Dr. Hallowell’s Response to the NY Times Piece “Ritalin Gone Wrong”

Dr. Hallowell’s Response to the NY Times Opinion Piece “Ritalin Gone Wrong”

Regarding the opinion piece “Ritalin Gone Wrong” written by Alan Sroufe, Ph.D., (NY Times, Jan. 29, 2012): As is usually the case when the use of stimulant medications like Ritalin makes it into mainstream media, the piece pushed emotional hot-buttons in a way that would scare the daylights out of uninformed readers and lead them to avoid ever using such medications or allowing their children to, thereby giving up on a class of medications with enormous potential benefits.

Let me offer a different point of view. I’m an M.D., a child and adult psychiatrist who’s been treating children who have what we now call ADHD for over 30 years. I was on the Harvard Medical School faculty for 20 years, and I still see patients in my offices in Sudbury, MA, and New York City every day. I have both ADHD and dyslexia myself. I’ve co-written, with John Ratey, the best-selling books on the topic of ADHD. I know this condition, and its various treatments, inside and out.

While I wince at the inflammatory rhetoric of Dr. Sroufe’s article, I actually agree with much of what he had to say. It is with his scare tactics and wrong-headed assumptions that I take issue. Let me quote and respond to several paragraphs from his article:

“First, there will never be a single solution for all children with learning and behavior problems. While some smaller number may benefit from short-term drug treatment, large-scale, long-term treatment for millions of children is not the answer.”

Who said there would be a single solution? No enlightened clinician offers medication as the single solution. We offer it as one tool that can help, but always as part of a comprehensive treatment plan which also includes other key elements like education of parent, child, and teacher; lifestyle modification, including sleep, diet, exercise, meditation and positive human interactions; coaching on how to better organize life; and ongoing follow up to monitor progress and offer encouragement and various specific tips on managing life with ADHD.

And what Dr. Sroufe cites as “some smaller number” is about 80% of individuals with ADHD who try medication. When these medications work, they do not solve the problem, any more than eyeglasses solve the problem of myopia. But they sure do help!

“Second, the large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them.”

It is a statement cited so endlessly as to become an accepted truth that we live in a society that believes all of life’s problems can be solved with a pill. But have you ever met anyone who actually does believe that? I haven’t. Furthermore, 19 out of 20 people who come to me for help for themselves or their child adamantly oppose the use of medication. Only when they fully understand the medical facts do many of them change their minds. Far being predisposed to the use of medication, the people who come to see me are predisposed in precisely the opposite direction.

Furthermore, no enlightened clinician prescribes the medication and leaves it at that, allowing the parent and child to imagine they have “something inherently defective in them.” I go to great lengths not only to present the medical facts but also to create a framework of understanding that describes ADHD in strength-based terms. I tell the child that he is lucky in that he has a race car for a brain, a Ferrari engine. I tell him he has the potential to grow into a champion. I tell him (assuming it is a he, but he could just as easily be a she) that with effort he can achieve greatness in his life, and then I tell him about the billionaires, CEO’s, Pulitzer Prize winners and professional athletes with ADHD I’ve treated over the years. But, I also tell him he does face one major problem. While he has a race car for a brain, he has bicycle brakes. I tell him I am a brake specialist, and one of the many tools I can use to strengthen his brakes is medication. I remind him he will have to do much more than take the medication to strengthen his brakes, but, if we’re lucky, the medication will help him in that effort.

The child and parents leave my office full of hope. Far from feeling defective, the child feels like a champion in the making. Which he most certainly can be!

“Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone – politicians, scientists, teachers and parents – off the hook. Everyone except the children, that is.”

Once again, Dr. Sroufe assumes the clinician, parent, and society at large all buy the notion that “children’s behavior problems can be cured with drugs,” and that such a belief gets us “off the hook,” as if we politicians, scientists, teachers, parents, and heaven knows who all else were so sweetly deluded and so uncaring that we welcome any excuse to get us out of doing the deep probing into the “complex solutions” one is left to presume only Dr. Sroufe and his exemplary colleagues can or will attempt.

