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Published: December 18, 2013
Andrea Kalfas

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For Op-Ed, follow @nytopinion and to hear from the editorial page editor, Andrew Rosenthal, follow @andyrNYT.

Re “The Selling of Attention Deficit Disorder” (front page, Dec. 15):

The surge in the diagnosis and treatment of attention deficit hyperactivity disorder over the last decade should be a source of concern for parents, clinicians and national policy makers. This article documents the contribution of major pharmaceutical manufacturers in marketing the A.D.H.D. diagnosis to the public while they underplay some of the known side effects of stimulant medications.

Tighter regulation of pharmaceutical marketing is warranted.

To improve treatment, however, we need to look beyond medications to our fragmented mental health system. A careful diagnosis of A.D.H.D. requires more than a short interview in a single office visit, yet many public and private insurers do not adequately reimburse for assessment with mental health professionals.

Likewise, the effective dosing and administration of stimulants require careful monitoring, yet most providers lack the time, training and resources for a proper follow-up with families.

Finally, some nonmedication alternatives — such as mindfulness meditation and social skills training — show promise, yet insurers remain reluctant to reimburse for these services.

Parents and providers will be less reliant on quick fix solutions — including pills — when there are truly robust alternatives and better information.

Philadelphia, Dec. 15, 2013

The writer is a health and society scholar at the University of Pennsylvania.

To the Editor:

As a child of the 1990s wrongly given a diagnosis of A.D.H.D., I found it validating to read “The Selling of Attention Deficit Disorder.” I have seen so many members of my generation fall prey to the idea that we are not capable of managing our own minds without medications like Ritalin or Adderall. It’s bred a helplessness in many of us (myself included) that renders us inclined to pop a pill when we have an assignment (or other trying task) to accomplish instead of working to hone our focus or trust in our capacity to concentrate.

A strange competitive culture has arisen among my generation, wherein those who can boast the most severe symptoms — “Oh, I’m so A.D.H.D.!” — get an exemption from responsibility and accountability.

New York, Dec. 16, 2013

To the Editor:

If such historical figures as Edison, Lincoln, Galileo and Socrates are now believed to have had A.D.H.D., how do I sign up and why would I want to take a pill to “cure” it?

A.D.D. and A.D.H.D. tend to be context-related disorders. For a 9-year-old boy to sit still in a classroom for five or six hours a day and pay attention to things he is not necessarily interested in is a fairly unnatural act, and he may have trouble focusing. If that same child is a leader on the playground, a not unusual observation, or excels at certain sports because he is able to shift attention in a rapidly changing environment, can we fairly consider it a pathology? Or that it should be medicated?

I do not mean to dismiss either diagnosis as a real problem. I have worked with many A.D.D. children whose performance in school has been appropriately enhanced by stimulant prescriptions. I have also worked with many children for whom a pediatric neurologist or psychiatrist suggested a caffeinated beverage such as coffee, cola or more recently Red Bull and seen similarly beneficial results. And I have worked with kids whose teachers or parents have unrealistic expectations of obedient “Stepford” children, and are looking for a pill to achieve that.

Medications have their place. So do behavior management strategies, with and without medications. The problem is that behavior management strategies are labor-intensive. It’s a lot easier to just look for a magic pill.

Medicating a child, especially on a long-term basis, is not something that should be taken lightly.

Red Bank, N.J., Dec. 15, 2013

The writer is a psychologist in private practice.

To the Editor:

As one who coped with unrecognized A.D.H.D. and as a parent of a young man who was successfully treated as a child with stimulant medication, I can testify to both the efficacy of treatment in the correct patient and to the unlimited potential of adults with this condition. As is true with most medical conditions, correct diagnosis and treatment can lead to a wonderfully liberating experience for patients afflicted with A.D.H.D. What is troubling, of course, is the pernicious influence of Big Pharma and money.

Your article touched on a vexing issue for medicine as a whole. As physicians, we are expected to practice “evidence-based medicine” — treatments that bear the imprimatur of careful research. But how can clinicians trust studies when Big Pharma influences the entire process — sponsorship of research, financing of professional associations and advertisement revenue in professional publications? How many studies describing the lack of efficacy of a medicine have been published in the past decade or two?

Falls Church, Va., Dec. 15, 2013

The writer is an orthopedic surgeon and an assistant professor at the Virginia Commonwealth University School of Medicine.


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