January, 2014

Another Open Letter to the Editor of the New York Times

Friday, January 3rd, 2014

Sent January 2, 2014. 

On December 29, 2013, the New York Times published another in its series of articles by Alan Schwarz arguing that medication is used excessively for treatment of ADHD. He cited a large research project sponsored by the U.S. National Institute of Mental Health twenty years ago which  compared medication treatment vs behavioral and vs combined medication/behavioral treatment of 7 to 9 year old children with ADHD over a 14 month period. Results of the study indicated that carefully managed medication was the most effective treatment for ADHD symptoms of those children over that time frame

Schwarz argued that this scientifically-controlled study oversold the benefits of medication treatment, distorted the debate over the most effective treatment, and failed to demonstrate adequately the longer term benefits of behavioral treatments for “teaching children, parents and teachers to create less distracting and more organized learning environments.”  He claimed that more recent studies have cast doubt on whether results of medication treatment last as long as those from behavioral therapy and offered brief quotes from several researchers involved in the NIMH study who shared thoughts about limitations of that research.

Unfortunately, this Schwarz article is seriously flawed in 3 important ways:

1)   The article seems to be based on an outdated understanding of ADHD. Current scientific understanding recognizes ADHD as a complex disorder involving developmental impairments of the brain’s cognitive management system, its executive functions.  These include chronic problems with activation and motivation, organizing and prioritizing tasks, sustaining effort for tasks, managing emotions, and utilizing working memory. Most of these problems, especially when experienced by older children or adults, are not improved adequately by behavioral treatments and are often, though not always, improved by carefully tailored medication treatment.

2)   It implies that creating “less distracting, more organized learning environments” would alleviate problems of ADHD. Impairments of this disorder certainly may be helped by environments that are well organized and not excessively distracting, but the essential impairments of ADHD are due to inherited problems in brain connectivity and brain chemistry; they are not caused by environmental distractions.

3)   It mentions that recent research studies “have also cast doubt on whether medication’s benefits last as long as those from (behavioral) therapy.”  Neither medication treatment nor behavioral therapy confers lasting remediation of ADHD symptoms any more than eyeglasses provide continuing remediation of vision problems after they are taken off.

It is unfortunate that this reputable newspaper continues to offer its readers information about ADHD which is so outdated, incomplete, and persistently biased as this series of articles by Alan Schwarz.

Thomas E. Brown, Ph.D.

Clinical Psychologist

Associate Director of Yale Clinic for Attention & Related Disorders

Dept. of Psychiatry

Yale University School of Medicine