No clinician worth his or her salt believes that all problems can be cured with drugs. But neither does a responsible clinician deny the good that medications can do. When people ask me, “Do you believe in Ritalin?” I reply that Ritalin is not a religious principle. Ritalin, like all medications, can be useful when used properly and dangerous when used improperly. Why is it so difficult for so many people to hold to that middle ground?

And yet difficult it is. Ritalin continues to be a political football, a hot-button issue almost on a par with abortion or capital punishment. One is pushed to be for it or against it, while the right and good position is to be for whatever will help a child lead a better life, as long as it is safe and it is legal.

Used properly, Ritalin is safe, safer than aspirin. And it is legal, albeit highly regulated. As to its long-term use, apply common sense. Use it as long as it is helpful and causes no side effects. That may be for a day, or it may be for many years.

Of course, we need to address the complex issues that contribute to behavioral, emotional, and learning problems in children. I’ve written extensively about what I call “pseudo-ADHD,” children who look as if they had ADHD but in fact have an environmentally-induced syndrome caused by too much time spent on electronic connections and not enough time spent on human connections, i.e., family dinner, bedtime stories, walks in the park, playing outdoors with friends or relatives, time with pets, buddies, extended family, and other forms of non-electronic connection. Pseudo-ADHD is a real problem; the last thing a child with pseudo-ADHD needs is Ritalin.

But that is not to say that no child needs Ritalin, nor that those who prescribe it are dimwits hoodwinked by drug companies to medicate children who do not need it. Sure, some doctors over-medicate, while other doctors never medicate because they “don’t believe in ADHD” and “don’t believe in Ritalin.”

Above all, children need a loving, safe, and richly connected childhood. The long-term study that Dr. Sroufe cited in his opinion piece does indeed show that over time, medication becomes a less important force in a child’s improvement and that human connections become ever more powerful. It is good and heartening to know that human connection–i.e., love–works wonders over time. Love is our most powerful and under-prescribed “medication.” It’s free and infinite in supply, and doctors most definitely ought to prescribe it more!

But that is not to say, as Dr. Sroufe does, that Ritalin has “gone wrong.” We may go wrong in how we use it, when we over-prescribe it, or when we use it as a substitute for love, guidance, and the human connection.

But as long as we use it properly, it remains one of our most valuable–and tested–medications. Going all the way back to the first use of stimulants to treat what we now call ADHD in 1937, stimulants have served us well as one tool–not the tool–for helping children and adults learn how to strengthen the brakes of their race car brains and become the champions they can be.

Warm regards,


Edward M. Hallowell, M.D.

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ADHD & AGING: or How To Stay Young At Heart Lesson 101

ADHD & Containing Excitement might be more appropriate for a title.  In two weeks I head for the Adirondacks for our 2nd Annual Big Chill Weekend.  An informal gathering of my first two years of college, NCCC and Townie friends, that started last year on Facebook and has been building steam ever since.  FUN and SUN (hopefully) and some of the best people I’ve ever known.

Most of these people are grandparents but when I look at them I see the young hippies that we used to be and hopefully they see the same when they look at me.  Today I look in the mirror and see my Mom, Grandpa Charlie and Aunt Dotty.  I’m not quite sure where I have gone, or at least the Me that I remember.  Living so far away from all of my relatives and friends that I grew up with, there is no one around that see’s the youthful girl I once was.  Sure they see me act youthfully but when they look at me they see me today, the way I see myself when I look in the mirror.  Hey, that’s OK because I like me, but it sure feels good to have someone look at me and know they are seeing Judi the college teenager.

