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Medicating Children With ADHD Keeps Them Safer

New research suggests that medication can reduce risky behavior in teenagers with attention deficit hyperactivity disorder, or ADHD

 

By

SUSAN PINKER

Updated Aug. 17, 2016 10:23 a.m. ET

See the column on the Wall Street Journal site

 

If a pill could prevent teenagers from taking dangerous risks, would you consider it for your children?

I’d be tempted. My skateboard- and bicycle-riding son was hit by a car—twice—when he was a teenager. I would have welcomed anything that could have averted those dreadful phone calls from the emergency room.

While some bumps and scares are inevitable for active guys like him, serious misadventures with long-lasting repercussions are often par for the course for a subset of them—those with attention deficit hyperactivity disorder, or ADHD. But a new article suggests that early medication can significantly cut the odds of bad things happening later.

Affecting nearly 9% of all Americans between 4 and 18 years of age, ADHD is one of the most common childhood disorders and also one of the most misunderstood. Its symptoms color almost every aspect of a child’s life—from being able to focus in school to making and keeping friends, reining in fleeting impulses and assessing risk and danger.

Indeed, accidents are the most common cause of death in individuals with ADHD, withone 2015 study of over 710,000 Danish children finding that 10- to 12-year-olds with ADHD were far more likely to be injured than other children their age. Drug treatment made a big difference, however, nearly halving the number of emergency room visits by children with ADHD.

Medicating children to address problems with attention and self-control remains controversial. ADHD isn’t visible, like chickenpox, nor immediately life-threatening, like asthma. Its distortion of a child’s ability to meet adults’ expectations creates an atmosphere of frustration and blame. So it’s not often taken for what it really is: a neurodevelopmental disorder with genetic roots.

An enduring myth about ADHD is that children grow out of it in adolescence. We now know that a 5-year-old with a bona fide attentional disorder may well become a dreamy, restless and impulsive teenager and adult. Adolescents with ADHD think even less about consequences than the average teenager and are especially thrilled by novelty. They’re more likely than their friends to drink too much, drive like maniacs, abuse drugs and have unprotected sex.

It’s a sobering list. But an article published last month by Princeton researchers Anna Chorniyand Leah Kitashima in the journal Labour Economics shows that treating ADHD with medication during childhood can head off later problems. “We have 11 years of data for every child enrolled in South Carolina Medicaid who was diagnosed with ADHD,” Dr. Chorniy told me. The researchers tracked each doctor visit and every prescription, with a sample of over 58,000 children whose health progress they tracked into adulthood.

This long view let the economists compare the behaviors of teens treated with the most common ADHD medications, such as Ritalin, Concerta and Adderall, to the types of risks taken by other children with ADHD who were not treated. The researchers found fewer and less severe injuries and health problems among the treated children: a 3.6% reduction in sexually transmitted infections; 5.8% fewer children who sought screening for sexually transmitted infections (suggesting they had had an unprotected sexual tryst); and 2% fewer teen pregnancies.

That adds up to a lot fewer teenagers in trouble.

The economists did their study based on existing data, but randomized, controlled studies—experiments carefully designed to establish cause-and-effect relationships—have reached the same conclusion: that medication to control ADHD can reduce the high price in psychic pain, loss of educational opportunity and riven relationships. A child whose disorder is diagnosed and treated early by a trained clinician stands a better chance of growing into a healthy and thoughtful adult.

 

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For Better Performance, Give Yourself a Pep Talk

‘Self-talk,’ stories we tell ourselves to change unwanted thoughts, can help us manage our feelings as well as boost our performance—even beyond sports

See the column on the Wall Street Journal site

 

Most of us yearn to bump up our game. Indeed, telling ourselves we’re better than the competition is so central to the American psyche that self-doubt can seem almost unpatriotic. But does egging ourselves on really help us to get better at anything?

Psychologists have long known that “self-talk” or “self-instruction”—that is, the stories we tell ourselves to change unwanted thoughts and behaviors—can also transform moods. As one feature of cognitive-behavioral therapy, self-talk—such as saying, “I am an interesting person who can make new friends” or “I can focus on one task at a time”—helps depressed people to revamp their way of thinking and thus their ability to cope.

Now a massive online study suggests that such talk can help us not only to manage our feelings but also to boost our performance—and relatively quickly, too.

The recent study takes its cue from sports psychology, which shows that self-instruction can push athletes to persist on quick tests of endurance or on highly technical bursts of effort, such as volleyball serves.

British sports psychologist Andy Lane at the University of Wolverhampton led the experiment in conjunction with the BBC Lab, a (now closed) arm of the broadcasting service, which invited volunteers to be citizen scientists. In an interesting twist on attracting research subjects, actor Ricky Gervais and Olympic sprinter Michael Johnson promoted the study on BBC TV before the 2012 London summer Olympics. Nearly 45,000 people participated, an enormous sample for a study in psychology.

