This morning, my colleagues at The Times Magazine published a remarkable cover story by Paul Tough about a surge of A.D.H.D. cases in the United States — and the way we treat them. Today, 23 percent of 17-year-old boys have received a diagnosis of attention deficit hyperactivity disorder. The number of prescriptions rose nearly 60 percent in a decade. You almost certainly know people who take these stimulants.
Why is this happening? One thing I love about Paul’s story is that it’s partly a tale about how science is made and changed. Researchers in the 1930s saw immediate benefits when they treated jumpy kids with amphetamines. Eventually, doctors crafted a diagnosis that could explain distracted and excitable personalities, and a consensus formed about how to treat them. Paul’s story describes how a few scientists have come to challenge that consensus — and some of the fundamental ideas behind A.D.H.D.
For today’s newsletter, I spoke to Paul about his reporting.
What got you interested in this story?
I’ve been writing for decades about education and children, and I now have two boys of my own. A few years ago, I began to notice how many families I met were struggling with their kids’ attention issues. Attention was something I worried about in my own children — and in myself, too. But I didn’t know much about the science behind attention. So I started talking to scientists. When I did, I discovered they had a lot of big unresolved questions.
What is A.D.H.D., and why is it so tricky to define?
There is no biological test for A.D.H.D. So it has to be diagnosed by its symptoms, and those symptoms are sometimes hard to pin down. One patient’s behavior can look quite different from another’s, and certain A.D.H.D. symptoms can also be signs of other things — depression or childhood trauma or autism. Take a child who is constantly distracted by her anxiety. Does she have A.D.H.D., an anxiety disorder or both?
So A.D.H.D. may not be a clear, distinct medical disorder with defined boundaries — something you either have or don’t have?
Increasingly, the science shows that the condition exists on a continuum, and there is no clear dividing line between people who have A.D.H.D. and people who don’t. For many kids, A.D.H.D. symptoms fluctuate over time — worse one year, better the next — and those fluctuations may depend on their external environment as much as their internal wiring.
Traditionally A.D.H.D. is treated with stimulants like Adderall and Ritalin. Now a few researchers are raising questions about them. Why?
Most researchers I spoke with believe that stimulant medications are, on the whole, a positive thing for children with A.D.H.D. But some feel that their benefits have been oversold. One big study found that stimulants were more effective than other interventions only for the first 14 months of treatment. By 36 months, their relative benefit had disappeared. And even when these medications improve children’s behavior in the short term, they don’t seem to boost their learning or academic achievement. As a result, some scientists — and some families — are looking for other approaches.
What other approaches work?
That’s another challenge for the field: At this point, there isn’t much solid evidence for any treatment other than stimulant medication. What I found encouraging, though, was research suggesting that changes in children’s environments — a more stimulating classroom, a calmer home life, or, as they get older, an interesting job — can often have a positive effect on their symptoms. My guess is that a lot of the field is heading in that direction.
It’s tough because parents can’t always pick their kids’ classroom or work fewer hours. Do you think the way we diagnose and treat A.D.H.D. in this country is likely to change?
I hope so! For many families, stimulant medication has been, and will continue to be, a lifesaver. But there are plenty of other children who would benefit from a new and different approach. My hope is that the research I’ve written about will lead to a new way to treat A.D.H.D. and a new way to think about it.
I recommend you read Paul’s story here.
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THE SUNDAY DEBATE
Is free trade free?
Yes. Markets are at their best when they’re allowed to work without central government planning. “I have money, my grocer has food. The grocer doesn’t need to buy anything from me for it to be a mutually-beneficial relationship,” The Orange County Register’s Matt Fleming writes.
No. What we call free trade works well for goods, but for the last five years, the European Union has been able to tax online services at the United States’ expense, only to cry foul at Trump’s tariffs. “If the EU has its way, on net, protectionism will increase,” Bloomberg’s Tyler Cowen writes.
FROM OPINION
The U.S. cannot afford to wait for Trump to take back his tariffs. Congress should act by itself and limit the presidency’s trade powers, the Editorial Board writes.
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Lives Lived: Max Kozloff was a leading art critic who wrote extensively about the New York art scene in the 1960s and ’70s. He later became a well-regarded photographer. He died at 91.
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“Everything is Tuberculosis,” by John Green: It doesn’t have the catchiest title. It covers a subject that might seem long ago and far away, but it’s not. As John Green demonstrates in his heart-tugging best seller, tuberculosis is a modern problem, killing over a million people a year worldwide, more than any other infectious disease. What’s more, Green tells us, in the simple, straightforward language that made him a folk hero to young adult readers — yes, this is the same John Green who brought us “The Fault in Our Stars” — “We know how to live in a world without tuberculosis. But we choose not to live in that world.” His slim, timely book is an examination of the history of this scourge and our maddening failure to eradicate it. (“The problem,” Green writes, is that “the cure is where the disease is not, and the disease is where the cure is not.”) But this is also the story of Henry Reider, a magnetic 17-year-old boy whom Green crossed paths with while on an advocacy mission in Sierra Leone. His fight against tuberculosis forms the spine of this book. His spirit is its soul.
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THE INTERVIEW
This week’s subject for The Interview is Ramy Youssef, whose new animated show, “#1 Happy Family USA,” tells the story of the fictional Hussein family as they try to fit into a changing America after the Sept. 11 attacks. We spoke about the show, Adam Sandler’s influence and how he thinks about politics in his work.
There’s this little title card at the top of every episode that warns that the characters should not be taken as representation. Why are you so uncomfortable with representation?
When we put out “Ramy” on Hulu, I remember seeing a headline that was like, “Muslims, Here’s the Show for You,” and my heart sinking and going, “No, no, we are two billion people, and a lot of them are not gonna like what I’m doing, and they shouldn’t, because I am a guy from New Jersey who thinks this type of thing is funny.” Putting the representation warning was a cathartic thing of being like: “I know you guys didn’t elect me.”
I know from some of my Muslim American friends that because their community has suffered so much scrutiny, they are wary of opening themselves up to the eyes of broader culture. Are you worrying about perception when you’re writing?
I think my way of handling that goes back to the work being self-reflective above all. I’m not satirizing the culture so much as I am looking at the way people behave. The father in our show is a lot of people’s fathers. We open up our pilot with him handing out to his family these small electrical bills that show the output that everyone is spending in the house, how much GameCube is being played. He’s so worried about getting his family through, under budget. The things that hit on the sensitivities that you’re talking about, I try to take a more tender approach toward.
Read more of the interview here.
THE NEW YORK TIMES MAGAZINE
Chances are you probably have a can or two of tuna in your pantry right now. In this week’s Five Weeknight Dishes newsletter, Emily Weinstein suggests using them to make spicy tuna and avocado tostadas, a five-star recipe from Kristina Felix. Emily also recommends some other (non-tuna) dishes, including miso-honey chicken and asparagus, and crispy gnocchi with sausage and broccoli.
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