So just exactly how does ADHD and Mindfulness fit into all of this?  Well, I’ve had to work OVERTIME to be able to focus on my work and stay in my moment instead of looking through old pictures (literally or in my mind), emailing old friends or chatting with them on Facebook.  Maintaining Attention and Concentration these days, and I imagine the next two weeks, demands a LOT of meditation and purposeful mindfulness.  My mindful lifestyle is saving my serenity, my diminished anxiety levels and my business, not to mention the quality of attention that I give to my clients!  Once again I have proven to myself that mindfullness matters!

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It has been a very rainy summer here in Vermont.  ADHD like any condition that has an effect on our moods, seems to be affected by sunshine or lack of it.  That's just a personal observation mind you.  The worst part of what is happening right now is that it rains every weekend and is hot and sunny during the week.

As I sit in my office looking out the window trying desperately to concentrate, I've come to the conclusion that all the meds and meditating in the world can't seem to stop me from wanting to go outside and play.  This weather is just not fair.  Hmm, what am I going to do about this?

I've got it!  I will expand my lunch "hour" to 60 minutes from 30 and go for a mindfulness meditation walk at lunchtime.  Now, how to rearrange my schedule and clients, and when will I eat my salad?  Details, just details.  I'll change the times in my appointment book and speak to each of the clients that will be effected.  My first priority is sunshine.  Here is an idea, I will do a mindfulness meditation walk to the park and eat my salad on the swings.  This way I will meditate, play, eat and feel the sun on my face.  This is a glorious way to take care of my need for mindfulness meditation, food and play.  It is also a great way to add balance to life and to help to take charge of ADHD.  Perhaps I should have named this article ADHD & Problem Solving?  always remember, mindfulness matters…  Mindfulness Matters Coaching®


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ADHD & Lost Youth

When you are diagnosed with ADD – ADHD as an adult it means that there were many “un-mindful” years that one had lived with their ADHD running rampant, alas, unknown.  As I sit here watching the snowfall head into 3 feet, fully aware when I am pausing my focus on work to focus on the storm, it struck me that I gave away so much of my youth to distractibility and impulse.  Lost time living in the state of unawareness, un-mindfulness was the norm.

So rarely did I truly pay attention to conversations.  So rarely did I ever stop to truly take in the enormity and joyous feelings that were cfreated during special events, never mind day to day living.  So rarely did I remember whatever it was that I wanted to remember.  Between the ADHD, the usual unawareness of youth and the cultural state of “auto-pilot” it seems that i just floated on cruise control much of the time instead of mindfully choosing, mindfully making decisions based on how I wanted to experience my life day to day.  Certainly I took in what interested me and had lots of fun and adventures along with all that schooling.  Yet looking back it seems that I rarely was purposefully in charge of my mind, my words or my actions.  (Wouldn’t my teachers and parents love to read this!)

No ‘do overs’ allowed!  However, living life fully, mindfully in each moment today, I sure can squeeze in a lot more of life than I ever would have imagined possible.  I can choose what I want to think, feel, say and do in each moment.  Mindfulness puts ME in charge of me, my ADHD and my life.  Outside forces interfere with and often steer the path in unexpected or unwanted directions, but I decide how to proceed with each of those unexpected paths.  Thankfully along with ADHD comes the gift of creativity.  I can use it or give it away to distractibility and disorganization.  I choose to use it.

What are you choosing today, in the next moment?  If today is a ‘snow day’ for you or just a regular ole’ work day, bless yourself with mindful living.  I am going outside in the blizzard and mindfully make snow angels and then come in and play with my Wii.  Always remember, mindfulness matters.

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Recuperating from Carpal Tunnel Surgery I decided to pamper myself and take a few days off.  Sure, I’d heard about the game/App, the #1 game/App in the world of smartphones; but knowing how easy it is for a person with ADD to hyperfocus on games and really needing to get my end of year bookkeeping/tax prep work done I had decided it was safer to stay away from it. I actually did for quite a while.  But THEN, I read about it in the N.Y. Times.  Lets face it, even an ADHD LIfe Skills Coach can’t resist something that the most intelligent newspaper in the country is touting as a ‘must have app’ and the #1 most downloaded app in the world…  (50 million downloads) I gave in.  OUCH!

