Katherine EllisonBack to OpinionKatherine Ellison

Needed: A guide for the perplexed ADHD parent

As another new school year gets underway, most of us parents are distracted enough, as we juggle carpools, shopping, housework and homework; deter sibling mayhem; and – oh, right, for most of us – report to our jobs.

But just imagine that you’re the parent of a child with attention-deficit hyperactivity disorder (ADHD). For all too many families, this can mean such a surfeit of distractions that life slides into painful chaos.

The Centers for Disease Control counts 4.5 million U.S. children diagnosed with ADHD, with its chief symptoms of forgetfulness and impulsivity. This suggests that there are many more millions of parents flailing, and, too often, failing, to help them. Despite constant claims that ADHD is overdiagnosed, which it may well be in some circles, the more serious problem is that so many kids who would benefit from help never get it. The surgeon general has estimated that only about 20-25 percent of children with any mental health problems receive adequate treatment.

When it comes to ADHD, the costs of failure are huge, including a heightened risk of school failure, drug and alcohol abuse, and jail time, and an estimated $30 billion annually in beyond-the-norm medical expenses. For the sake of our tax burden, then, as well as because it’s the right thing to do, society should be supporting parents of children with this disorder, instead of blaming them, as is now the default mode.

To get started, let’s take a closer look at ADHD families’ trifecta of challenges.

First: Because clinical-grade distraction is so often hereditary – more than schizophrenia, and just less than height – the disorder can be a double-whammy. In other words, many parents of kids with ADHD are also seriously distracted, having trouble finding their keys, much less maintaining the daily “reward charts” recommended by their child’s latest therapist.

Second: Despite all that scientists now know about the biology of ADHD, including a new report in the medical journal Lancet, with yet more evidence about the disorder’s genetic basis, many influential media commentators continue to insist that the disorder isn’t “real,” but rather the result of bad parenting or just bad kids.

Third: Families in despair about how to cope with a child’s snowballing failures at school and at home have helped engender a booming market in costly, risky and often unregulated treatments – let’s call it the ADHD Industrial Complex. This business behemoth includes not only the $290 billion U.S. pharmaceutical industry, with its lavish ads for stimulants, such as Ritalin and Adderall – effective under some circumstances but by no means a cure-all — but also a host of alternative treatments, including special diets, herbal supplements, computer-based programs, boarding schools and “dolphin-assisted therapy.” Overwhelmed parents are especially easy prey for charlatans who waste their time and money.

Once we finally acknowledge all that families coping with ADHD are up against, perhaps we can start effectively supporting them, and saving everyone money and anguish in the process. The easiest, cheapest and most immediate way to start helping is to make sure that high-quality information on effective interventions is available.

The good news is that the American Academy of Pediatrics recently took a small step in this direction. Earlier this year, it published an unprecedented chart rating evidence-based treatments for 10 common childhood mental health complaints, including ADHD. The chart was based on research by a for-profit firm, and it ranks treatments including medication and behavior therapy, biofeedback and working memory training according to their support from peer-reviewed publications. (Notably, cheap and easy physical exercise is listed as having “good” support, something few parents ever learn.)

Again, it’s a small step. The chart is published in a medical journal and is filled with obscurities for the uninitiated, including treatments labeled “self-verbalization” and “contingency management.”

In the long run, considering the social costs of ADHD, you’d think it would behoove policymakers and insurance companies to help train pediatricians, the most common first-responders, and give them time and resources for effective follow-up. But in the short-run, given that the federal government has spent more than $400 million on ADHD research in the past four years alone, just how much would it take for one federally sponsored analyst to prepare and regularly update a chart in plain English, available free and online for parents, listing potential interventions by weight of scientific corroboration?

It wouldn’t really require much money, just some quality attention.

Does anyone out there have any?

Katherine Ellison is the author ofBuzz: A Year of Paying Attention.”

 

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