but by then we had already struggled and gone through a great deal of pain for many years.

During this interview, misleading statements are made, allowing the audience to interpret things about an ADHD diagnosis that are false. Mr. Swartz states that medical practitioners and parents do not look at other potential causes for difficulties with focusing. He ignores medical guidelines that state that all other potential disorders whose symptoms may mimic ADHD must be ruled out when assessing for ADHD. Guidelines further state that ADHD symptoms must be severe enough to cause impairment, and evident in more than one setting, for ADHD to be diagnosed. Mr. Swartz describes diagnosable inattention as a child who can’t do anything for more than a few seconds. This statement indicates how little he really knows about ADHD since children with ADHD can hyper-focus for hours at a time, if they find something engaging and stimulating.

Do pharmaceutical companies attempt to promote their products? There is no denying that they do. They are for-profit companies, after all. This is why advertising of medication is not allowed in this country. Thankfully, Jian did make this point himself, although very briefly. Physicians are courted by “Big Pharma” for every drug they manufacture; this is a fact. But, we trust them to use their training and judgement to keep this in perspective when treating all other conditions with medication. Why should treating ADHD be any different?

Are there physicians in the US who are misdiagnosing children, adolescents, and young adults with ADHD because parents want their child to be better behaved and get better grades? If so, that is a shame, and should be dealt with. Are university students in the US and here in Canada misusing ADHD medication to “pull all-nighters” trying to finish excessive work-loads or boost their grade average? Certainly, and perhaps universities should address why these students feel the need to do so. Yes, these issues need to be discussed; but ADHD is a medical condition and has the right he be treated as such when discussed in the media. In my personal view, media should be aiming to provide up-to -date medical information backed by scientific research, but that may be naïve. At least CBC should allow for a balanced Canadian medical perspective rather than contributing to the continued controversies and misinformation surrounding ADHD for ratings.

In the past twenty years, I have worked with many dedicated ADHD medical practitioners; and have spoken to thousands of parents desperately struggling to find the best care and treatment for their children with ADHD who do not take this disorder lightly. Therefore, I find it insulting that many journalists would rather sensationalize the topic than ensure that an accurate Canadian medical perspective on ADHD is available for their listeners.

To listen to the interview access

http://www.cbc.ca/q/blog/2014/01/16/are-we-overdiagnosing-adhd/     

If you feel inclined to comment to CBC

http://www.cbc.ca/help/contact/programming_feedback

Although I searched, I was unable to access a published comment to the NY Times article by a Canadian ADHD expert, but here two interesting comments from Dr. Thomas E. Brown:

http://www.drthomasebrown.com/an-open-letter-to-the-editor-of-the-new-york-times-from-thomas-e-brown-ph-d/

http://www.drthomasebrown.com/another-open-letter-editor-new-york-times/

Sincerely,

Heidi Bernhardt
President and Executive Director
Canadian Association of ADHD Awareness (CADDAC)