How accurate is media coverage of attention deficit disorder? - ADD

USA Today (Society for the Advancement of Education), July, 1997 by Richard E. Vatz, Lee S. Weinberg

There has been a recent boomlet in the print and electronic media in stories raising serious questions about the diagnosis and treatment of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). Many of these reports make the same points: ADD has become a "fad disorder," difficult to diagnose and more difficult to disconfirm; whether one is diagnosed often depends on where one lives; and the treatment, methylphenidate (Ritalin), is being legally overprescribed in some cases and illegally abused in others.

All of these charges, except the illegal abuse, had been made in academic publications in the 1970s and 1980s. In fact, a substantial collection of academic material critical of ADD diagnosis and prescribing Ritalin have been available to writers for years.

The Myth of the Hyperactive Child (1975), by Peter Schrag and Diane Divoky; The Learning Mystique (1988), by Gerald Coles; and writings by psychiatrist Thomas Szasz and others have made these points. For example, Coles'book pointed out that "the description of a child with an attention deficit disorder ... is ... vague and preposterous.... Even those who believe there is such a condition ... agree that it `is not well defined.'"

An Oct. 21. 1988, article in the Journal of the American Medical Association reported a tremendous rise in the use of Ritalin in certain regions. Looking at a sample in Baltimore County, Md., the piece noted that, since 1971, there had been "a consistent doubling of the rate of medication [methylphenidate or Ritalin] for hyperactivity/inattentive students every four to seven years." This was followed by a drop in use due to bad publicity about lawsuits, but the increase resumed. Recently, there has been an acknowledged quadrupling of the prescribing of Ritalin. In 1989, an article in The Atlantic Monthly warned of the danger of physicians' ignoring commonsense precautions readily available in professional journals regarding the prescribing of Ritalin.

Thus, by the 1980s, skeptical rumblings about ADD were being heard intermittently within the psychiatric community, particularly concerning the use of Ritalin. In 1987, Georgia's Composite State Board of Medical Examiners became aware of a tremendous jump in the prescribing of Ritalin in that state.

Still, both print and electronic coverage of ADD well into the 1990s continued to misinform the public regarding the accuracy of diagnosis and the safety of Ritalin. In The New, York Times (June 21, 1990), Daniel Goleman, a former editor of Psychology, Today who rarely criticizes conventional psychiatric practice, warned of the problem of ADD continuing into adulthood and, offering no cautionary statements, wholeheartedly favored "a combination of medicine and psychotherapy." Though Goleman did not report it, researcher Russell Barkley of the University of Massachusetts Medical Center wrote in his 1990 book, Attention-Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment, "There are as yet no consensus criteria for making the diagnosis of ADHD ... in adults."

With a few notable exceptions, the coverage of ADD continued to be uncritical, and the increasing uses of Ritalin also went mostly unscrutinized in the early 1990s. One exception was Time (Jan. 16, 1989), which typically has been ahead of other publications in raising questions about ADD. The magazine represented almost a voice in the media wilderness when it expressed the concern that "too many youngsters [were] being misdiagnosed and medicated" and made the prescient, if inaccurate at the time, observation that "Doctors emphasize that drugs should be a last, not a first resort."

Contrast this with medical columnist Jane Brody's observation in The New York Times (April 25, 1991) that, "Unfortunately, many parents hesitate to try medication because of widespread misunderstandings...." Similarly, The Baltimore Sun (March 28, 1989) obviously was untroubled by any second thoughts in the "To Your Health" section when it ran a piece titled "Child Who Is Hyperactive May Benefit from Ritalin." It included no warnings or caveats about use of the drug. The Times, however, showed signs it had gotten at least part of the message, admitting on March 28, 1986, that "There is no reliable test to make a diagnosis [of ADD]...."

In 1993, the major ADD story was that the disorder had spread virtually unnoticed to the adult American population. With this discovery came record levels of Ritalin prescriptions. Yet, according to The New, England Journal of Medicine (Nov. 15, 1990), in Great Britain, "stimulants are rarely or never used" in treating ADD. The obviously dramatic "discovery" of the prevalence of adult ADD triggered the tremendous herd instinct of the media to report, uncritically, on the claim that it was a significant problem -- especially when left untreated -- among Americans.

On "ABC News" (June 25, 1993) and repeated on "20/20" (Sept. 2, 1994), Catherine Crier warned that ADD might reflect the spread of a "biological disorder of the brain" to adults. She offered no warnings about Ritalin use, but acknowledged in the 1994 follow-up that, "because the symptoms are a bit vague, misdiagnosis is possible...." Similarly, on "Good Morning America" (March 28, 1994) and later in June of that year, Tim Johnson reflected the new climate by warning of the previously unrecognized existence of ADD in what "experts" say is "as many as 10,000,000 adults." CNN and other sources echoed this concern. On Jan. 11, 1993, The Wall Street Journal published an article alerting readers to adult ADD, but expressed substantial skepticism as to its frequency.