ADHD: Is Stigma Back in Style?

With the latest ADHD controversy, it seems as if we've regressed to an era when all mental health problems were blamed on Mom

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“Ritalin Gone Wrong,” L. Alan Sroufe’s recent op-ed  in the New York Times, which argued, among many other odd things, that attention-deficit disorder (ADD) could be “especially” caused bypatterns of parental intrusiveness” like picking a baby up from behind and plopping “it” in a bath or taunting or ridiculing a frustrated 3-year-old, was like a ride backwards in a time capsule.

A trip back to an era when autism was routinely blamed on “refrigerator mothers.” When children with psychiatric ills were believed to be victims of toxic “schizophrenogenic” mothers — women who loved too much or too little, were too effusive or too lacking in affection, pushed their children away or bound them to them too closely, didn’t embrace their “feminine” role with proper delight or pursued it to seductive excess. It was a remnant of a time when what mental health experts now officially call attention-deficit/hyperactivity disorder (the ADD nomenclature that Sroufe prefers having changed back in 1994) was seen as “minimal brain dysfunction” or “hyperkinetic reaction of childhood.”

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The “reaction” concept was key. For back in that era — the Freudian era, a time when homosexuality was officially categorized as a mental pathology and when women could be considered “sick” if they didn’t joyfully conform to the impossible and conflicting definitions imposed upon them by psychoanalytic theory — children’s behavioral, emotional and even learning difficulties were generally seen as reactions to their environments. Environments dominated, once again, of course, by their beleaguered mothers.

This was the era in which Sroufe, who received his Ph.D. in 1967, was educated and began to make his mark in the field of child psychology. It was the era in which he authored his one study of the use of stimulant medication in “problem” children — children who might or might not have actually had what’s now understood to be ADHD.

As a specialist in attachment, and the effects of good or bad infant attachment patterns on later stages of child development, Sroufe’s work centered on relationships. He labored to show how disruptions in good mothering could lead to disordered behavior — an approach that no doubt was forward-looking at a time when public opinion tended to view the children he focused on (low-income kids, often born to single mothers who lacked education) as bad seeds. There is a notable sound of compassion that rings through his early work, even in his rather damning 1980 study of how “seductive” mothers, who engage in “stimulating physical contact” like “stroking the stomach” and “passionate kissing on the lips” as well as “coquettish behavior” and “flirting” with their sons in a laboratory-bound toy-cleaning-up situation end up having troubled kids. (Many of these misguided moms, he notes, were themselves victims of incest or other boundary violations by their parents.)

But somewhere along the line, perhaps as Sroufe found himself on the losing side of a paradigm shift in children’s mental health, that compassionate impulse seems to have faded away. In his Times piece, he wages what appears to be a late-career turf war with biological psychiatry (“The National Institute of Mental Health finances research aimed largely at physiological and brain components of A.D.D.,” he writes, ” …  Scientists, aware of this orientation, tend to submit only grants aimed at elucidating the biochemistry.”) In so doing, he relies for backup upon a wide array of our society’s myths and prejudices about “politicians, scientists, teachers and parents,” who believe, as he puts it, that “all of life’s problems can be solved with a pill” and who want nothing more than to be gotten “off the hook.”

Is the point of all this really to do better by kids or is to settle scores with a world that has evolved in ways that Sroufe doesn’t approve?

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Over the course of this past week, Harold Koplewicz, the president of the Child Mind Institute in New York, and Edward M. Hallowell, a psychiatrist who specializes in ADHD, both wrote point-by-point rebuttals of Sroufe’s anti-medication argument. Koplewicz attacked Sroufe’s assertions on scientific grounds, while Hallowell zeroed in on the professor’s seeming deficits of connectedness to and compassion for today’s parents.

To their excellent and eloquent statements, which should be read by and emailed to anyone touched by Sroufe’s opinions, I’ll simply add this: Forty years ago, parents who saw that their children were struggling at school, at home or with friends, punished them sometimes, but generally, if they could get away with it, did nothing. They feared the stigma, they feared the blame, that they knew would all but inevitably come if they took their child to see a mental health professional. Now that mainstream expert opinion has changed, particularly as regards what we now call ADHD, why would we want to regress to an era of stigma and shame?