In a much discussed New York Times story on the explosion of attention deficit hyperactivity disorder (ADHD) diagnoses, reporter Alan Schwarz writes that 15 percent of high school kids now have a diagnosis, and the number of children on medication to treat it has grown to 3.5 million, up from only 600,000 in 1990. “The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data,” Schwarz writes. However, a critical analysis of Schwarz’s reporting notes several problems with his major claims.
The central tension of diagnosing ADHD is neatly summarized by Rich Lowry: “There is no doubt that ADHD is a legitimate neurological condition that makes kids (and those around them) miserable, that blights their potential, and that can be alleviated by prescription stimulants like Adderall and Ritalin. There also is no doubt that diagnosis and treatment of the disorder has run wildly out of control on the promise of an easy pharmaceutical fix to the natural rambunctiousness of childhood.”
The New York Times story was widely disseminated and sits atop the paper’s most emailed story list. However, the story does raise questions about Schwarz’s reporting. Paul Raeburn, a former science editor at The Associated Press and BusinessWeek, and past president of the National Association of Science Writers chimes in at MIT’s Science Journalism website: “This is the latest in a string of stories Schwarz has written criticizing the use of stimulants in children. In early April, he did his own analysis of data from the Centers for Disease Prevention and Control to conclude that ‘nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder.’ I questioned whether Schwarz had done the data analysis correctly. It seemed beyond the scope of most reporters’ expertise.”
This is not the first time Raeburn has taken Schwarz to task. Raeburn notes: “In February, he wrote a page-one story headlined, ‘Drowned in a Stream of Prescriptions,’ about a 24-year-old college graduate who was ‘getting dangerously addicted’ to the ADHD medication Adderall and later committed suicide. I noted that it was impossible to know whether there was any link between the Adderall and the man’s suicide. Schwarz incorrectly implied that there was.
And in June 2012, he wrote a page-one story that opens with a scene of a high-school student snorting a line of Adderall on the armrest of his car in the school parking lot minutes before stepping inside to take the SAT. ‘At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse prescription stimulants,’ Schwarz wrote. I noted that Matthew Herper at Forbes had raised numerous scientific questions about the story.”
Turning to the latest story on ADHD drugs, Raeburn rips into Schwarz’s use of data: “[The] latest story reports more bad news about ADHD drugs, which is startling–because the UCLA press release promoting the study praised the findings as good news. Schwarz links to the release, which says: ‘Children with ADHD who take medications such as Ritalin and Adderall are at no greater risk of using alcohol, marijuana, nicotine or cocaine later in life than kids with ADHD who don’t take these medications.’
The press release clears the drugs of any taint that they lead to later drug addiction. That’s a good thing. But Schwarz’s story twists that into an indictment of the drugs for not lowering the risk of addiction later on.
Does anyone besides me suspect that Schwarz has an agenda here?” (emphasis added)
Raeburn’s central critique of Schwarz’s reporting is the lack of clarity regarding the drugs’ positive effects. Raeburn writes: “The missing piece here is that some children are helped enormously by these drugs. Schwarz acknowledges that, but immediately heaps on more criticism: ‘Stimulants can drastically improve the lives of children with severe A.D.H.D., but are also increasingly abused by high school and college students for their jolts of focus toward schoolwork.’ Those are two separate things. Let’s acknowledge that the drugs can help; full stop. Yes, they are also abused. But that doesn’t detract from their effectiveness in the children who need them. Morphine is abused, but it is also effective in reducing severe pain. Both things can be true.”
Raeburn also notes there are problems with the study that prompted Schwarz’s story. He continues: “Schwarz reports that the study had an important limitation: The researchers knew only whether children had ever taken medication at all, not how much they used, how long they took it, or at what age they took it. It’s possible, Schwarz reports, that the medication encouraged drug abuse in some and deterred it in others, leading to the conclusion that, overall, it had no effect on later abuse. That comes from one of the authors of the study, who should know.
Given those limitations–researchers did not know the dose of stimulants and did not know whether they could affect some subgroups differently–it’s hard to know what to conclude from this study. Furthermore, this was not original research; it was a so-called meta-analysis, in which the results of previous studies are pooled and re-analyzed. Such studies can be useful but are rarely considered definitive. It’s safe to say that what we can conclude from this study is: Not much.”
Raeburn’s concludes that editors at the New York Times should “look closely” at Schwarz’s reporting and “strive for more balance.” He writes: “they should ask him why he is so determined to attack these drugs at every opportunity, even if it means turning a press release inside out. What is his agenda?”
Disclosure: As a parent of an ADHD child, who tried every possible alternative treatment prior to initiating drug therapy, stimulants have been a godsend in allowing my child to operate on the level of his intelligence. The New York Times should solicit parents who can tell the before and after stories. Putting fear in the heart of parents whose children could potentially benefit from the treatment is irresponsible and self-serving at best.
I believe that the main problem is that we categorize many different disorders under ADHD label. There are cases in which people do need drugs and serious medical treatments, however there are many many cases where simple diet and exercise may be enough. Those are very different disorders and we all are getting hurt by doctors treating it as one.