Are parents guilty of overmedicating their children? Are they the culprits responsible for mental health diagnoses such as attention deficit and hyperactivity disorder (ADHD) and bipolar disorder in kids? These were the questions Judith Warner asked as she set about to write a follow-up to her 2005 New York Times best-selling book Perfect Madness: Motherhood in the Age of Anxiety, an examination-meets-condemnation of the culture of overachieving parents. She intended her next book to address perfectionist parenting in terms of childhood mental health disorders. Of course, she thought she knew the right answers: Yes and yes.
"It had to be these hypercompetitive, pushy parents trying to perfect their kids... None of this was real" to me, Warner explained at a recent event which was sponsored by the Parents League of New York and hosted by New York Times "Motherlode" blogger Lisa Belkin to launch her new book. "I saw ADHD and bipolar disorder as flavor-of-the-month diagnoses," the result of our "culture of overmedication." After interviewing real parents who were "just in despair" over their children's health, Warner came to the same conclusion that ADDitude readers -- parents of ADHD children and ADHD adults -- are all too familiar with: ADHD is real.
During her interviews with parents, she ran into the issues ADDitude readers face every day: Inadequate public schools, violent kids, and issues with working memory, impulsivity, hyperactivity, inattentiveness, which "cause real difficulties living life."
"It's not just a problem of fidgety boys who can't sit still," she said at the event. Explaining that after she first met with real parents, "I went home and cried. I had never experienced the personal pain" those parents felt. Warner realized, "Maybe I could be more compassionate." Her new book We've Got Issues: Children and Parents in the Age of Medication (February 2010), is an attempt to spread that message to the rest of the mainstream-media consuming culture.
Fear of Overmedicating: Is the Media to Blame?
Though initially she saw the rise of mental health problems in kids as a "manifestation of problems of society," Warner realized that her perceptions came "largely from the media," which, she said, "primes viewers to think parents are lazy and irresponsible and that they don't want to do the hard work of parenting." As far back as the 1940s mental health problems were attributed to bad mothering, she added.
The media, she said, "jumps to the conclusion that parents would go to this length -- diagnosis -- simply to 'perfect' their children... What does it say about us for believing it?"
In her candid conversation with host Belkin, Warner addressed this and the several myths that surround the topic of diagnosing and treating mental health disorders in kids.
Mainstream Myth #1: ADHD Doesn't Exist... Because it Didn't Used to Exist
The event's host Belkin raised the point that perhaps there is a mistrust of diagnoses because adults take the stance, "When I was a kid, this diagnosis didn't exist...because we didn't use the words."
Warner responded by saying that even if a diagnosis existed, it was applied narrowly. For instance, the second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) -- or the American Psychiatric Association's guidelines for diagnosing and treating mental health problems -- introduced a form of childhood hyperactivity in 1968, but it wasn't until 1980 when attention deficit disorder (ADD) was introduced in DSM-III, and in 1994 DSM-IV updated the diagnosis to ADHD. (DSM-V may bring even more changes to the ADHD community.) The history is similar for other disorders, Warner explained. "Until the 1970s, people didn't think children could suffer from depression. There wasn't a category for Asperger's until 1994r... If you don't have the terminology, the concepts, you're not going to find the kids."
Mainstream Myth #2: ADHD Is a Rich Kids' Disease
"Public schools are supposed to provide individualized education programs (IEPs) and learning disability (LD) testing but they throw up roadblocks. It's expensive. Parents of means have all sorts of opportunities," to pay for diagnosing and treating ADHD, Warner said. "So it can appear like it's wealthy parents pushing their kids too hard. Because they can afford it."
Mainstream Myth #3: Psychiatrists Can't Be Trusted
In her research, Warner traced her personal mistrust of mental health diagnoses in children to the anti-psychiatry movement of the 1960s (the focal point of which was to point out, and limit, the power and abuses of psychiatrists over patients, which "was popularized in Kesey's 1962 novel, One Flew Over the Cuckoo's Nest," wrote Pyschiatric Services authors David J. Rissmiller, D.O. and Joshua H. Rissmiller). "We all carry around pieces of this. We all think the worst of parents and psychiatrists," Warner said at the Parents League of New York event.
Distrust of Drug and Insurance Companies: Not a Myth
In addition to admitting that conditions like ADHD are real, Warner believes the drugs used to treat them "are real -- and a part of the answer." But the pharmaceutical industry that produces them isn't without its flaws. Among them: The bulk of research related to mental health disorders, and treatment, is paid for by the industry, allowing them to hide poor results. Government regulation is faulty at best, Warner added.
Additionally, she said, "Insurance companies need to reimburse [patients] for longer visits, for follow-up calls" and the additional leg and paperwork that is necessary for getting proper ADHD treatment.
Are Mental Health Diagnoses on the Rise, or Are We Just Better Able to Detect Them?
"Some experts believe there are more mental health illnesses out there," yet undiscovered, while others say this isn't true, Warner said. Changing terminology is to blame, because it limits our ability to compare current diagnoses to the past rate, she explained. However, she added that today's diagnosed adults, "say they started to have symptoms as early as before their teens."
There Is Hope for Mental Health Awareness in the Future
"What I've seen anecdotally, is there is a generational component. Younger teachers are sensitized to it. They're familiar with it. It isn't strange to them."
