What Doctors Don’t Tell Parents After an ADHD Diagnosis
The first prescription is often presented as the solution. But for millions of kids, it is the first step into a lifetime of pills, side effects, and more prescriptions.
This article originally appeared on The Defender and was republished with permission.
Guest post by Suzanne Burdick, Ph.D.
Labeling a child as having ADHD is the “gateway diagnosis” that opened the door to “the medicalization of childhood and to drug cocktails for young children,” according to Gretchen Watson, Ph.D., a clinical psychologist and researcher. “It makes no sense. The children aren’t the problem. We are.”
Roughly 10 million U.S. children and young adults ages 2-24 are on medication for attention-deficit/hyperactivity disorder (ADHD) — and 40% of those are on multiple psychotropic drugs, including antipsychotics, according to Gretchen Watson, Ph.D., a clinical psychologist and researcher.
“That is just absolutely unconscionable,” Watson said. “It makes no sense. The children aren’t the problem. We are.”
Watson is one of the U.S.’s foremost authorities on the overmedication of children with psychiatric drugs, according to her website.
On May 4, she spoke at the MAHA Institute’s Mental Health and Overmedicalization Summit in Washington, D.C. She discussed the explosion of U.S. childhood ADHD diagnoses in the late 1990s that snowballed into prescribing an ever-growing list of psychotropic drugs to young children.
“It’s now evident with the benefit of hindsight that ADHD is a gateway diagnosis that opened the door to the medicalization of childhood and to drug cocktails for young children,” she told the audience.
In a May 26 exclusive interview with The Defender, Watson gave a sneak peek at material from her forthcoming book, “Prescription Affliction.” She calls the book “a road map for parents, educators, and clinicians who want to protect children and find better paths forward.”
Watson’s experience in Hampton Roads: ‘Why are we doing this?’
In the 1990s and 2000s, Watson was studying the prevalence and impact of ADHD diagnoses and drug treatment patterns.
Initially, she worked as a psychologist in a pediatrics department in San Diego, where she saw very few children diagnosed with ADHD.
But that changed when she took a job in Hampton Roads, Virginia. “I was supposed to be doing exactly the same work, but the pediatricians were diagnosing most of the children with ADHD,” Watson recalled.
She kept pushing back, saying, “Why are we doing this?… We’ve diagnosed 75% of the children who’ve come into our clinic with ADHD. This doesn’t make sense.”
Nearly 1 in 5 Hampton Roads kids diagnosed with ADHD, most medicated
Wanting to investigate what was going on beyond the clinic where she worked, Watson analyzed student data from local schools. Her discovery stunned her.
By 1999, nearly 1 in 5 children in Hampton Roads had received an ADHD diagnosis. Half of those diagnoses happened before the child entered first grade.
Eighty-four percent of those diagnosed were medicated — and of the kids who were medicated, 28% were on two, three or four psychiatric medications.
“That meant we were diagnosing more ADHD than any place else in the country and we were medicating it aggressively,” she said.
Watson kept checking her data to be sure the numbers weren’t skewed.
That’s when U.S. Drug Enforcement Administration staff asked if she would independently evaluate its huge database on Ritalin distribution rates for the entire country.
“I was able to look at what was going on in the country and see that, in fact, my data really were on target because we were in the top 1% for Ritalin consumption for the country,” Watson said.
Local children’s hospital ran clinical trials for ADHD drugs
Why was Hampton Roads such a hotspot for ADHD diagnoses and prescriptions?
Since the area is home to many military families, Watson compared the rate of military children to non-military children — and determined that it didn’t explain the increased ADHD diagnosis and prescription rates.
However, Watson later discovered this: Pediatric neurologists at the local children’s hospital had developed a clinical research organization that conducted drug trials.
The organization started out testing ADHD drugs. “But it was so lucrative that they rapidly expanded,” Watson said.
The pediatric neurologists involved in the drug trials likely had good intentions, she said. But “research has shown it takes very little contact with a pharmaceutical rep to have a prescriber’s behavior influenced. So if you’re interacting extensively and getting large payments for testing their drugs, you’re going to also prescribe their drugs.”
Watson added:
“It really started at the children’s hospital with the ‘experts’ who had been trained. And then what happens is the community doctors want to mirror the experts. So it becomes a thing, and then parents don’t want their child left behind.