The volunteers filled out questionnaires on home computers about their emotions and played a series of online number-finding games, with instructions and feedback narrated by Mr. Johnson. The yearlong study came out in March in the journal Frontiers in Psychology.

After completing practice and baseline tests, participants were randomly assigned to one of four groups: self-talk, imagery (e.g., imagining oneself reacting more quickly), “if-then planning” (e.g., planning a reaction to what might happen while competing) and a control group, which encouraged reflection on performance but didn’t give any instructions or motivational hints. The subjects had to beat their previous performance as well as an “opponent”—actually a computer algorithm matched to their skill level. The scientists wanted to know which of the interventions would help people to manage their emotions when under pressure.

The results showed that simple self-talk—like saying “I want to be the best” or “I’m going to try as hard as possible”—was the most effective technique, especially if the script was about increasing motivation. Self-talk focused on specific goals, such as “I’m going to get a score of 90,” didn’t work as well.

One caveat: There’s a world of difference between effort and skill—as anyone who has ever tried to swim faster or master the violin knows well. Roy Baumeister, a psychology professor at Florida State University, said that a number-finding challenge (like that in Dr. Lane’s study) “is based on effort; there’s not much skill involved. In that context, self-talk can help with effort. I’m not so sure about skill.”

Dr. Baumeister, who has researched how emotion shapes behavior, added that when it comes to skill and effort, “what works with one will not work with the other.” Choking under pressure decreases our ability to show what we can do—it inhibits our skills—whereas pressure usually increases effort, he explained.

Dr. Lane agrees that generalizing his results should be limited to brief tasks that require tremendous exertion—say, weight training or sprinting. “The language you tell yourself in these situations is usually negative, and you get some unpleasant emotions. But you can train your emotions to say, ‘You can endure another five or 10 seconds.’ So instead of being demoralized, you teach yourself to push just a little bit harder and a little bit longer.”

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A Pair of Witnesses Can Be Better Than One

New research questions the assumption that police should interview witnesses to a crime separately

See the column on the Wall Street Journal site

 

If you witness a crime, what’s the best way to recall what happened? Minutes to months later, police might ask you the color of the perp’s eyes, the design of his tattoo or how long it took him to pull out a gun after he entered the room. Would it be better to recount your story on your own or alongside the person you were with at the time?

Anyone who has ever watched a police procedural can answer that question. Witnesses are always interviewed alone, in a dismal, windowless holding cell—that is, if the interview takes place in Hollywood.

But the isolation of witnesses is not just for dramatic effect. Psychologists have long warned police that one witness can contaminate another’s testimony. Social pressures can make someone change his tune, or errors might be introduced into the testimony.

Contagion and the power of suggestion might also create the feeling that events that never even happened actually occurred. That was the case during the 1980s epidemic of “repressed” memory syndrome, which focused on false claims of childhood sexual abuse. In 2013, researchers at the Massachusetts Institute of Technology were even able to plant false memories in lab mice, leaving neurochemical traces indistinguishable from the neural footprints left by real experiences.

Still, even if memory is highly malleable, two new studies show that there are big benefits in bringing witnesses together to collaborate on testimony. The findings could shake up decades of practice in legal circles.

One study, published in the journal Memory this past May, shows that witnesses who are interviewed together do, in fact, influence each other. But they also correct and amplify each other’s accounts of the same event, increasing accuracy in the process. The opportunity to edit each other’s memories allows pairs of witnesses to make fewer errors than witnesses who are questioned on their own.

Led by the Dutch legal psychology professors Annelies Vredeveldt and Peter van Koppen and colleagues at VU University Amsterdam, the researchers asked people who had recently seen a play to describe a violent, emotional scene. Of 53 adults who saw the same play on three separate nights, 36 came to the theater as couples and were interviewed together afterward. They ranged from spouses to one pair that had just met for the first time. The 17 others were interviewed as individuals. The researchers then compared the two groups. Who would produce a more accurate chronicle of a rape-and-murder scene acted onstage the week before?

The people who came together corrected each other’s errors, as we know. But a second, more intriguing finding surfaced, too: The nature of a couple’s communication skills influenced how much detail they remembered. “People who repeated, rephrased or elaborated on what their partner just said remembered more,” Prof. Vredeveldt told me.

It wasn’t how long they had been married or how well the couple knew each other that mattered. It was their skill in creating a joint narrative. If the husband described the crime victim as wearing “some type of dress,” the wife might add “one that opens at the front.” When the man agreed and added that the dress was white, the wife concurred, then specified that it was “a dirty white.” Because the researchers didn’t examine the features of a pair’s relationship, they plan to find out what happens if the couples are strangers or are asked to remember an event in groups.

A second study, published in Legal and Criminological Psychology in June with some of the same authors, used a larger sample and more controlled conditions—and had the same findings: People interviewed together made fewer errors.

Prof. Vredeveldt still believes that people should be interviewed individually. “But instead of sending them home after that, you might generate more leads and fewer errors if you put witnesses together.” Because when couples are bouncing ideas off each other, “the whole is greater than the sum of its parts.”

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