I watch a certain amount of CNN’s newscasts; apology complete. Over the weekend they ran a story that reiterated one that has cropped up in many forms in recent years: do we over-diagnose and over-medicate kids for psychological and behavioral disorders, autism and ADHD (attention deficit hyperactivity disorder) leading the pack? The question seems to admit the easy answer of “yes.” Too easy. For complex patterns of sometimes intertwined behavioral sets, no easy answer can account for all variables, let alone all outcomes, benign or otherwise.
Usually in such instances one can simply defer to the professionals, but in the case of childhood behavioral maladies we lack the consensus of opinion to render that recourse viable. The problem begins with the fact that kids will by definition sometimes come in an unruly package. Defining when that unruliness crosses a line to pathology poses problems even for professionals, let alone putting a name on the transgression, given the resemblances among the identifiable disorders, and the genetic relatedness of some. Autism and ADHD, for instance, share a chromosomal allele.
The plot thickens when we add medications to the story, for to some battered parents and teachers they seem to offer that elusive quark, the “quick fix.” And here some professionals object with many layfolk that we use too many meds too freely. Perhaps; and no wonder, since some really work, or seem to, or do for a time before our systems acclimate to them—the case with Ritalin, the wonder-drug of ADHD.
But at this point the story can get weird. Some argue that the alleged fact of ADHD’s or autism’s over-diagnosis—I have heard this case made by professionals particularly with reference to ADHD—suggests that the disorder really does not exist. I suppose Psychology Departments leave the teaching of logic to Philosophy Departments, but such thinking has serious ramifications for those who have a truly clinical case of whatever behavioral nexus we might consider.
I have gone through a couple of diagnoses as an adult—ADHD and manic-depressive illness, or bipolar disorder—that both illuminate and confuse the issue. The fact that doctors and other professionals find these disorders hard to diagnose, or may get stuck in a one-size-fits-all diagnostic rut or fad, does not eliminate the pain of those so diagnosed, the pain the meds can and often do ameliorate.
Often. Not always. I remember Prozac as though through a cloud of jello, and Depakote as a ruthless secretary re-filing the folders of my brain at painful will one weekend. Wellbutrin helped my depression but probably made me manic, or rather facilitated the emergence of a manic episode that cost me a career I had worked very hard to nurture. So, no, think not of all meds as benign for all patients. In the trial-and-error world of medicating, one claims universal efficacy for a drug at the risk of one’s reputation for sanity.
On the other hand, once having established that I do not tolerate lithium—it nearly killed me—my new combination of meds works quite well. I could have given up after lithium, but so could the mother of a child mentioned in the CNN segment, until she found the right professional with right answer for her child after he had received the supposed death sentence of severe autism. Instead she found a doctor who diagnosed the child as having ADHD, and successfully medicated him.
Health professionals forget at their peril—and their patients’—that they have lives in their hands, not classroom abstractions. And we forget that though diagnostic fads no doubt live longish and prosper, to dismiss the diagnosis as such misses the point: that some of us need some version of it at some time in our lives to flourish. Punish those who give out Ritalin as candy, but remember that the diagnosis of ADHD did not develop in a first-grade classroom, but in the practices of those who know something whereof they speak, and have the compassion to persist through their mistakes.
Chapel Hill, NC
December 5, 2011