ADHD Is Exploding. Are the Kids All Right?

‘It’s impossible to ignore the school system’s role in overdiagnosis and prescription.’

“For Many Kids, ADHD Pills Kick Off a Drug Cascade” (Page One, Nov. 21) sheds light on the pervasive diagnosing and use of drugs for behavior in otherwise normal children. Because there are no biologic markers of attention-deficit/hyperactivity disorder, there is no way to ascertain whether there is any biologic benefit of the drugs used to treat it.

Representational image.

Consider the behaviors that constitute the diagnosis: inattention, disorganization, being more active than typical—nothing violent or extreme. The diagnosis doesn’t take into account family or social conditions that contribute to a child’s behavior. Unlike medical illnesses, there are no proven medical abnormalities in those diagnosed. This sometimes comes as a shock to parents and others who assume the diagnosis is medically precise, beyond question.

Many adults state that the amphetamine-like drugs and other pills they were given for ADHD improved their lives. But that doesn’t negate that the diagnosis has no medical basis—or that there is no medical basis for long-term prescriptions of what are essentially mind-altering drugs with potentially adverse side effects. The children I used to treat typically said that medication not only changed their unwanted behavior but also curtailed or erased their normal activity and spontaneity.

Daniel L. Zeidner, M.D.

Cheswick, Pa.

It’s impossible to ignore the school system’s role in overdiagnosis and prescription. A growing share of referrals to primary care come directly from schools when a child struggles to sit still or keep pace in class. Too often the first step is to “see a doctor” rather than adjust the learning environment or provide behavioral support. If the educational system funnels children toward medical evaluation as a default, it’s no surprise medication rates rise.

Medication overuse is a legitimate worry. But focusing solely on prescribing patterns misses the larger drivers: how children are evaluated, what support they receive before a prescription is considered and how heavily schools rely on medical referral in place of educational adaptation.

Michael Sparks, M.D.

Sanford, Fla.

Parents and physicians are portrayed as escalating medication in response to challenging behavior, but far less effort is spent on ensuring their expectations are appropriate. A child who needs movement to learn should be allowed to stand or pace. An intensely emotional child should be validated and made to feel as though his feelings matter. These children are navigating the world in bodies with neurologies they inherited. Children identified with ADHD often have parents with similar profiles. What families and schools need most is training and support—not hand-wringing over the lack of behavior therapists or fear-mongering. Medication saves lives, but it isn’t for everyone. What is universally beneficial is giving children the benefit of the doubt, flexibility and empathy.

Julie F. Skolnick

Potomac, Md.