“When the parent says, ‘Well, Sarah has been getting straight A’s, she comes right home and does her homework if I give her Ritalin.’ Well, the next parent who hears them thinks, ‘Well, maybe my child should get the medication too.’”
‘Before you know it, antipsychotics are added to the mix’
Once doctors and parents felt comfortable putting children on stimulants to medicate ADHD, the prescribing of psychotropic drugs for children “rapidly expanded,” Watson said.
Since long-term use of stimulants has significant side effects, including altering one’s mood and causing mania or depression, doctors start prescribing other drugs to address those effects, Watson said.
“Antidepressants get added, mood stabilizers get added. Now you’ve got children’s moods and minds being affected in a variety of ways. And before you know it, antipsychotics are added to the mix,” she said.
Government website still omits long-term negative effects of ADHD medication
What happened at Hampton Roads should have been the alarm that warned the country about overprescribing ADHD medication — instead, the trend spread across the nation, and children today are suffering as a result, Watson said.
Now, even toddlers are put on ADHD medications, usually stimulants, she said.
Despite what pharmaceutical companies might wish people to believe about ADHD medication, the data show that the drugs can have major negative impacts, Watson said.
For instance, higher prescription rates in schools have been linked to higher drug abuse rates, she said.
Educational outcomes are also worse for kids medicated for ADHD versus kids diagnosed with ADHD who are unmedicated.
The notion that ADHD medication led to poorer educational outcomes went against everything Watson had been told, so when she first saw it in her Hampton Roads data, she thought, “Gosh, that can’t be right.”
But then the government’s own huge ADHD study confirmed it.
Funded by the National Institute of Mental Health (NIMH), the 1999 Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study evaluated leading treatments for ADHD, including behavior therapy, medications and the combination of the two.
Although kids on ADHD medication appeared to do slightly better in the short term, “the longer the children were on the medication, the worse their social, emotional and academic functioning became,” Watson said.
“But those long-term results were never trumpeted in the media, while the short-term effects were,” she said. “And to this day on the NIMH website, it lists only the outcome of the short-term — the first pass of the data — and it still pitches the medication as safe and effective. That’s a misnomer.”
Here’s what parents and doctors can do
The current situation of overprescribing psychotropic drugs for children is grim but changeable.
Watson encourages parents to try to find out about how many kids in their local community are diagnosed with ADHD and prescribed medication.
Big national statistics can be overwhelming. But knowing your community’s numbers gives you something to work with, she said. “People need access to what’s going on in their community so they can take action at the community level.”
In her book, she provides advice to parents on how to resist the pressure to prematurely or unnecessarily accept an ADHD prescription for their child.
“I talk about the importance of really seeing your child for who they are. That sounds simple, but I go through some strategies of how we get back to really having a presence where we can more realistically see our children without panic.”
Cultural norms about what kids are expected to be and do need to become more tolerant, she said. “We’re intolerant, we’re afraid and our kids are indoors and on devices way too much.”
Doctors should think about non-drug options first and always give full informed consent before putting a child on a drug.
Social workers, psychologists and family counselors also need to step up. “They are part of the problem because they have bought into the mindset, too, that we are suffering from these chemical imbalances and they play a role in referring people to doctors and reinforcing what doctors are doing.”
Children’s mental health has ‘nothing to do with politics’
Watson warned against letting children’s mental health become a partisan issue.
“This has nothing to do with politics left, right or center. This is strictly evidence-based and affects people of every persuasion.”
Watson said we have an opportunity to make big shifts at the national level — if we don’t get derailed by partisan divisions.
Referring to U.S. Health Secretary Robert F. Kennedy Jr., she said:
“We are really at a historic moment when we have somebody who is historically a Democrat working in a Republican administration to move these issues front and center.
“So I hope that people don’t get distracted by partisan politics when it comes to improving child mental health.”
Related articles in The Defender
‘Nobody Told Me’: Former Mental Health Patient Calls Out Dangerous Side Effects of Psychiatric Drugs
55 U.S. Doctors Behind Psychiatric Diagnosis Manual Took $14M From Drug Companies
‘Medically Reckless’: AAP Pushes Mental Health Screenings for Kids as Young as 6 Months Old
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