I started with the free edition to test my ability to balance and structure my time management skills VS my hyperfocus hell.  OK, so far so good. There were only 12 levels so how bad could it be?  Hmmm a ‘Mighty Eagle’.  Nope, I’m not going to buy this game or this Santified Cheat Tool.

Then  I had a death in the family and couldn’t concentrate on anything but crying so I started playing a little more often.  “Angry Birds” to the rescue. Hmmm time to get the egg timer out..  OK, back on track.  Then VT got hit with a big blizzard and I couldn’t even walk down the driveway and across the street to get the mail or the newspaper from my box.  “Angry Birds” to the rescue. Where did that egg timer disappear to?  OK, back on track.

But then I got greedy.  Finished the free levels and for a whopping .99 cents I bought the iphone app with 210 levels.  Let me just say that 6 weeks later and a second day stuck on the same level, out comes the .99 cents to buy the “Mighty Eagle”.  To my credit, I am more susceptible at night to giving in…

And where does the Carpal Tunnel Surgery fit in.  Well, my wrist is so sore that I’ve either reactivated it or given myself tendonitis!  How, you might ask is my wrist so sore when all you do to play this game is move your index finger a smidgen to prime a sling shot and use your middle finger (how appropriate) to touch the screen for more fire power?  Well, people with ADHD have an intensity about us that creates Carpal Tunnel, Tendonitis, TMJ and over competitivenss where others would be creating relaxation.

Today we are again having a HUGE ‘Noreaster, I am taking a break to play and I am remembering to do my breathing exercises while I play, meditate in-between levels and touch that screen so lightly that I have to double check to see if I really did!  Oh, and I am letting that Mighty Eagle soar instead of fighting my way through the impossible levels. Aahh this feels good.  Peace at last.

Hmmm, what’s this golden egg they keep talking about?

Mindfulness CAN overcome hyperfocus and oblivion.  We just need to remember to live it. Yes, I did say “live it” not just ‘practice’ it.  Mindfulness is a lifestyle, a way of existance.  May you live it in peace. Always remember, mindfulness matters…
Mindfulness Matters Coaching

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I've recently been asked which is the best smartphone for a person with ADHD. Considering that it took me 3 years to make that decision and then to actually buy it, I had to smile (OK GRIN) that someone wanted that information from me! Here is what I replied:

First you need to decide which wireless company you want to go with, unless the specific phone you choose is only offered by one particular carrier. Then you want to make a list of everything that you need your phone to do for business, for organization and for fun. My suggestion would be to start by trying out the 3 most popular ones, Blackberry, Android X, and iphone and decide which one is best for your needs. You can go to your local wireless phone company stores and tell them that you want them to teach you about the phone and then they will lead you through it and then leave you alone to let you play with it for awhile. This is what I did. Also, spend some time with your friends phones and read the manuals. Get a feel for each one.

It really depends on your individual needs, your level of tech savvy, your particular computer system and the software that you use daily (remember that you will be syncing and backing up your phone to your computer). Take notes at each store or friends house so that you can remember what you've discovered and decided and list the pros and cons as well as your questions. Good luck with your exploration into a new adventure.

always remember, mindfulness matters

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“ADHD & Laundry; Look Before You Dump”

Doing laundry with ADHD can be very frustrating, and expensive.  For months now my fine silk washables and delicate sweaters have been piling up next to the washing machine waiting for me to take the time to slowly read and follow the directions on the special detergent that the kind woman at the Dry Cleaners gave to me.  I wanted to be sure I had the time and patience to be extra mindful. 

