What's Wrong with The NY Times Article on ADHD - #1 (of 4 Parts)

Summary

In this video, Russ Barkley critiques a *New York Times Magazine* article about ADHD, highlighting key inaccuracies and misunderstandings. He refutes claims about the MTA study, which the article misrepresents, particularly regarding the roles of experts and treatment effectiveness. Barkley challenges the article’s use of unreliable CDC prevalence data and vague statements from experts, arguing that they create unnecessary fear about ADHD. He emphasizes the importance of proper diagnosis, treatment guidelines, and the need for a balanced approach to ADHD management, offering a comprehensive breakdown of the article's flaws.

Takeaways

• 😀 The New York Times article on ADHD raises concerns, but many of the issues discussed were already addressed in previous articles, especially from The Economist.
• 😀 The author, Paul Tu, used some of the same experts as earlier pieces, creating overlap in arguments, though the New York Times article is more comprehensive.
• 😀 Russ Barkley critiques the portrayal of ADHD in the article, suggesting that some of the issues stem from the experts selected and oversights due to the author's lack of expertise in ADHD.
• 😀 The MTA (Multimodal Treatment Study of ADHD) is a key focus in the article. However, Barkley points out that the New York Times misrepresents Jim Swanson’s role in the study and overlooks some methodological flaws.
• 😀 The MTA study's design and its outcomes are critiqued, particularly the limitation of its sample, which wasn't representative of the general ADHD population, as it focused on families with higher levels of functionality.
• 😀 The article overlooks a key issue: after 14 months of treatment, the differences between treatment groups dissipated as participants sought alternative treatments, contaminating the study’s results after this period.
• 😀 The New York Times article includes vague statements about ADHD that appear designed to induce concern, without offering clear explanations of what’s wrong with current ADHD practices or research.
• 😀 The article uses CDC prevalence figures on ADHD, but Barkley criticizes these as unreliable due to their poor methodology, arguing that better studies suggest a prevalence rate of about 5-7% in children and 3-5% in adults, not the inflated figures cited by the CDC.
• 😀 The article states that stimulant medications are the preferred treatment for ADHD, but Barkley disagrees, emphasizing that proper ADHD treatment should include a combination of education, behavioral interventions, medication, and environmental accommodations.
• 😀 Barkley disputes the claim that stimulant medication is the preferred ADHD treatment, explaining that professional guidelines recommend a more holistic approach, involving behavioral interventions and environmental adjustments alongside medication if necessary.

Q & A

What is the main focus of Russ Barkley's critique in this video?

Russ Barkley critiques a *New York Times* article about ADHD, addressing the misconceptions and misunderstandings presented in the article, particularly regarding ADHD treatments, diagnosis, and the science behind the disorder.

How does Barkley describe the New York Times article's portrayal of the MTA study?

Barkley believes the MTA study's portrayal in the New York Times article is flawed. He claims that the article misrepresents the study's results, specifically exaggerating the role of Dr. Jim Swanson and failing to mention key methodological issues, such as the study's sample being unrepresentative of the general ADHD population.

What is the significance of the 14-month treatment phase in the MTA study?

The 14-month treatment phase is crucial because it marks the period where the study tracked the effectiveness of different ADHD treatments. After this period, participants were free to choose their treatments, leading to 'contamination' of the data as groups mixed treatments, making comparisons unreliable beyond the 14-month mark.

What critique does Barkley offer regarding the CDC's ADHD prevalence figures?

Barkley criticizes the CDC's ADHD prevalence figures, noting that the CDC's survey is poorly designed, relying on vague questions like asking whether a child has ever been told they might have ADHD. He argues that this leads to grossly exaggerated figures compared to more accurate studies using rigorous diagnostic criteria.

What is Barkley's opinion on the use of stimulant medications as the 'preferred treatment' for ADHD?

Barkley disputes the idea that stimulant medications are the 'preferred treatment' for ADHD. He explains that current practice guidelines recommend a combination of treatments, including education, behavioral interventions, and environmental accommodations, with medication being just one component, not the preferred sole treatment.

What does Barkley say about the role of behavioral treatments in managing ADHD?

Barkley emphasizes that behavioral treatments, particularly behavioral parent training and interventions in the child's home or school environment, are crucial components of ADHD treatment. These interventions are often recommended before medication in many clinical guidelines.

How does Barkley address the concerns raised by the New York Times article's use of expert quotes?

Barkley critiques the New York Times article for quoting experts like Dr. Jim Swanson and Dr. Edwards Senuga Bark without providing clear explanations or context for their concerns about ADHD. He believes these quotes are vague and fear-inducing without sufficient clarification on what exactly is 'wrong' or 'disconnected' in the field.

Why does Barkley believe that the criticisms in the New York Times article are not new or innovative?

Barkley argues that the criticisms presented in the article, particularly those about ADHD being dimensional or influenced by environmental factors, are not new. These views have been discussed in the ADHD field for decades, and he believes the article presents them as if they are novel, which he disagrees with.

What does Barkley mean by 'contamination' of the study data after the 14-month follow-up in the MTA study?

Barkley refers to 'contamination' in the study data after the 14-month follow-up because, after this period, many participants began seeking additional treatments outside of the study protocols, mixing different interventions. This makes it impossible to draw valid comparisons between treatment groups, as the treatments became inconsistent.

How does Barkley criticize the methodology behind the MTA study's sample selection?

Barkley criticizes the MTA study's sample selection, pointing out that the study's requirements, such as frequent follow-ups and randomized treatments, led to a non-representative sample of children with ADHD. Families who were less functional or unable to comply with the study's demands were likely excluded, which skewed the results.