Are kids being medicated for ADHD at alarming rates? How about for “Sluggish Cognitive Tempo” a syndrome often referred to as the Day Dreamer’s Disease. Sluggish Cognitive Tempo was first talked about in the early 1980s, but present-day researchers and doctors want it to be its own separate diagnosis, weeded out from ADHD. Experts consider Sluggish Cognitive Tempo a type of “inattentive ADHD,” with the following symptoms: excessive day dreaming; lethargy; poor memory retrieval; trouble staying alert in boring situations; and acting withdrawn. When I first heard of Sluggish Cognitive Tempo, my first thought was that I would have been diagnosed with it as a kid. I got bored easily and preferred high-adrenaline environments. I fell asleep during Nursery School and Kindergarten daily, because I was bored. The nuns, as I went to Catholic school, hated me for it. But I assumed it was THEM and not ME, and so did my parents, so they just found more stimulating learning environments for me. Even as an adult, I can do “boring” for only so long, before I fall asleep. If a movie is boring, I can’t stay awake for it…something that drove my Ex nuts. Even now, I need to make my work environment somewhat stimulating, otherwise I’ll fall asleep. I daydream easily, but I love my daydreams? In medical school, I couldn’t study in a library to save my life. I had to be in a park, in a green room ( I dated a guitarist during med school), or just somewhere that gave me some kind of adrenaline nudge.
I haven’t revisited the idea of kids being medicated for ADHD OR Sluggish Cognitive Tempo for a long time. The reason I’m thinking about this topic now is that I recently met parents who said that their school psychologist recommended that their son be seen and possibly medicated for ADHD and/or Sluggish Cognitive Tempo. Their son is four. It’s not my place to advise those parents. I’m not an expert on ADHD, I’m not a psychiatrist,… I’m an MD/MPH turned business owner. I work in “wellness” ( an umbrella term with often a lot of nonsense under it) , medical writing and public health. But the conversation reminded me of a NYT article I read, several years ago now, and a subsequent email exchange I had with Dr. Barkley, one of the current experts on Sluggish Cognitive Tempo. I posted about it then, in 2014 to be exact, and figured I’d share it again below, because so much about it is still relevant: media bias, professional tribalism, profit-driven medicine, doctors being paid by super-rich drug companies, the race for new diagnoses, the risk:benefit question over pyschiatric medication ( especially in kids), and my own personal bias, which is still as strong as it was today as it was then. However, I DO think I’m better at hearing and accepting views that are contrarian to my own. However, THAT, which I view as a skill, is something that gets me ostracized by mostly everyone. People pressure me and twist my arm and my words in an effort to force me to a side, while I’m pretty happy in my directionless, shifting shape. I DO take strong stances on issues, but my addiction to being right has gotten less and less over the years, while I think it’s gotten stronger in those around me. I think that makes me a very annoying and uncomfortable person to be around. But I digress. Read the post below, and let me know what you think:
A walk-back-in-time, to 2014:
The New York Times posted an article titled, “Thousands of Toddlers are Medicated for ADHD,” which mentions that around 10,000 2-3 year olds are on medication for ADHD outside of proper pediatric guidelines. The article was written by Alan Schwarz who has been writing about ADHD in the Times for a while now. I think he’s biased and biased in the same direction as me. One of his earlier articles in 2013 titled, “The Selling of ADHD,” should make his bias evident. It is not exactly a neutral headline.
I fully admit to being biased when it comes to giving two or three year olds psychiatric medication. I think medicating two to three year olds for any sort of mental condition is ludicrous, and on some days, you might even hear me call it child abuse. I do not believe there is a two or three year old crazier than the act of medicating a two or three year old with amphetamines, the drugs commonly prescribed for ADHD. So I side with Schwarz most of the time.
That said, I have been steadily working to keep my own bias in check when it comes to controversial topics like medicating children for mental disorders. Through my wellness endeavors, I have met parents who have a child on medication and explain to me that it was a last resort, that they felt helpless and that their child is doing better on the medication. For example, I recently talked to a mom who had a defiant child with ADHD who was now on medication and doing a lot better. Now her child is able to sit still and do his homework and is no longer failing out of the first grade. I am Irish, extra stubborn and hotheaded, and let me tell ya: It is a humbling experience to recognize and muzzle your bias on tough issues you feel strongly about. The reactive part of me wanted to yell at her, “How could you give your 6 year old an amphetamine? What about the long-term side effects? Maybe he is just being a kid? Kids go through a million and one awkward and weird phases, just let them be!”
Instead, I went away from that conversation thinking to myself, “There is no way she tried everything. There is no way medication was her last resort…, she is just saying that.” So, yes. It is a struggle to muzzle your own bias. Recognizing that fact, and just being open and honest about it with myself and others, I think ( I hope) has made me a better scientific investigator. A better medical detective. And a better medical writer. I am now better at investigating an issue and keeping my bias to a minimum before preemptively jumping in and calling someone wrong. Or an idiot. But I am a work in progress. And it is always a struggle, especially when it comes to medicating really young kids for ADHD.
Realizing I continually have to hear all sides of a story, I recently reached out to psychologist Dr. Russ Barkley of South Carolina, who is one of the premier researchers on a possible new pediatric mental disorder, Sluggish Cognitive Tempo. Sluggish Cognitive Tempo is still being defined, but it has been described as an attention-deficit disorder that is unique from ADHD. Barkley is a big believer in Sluggish Cognitive Tempo and has a large evidence base for it. He has also been criticized for being paid over 100,000 dollars by the drug company giant, Eli Lilly, for giving lectures on their behalf. Eli Lilly has funded research on Sluggish Cognitive Tempo, and specifically research that tests one of their drugs, Strattera, as a possible treatment.
I am biased against doctors like Barkley, but of course I would be: He is a doctor who is trying to create a new mental disorder for kids and he’s a doctor who gets paid by a massive drug company to speak on their behalf. Still, a responsible and thoughtful investigator should hear all sides of an issue to have the best possible picture of a complicated, controversial issue, even if that means punching your punching bag a few times before sitting down to talk to him.
I found his email, wrote a thoughtful letter explaining who I was AND my bias, and asked him if he would be willing to do an interview on Sluggish Cognitive Tempo and how one could distinguish it from normal childhood behavior. He wrote me back the following email:
“Sorry but I am not available for such an interview. You can find all of the information on SCT that is known in the research literature in the Fact Sheet on this condition on my website under the Fact Sheets directory. Here is the article of mine that led the NYTimes sports journalist to contact me for an interview, which I and other clinical scientists working in this area refused to do given his past sensationalized articles on ADHD. I hope you find these informative.
Russell A. Barkley, Ph.D.