Apparently that time had come, or so I thought.  I'm not sure when but it must have been some time during the past week.  Today I decided to wash my blanket and slippers.  I quickly stuffed them into the washer and ran back upstairs to flee the freezing basement.  An hour later when I threw them into the dryer something caught my eye in the washer.  Sure enough, there were the fine silk washables and my delicate sweaters sitting at the bottom of the machine.  Even though all of my windows are closed I am sure that my neighbors must have heard me scream and then scream again.  So much for careful planning. 

There is a lesson that goes along with this confession.  Either heat the basement, move the washer and dryer upstairs or breathe, meditate and take your meds before attempting to do something that requires extra focus!  always remember, mindfulness matters!

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60 degrees, that is what it is supposed to get up to today.  Believe it or not, that is bathing suit weather in Vermont.  Because I went to an all day conference on "Ethics & Mindfulness" on Friday, I'm a day behind on my work.  So the age old dilemma still prevails, when do I do all the billing, bookkeeping data entry, phone calls and various other paperwork that I normally do on Friday's? 

One of the classes that I took many years ago from the amazing Jennifer Koretsky taught me how to manage the different roles that I have as a solo business owner.  How to prepare for or make up time that is normally delegated for something else was covered, learned and utilized ever since.  

'Yeah Butttt', there is hammering, there is stomach bug, there is…  So much for Saturday.  And now it is Sunday.  The sunshine, a somewhat rare commodity in VT, could blind you it is so bright.  I want to go out and play.

My mother's words will always ring in my ears; "Don't leave your homework until Sunday night".  She said it to me shortly before she passed away; it was one of our 'gags'.  Undiagnosed ADHD = every Sunday night rushing to do my homework so that I could watch Ed Sullivan.  

I did most of my billing on Thursday evening.  During the week I did all but the copying on a file audit that is due and I squeezed in most of the phone calls.  However, all of the mindfulness in the world still can't make 8 hours of work mysteriously disappear.  And now it is Sunday.  The sun is shining.
always remember, mindfulness matters.

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ADHD & Self-Anger

Ever been mad at yourself? Well it is time to laugh about it. Enjoy!

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This morning I was procrastinating, cruising the web trying to come up with an idea of what to write about today.  My ADHD N.E. Coaches Group sent an email and mentioned a blog by Andy Dooley.  He talks about Storytelling as a tool for changing your negative thinking and therefore changing your actions and behaviors.  In psychology this is called Cognitive Restructuring.  I like to think about it as "Positive Brainwashing".  By the way, in the 12-Step Programs they refer to it as "Fake it till you make it" and "act as if".  Whatever you choose to call it, your self-esteem grows from positive affirmations and droops with negative ones.

It is very easy for anyone at any time to get stuck in a rut with what we think, say and do.  For those of us with ADHD the 'rut' can become somewhat obsessive.  "Stick to you guns" is an old expression that sums it up pretty well.  Our choices stem from our thoughts, our beliefs, our emotions.  Words, both spoken and silent are powerful

I truly believe that people with ADHD are very creative and if you think back you will most likely remember many stories that you 'made up' (either true or false) to offer explanations for 'non-acceptable' behaviors or obligations forgotten, or…

Today I challenge all of us to find one negative belief and not only substitute a positive belief for it but make up a story to go along with it.  As an example I will use a negative statement that I hear from clients way too often. "I am too fat and have nothing to wear".  The substitute belief could be, "My body is beautiful and I will find something to wear".  The story could be: 

Once upon a time and still to this day there was and still is a beautiful person named ________.  _______ has a closet and dresser filled with really nice clothes that she looks great in.  Today when _______ got dressed and looked in the mirror he was so pleased that she started grinning and dancing around the bedroom. As _______ was waving her arms around dancing and singing he stopped and looked in the mirror again.  Much to ______'s delight she realized that he felt 'juiced' to head on out and start her day, which was going to be terrific because life is as beautiful as she is.  The end.  mindfulness matters

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