ADHD and how drugs impede meaningful help for children

I recently received a call from a mother that made me both want to cry and scream out in frustration.

Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family to address both his behavior problems and the effects of his early trauma, then did not follow through. Whether it was lack of access to care, a wish not to deal with the problem, logistical difficulties, or some combination of these I do not know.

Then when he was in first grade, psychological testing revealed a likely diagnosis of ADHD and it was recommended that the parents consult with their pediatrician to consider a medication trial. His mother called me to set up an appointment. That was when I wrote the blog post.

I also returned his mother’s phone call, but she again did not follow through, and I did not hear from her again until last week, nearly three months later. She left me a message saying that things were much worse and she wanted to see me right away to put her son on ADHD medication.

When I finally was able to speak with her today, she shared with me a story of a child clearly out of control. Her son had run away from teachers several times. He often crawled under his desk and curled up on the floor during class. He was disruptive and at times totally unapproachable. His mother again repeated her wish to see me right away so that I could prescribe medication for his ADHD because “they want to put him in a class for emotionally disturbed children.”

My inclination was to stare at the phone in disbelief. How is it that this mother, a reasonable person, could expect that a pediatrician could effectively treat this problem simply by prescribing a pill? Clearly she was supported in this idea by the school. In fact our culture as a whole tends to disregard the impact of early trauma on development and relies heavily on medication to treat children once they reach an age when they are a problem in the school setting.

I explained to her that I was leaving the practice in a few weeks but that in any case, I felt that given the severity of the problem her son needed to have a comprehensive psychiatric evaluation, and, as I had recommended 3 years earlier, the whole family would need intensive help to manage this very challenging situation.

With Medicaid as the child’s insurance, their only option was the local mental health clinic. I knew that the wait for a visit with a psychiatrist could be as long as three months, and a wait for a therapist could be almost as long. I worried for the boy’s safety. I told her about the crisis team, and explained that if at any time she felt the situation was unsafe, she call that number and they would be seen right away.

This exchange left me with a feeling of despair. It is imperative that our culture as a whole recognize the value of early parent-child relationships in promoting healthy emotional development and the importance of early intervention when things go wrong. With powerful medications to fall back on when children reach an age that they are a trouble to society, as was the case with this little boy, there may be little incentive to provide or obtain meaningful help.

Claudia M. Gold is a pediatrician who blogs at Child in Mind and is the author of Keeping Your Child in Mind.

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  • IVF-MD

    Dr. Gold,

    Thank you for sharing on this important issue. It’s mindboggling to learn how things have progressed to what we have today where there can be over-reliance on pharmacological “solutions” to fundamental parent-child bonding issues.

    One has to ask what solutions there are to optimize the family structure to begin with so as to minimize the conditions that lead to this horrible waste of life potential.

  • Greg

    The wait for the therapist would likely be even longer than that for the psychiatrist. There is a severe shortage of child/adolescent psychiatrists, especially those who see medicaid patients, but the shortage of child psychologists and other therapists who accept medicaid is even more dire. In my clinic, we have 2 child psychiatrists, who both see medicaid patients, but every psychologist bills only private insurance, or cash, neither of which patients like the one you describe can likely afford. The psychiatrists then do psychotherapy and family therapy for these patients themselves, but that ends up extending the waiting list even further.

    I would take issue with the idea that medications are responsible for the lack of, as you state, “incentive to provide or obtain meaningful help.” It’s very easy to blame medications for all of society’s ills, but what you have done is set up a straw man argument which doesn’t get to the heart of the issue: Good therapy was difficult to come by even BEFORE the advent of psychotropic medications.

    50 years ago, most mental health providers didn’t believe children even had psychiatric issues, save for mental retardation and obvious autism. ADHD, or “hyperkinetic disorder” as it was known then, was diagnosed rarely, and little effective treatment was offered. Children were thought not to be capable of being depressed or anxious, which sounds nutty today, and abuse and trauma were issues which were neglected by healthcare providers and swept under the rug by families.

    So to blame the easy access to medications for the fact that kids are not given therapy is misguided. That problem has been going on looooong before medications were ever prescribed for children.

  • stargirl65

    I had a parent and child come in last month for ADD medicines. He has no diagnosis of ADD but his older sibling do (I have no idea how they were evaluated). The child is a junior in HS and has decent grades.

    I did a history on the student. The parent filled out informational questions. The student also did some questionnares. The results did not support ADD at all. Also the school had no concerns about ADD in this child.

    I told the mother that he did not appear to have ADD but if they wanted more formal testing we could see about him getting it elsewhere. They went home. The next day the mother called back and said that she and her husband had talked it over and they wanted him on the medicine anyway. They read that the medicines improved concentration even in children without ADD.

    I said no.

    • EHR Scope

      How rampant are stories like this exactly? For someone that actually “read” stuff about ADD drugs, they should have recognized it’s an amphetamine. Why would anyone put their child on a drug like that without diagnosis?

  • Health News

    I recently read something on how children with ADHD often have trouble finishing high school. As an adult who’s had ADHD for his entire life, I can tell you, yes, it is difficult, but not impossible.

  • IVF-MD

    I looked up the ADHD DSM4 criteria and I’m pretty sure an overzealous diagnostician could have possibly labeled me as having it when I was 7 and plugged me into a treatment program. It all depends on whether the definition of “impairment” includes not going along with the teacher’s rigid game plan and instead reaching out to learn and explore on my own. Yikes. -_-

  • Gayle Schrier Smith, MD

    Dr Gold, I read the original post on your site months ago, and found myself nodding in agreement, frustrated for and with you. It is far too hard to deal with a problem at crisis stage and far too easy to ignore it before it becomes a crisis. Your compassion, patience and commitment to good care could lead a group of likeminded providers to stay the course, do what’s right and with kindness…hold parents to the same standard of commitment.

  • EHR Scope

    I have intimate experience with a case like this, and I know that that child would have self destructed without THERAPY. For a child that got taken away for neglect, then adopted, the parents are being awfully neglectful.

  • petth

    I have been practicing for 27 years. The not followed through with counseling story is the rule not exception. If Primary care does not take over these patinets someway the patient may never be helped. Psychiatry will never have parity with regard to insurance coverage until they make Primary care in Psy possible. Family Practice, Pediatrics, General Internal Medicine and OB/GYN have to provide more than an appropriate referrl we have to start treatment .

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