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Personal Accounts: The Psychiatrist-Mom: Added Stigmatization When Children Have ADHD
Liza H. Gold, M.D.
Psychiatric Services 2010; doi: 10.1176/appi.ps.61.12.1181
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Dr. Gold is a clinical professor of psychiatry with the Department of Psychiatry, Georgetown University School of Medicine. Send correspondence to Dr. Gold, 2501 N. Glebe Rd., Suite 204, Arlington, VA 22207 (e-mail: lhgoldmd@gmail.com). The author's husband and children read the final draft and consented to the submission of this column for publication. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.

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Sounds of our household: "Stop jumping!" "Slow down!" "Stop making noise!" "Stop interrupting." "Focus, please." "What did I just tell you?" "What just broke?" "Why is this assignment marked 'incomplete?'" "You haven't finished your homework yet?" "Where is your homework?"

I read with great interest a study published in Psychiatric Services titled "Stigmatizing Experiences of Parents of Children With a New Diagnosis of ADHD" (August 2010 issue, pages 811—816). As a psychiatrist and the mother of two children with attention-deficit hyperactivity disorder (ADHD), I was not surprised by the study's results. In addition to some of the parents' experiences discussed, I have experienced stigma associated with being a mother who is also a psychiatrist as a result of common and widespread stereotypes regarding psychiatrists.

From the time our first child could stand, he did not sit. Ever. From the time he could walk, he would not stay in a stroller. Ever. I stopped going to malls with him because the only way I could keep track of him was to keep him on a tether, a socially awkward parenting intervention. Our son was kicked out of his first preschool because of his hyperactivity. He could not sit still during what we referred to as "dreaded circle time." By kindergarten, he was having peer problems. His impulsivity, hyperactivity, and constant talking caused other kids to avoid him and taunt him, sometimes cruelly.

Our son received a formal diagnosis of ADHD that year, at age five, and we started him on medications. My husband and I both remember our amazement the first time our son sat through a meal. The medications have not resolved all his behavioral problems, but they have helped him tremendously, both academically and socially. My son's teachers have been consistently grateful for our willingness to use medication, especially when they are exposed to the alternative.

But family and many friends were judgmental: How could we start a five-year-old on medication, especially one as smart as our son, who had taught himself to read before age four? They seemed to assume that he was different because he was so smart. Anyway, the logic went, a lot of boys are a handful at that age, and that's not a reason to put a five-year-old on medication. They concluded that the problem was that I was a psychiatrist. Clearly, I was pathologizing a boy who was just being a boy. How else would you expect a mom who is a psychiatrist to handle a rambunctious, precocious five-year-old besides putting him on medication?

Others reacted by repeating the cliché, "All psychiatrists' children are crazy." This comment was particularly painful. Apparently, my choice of profession had doomed my child. Again, I felt stigmatized, given that the cliché is a corollary of the axiom, "All psychiatrists are crazy." Offered sometimes as an offhand remark and sometimes as a sarcastic jibe, this comment implied that if I hadn't become a psychiatrist, maybe my son would not be having problems. It also implied that if he was having problems, a nonpsychiatrist mom (that is, a "good" mom) would not be so quick to put him on "those medications."

The obvious positive differences that the medication made in my son's behavior and ability to learn did not always lessen the judgmental stigma I felt directed at me for medicating our child, even from people who saw the differences that medication had made. Had I tried behavioral interventions, such as a system of consequences and rewards? Had I tried dietary changes or supplements? Had I considered that his problems might be due to allergies? Sometimes these queries were well intentioned, sometimes not so much. Almost always they carried the implication that being a pill-pushing psychiatrist, I needed to have these alternatives pointed out to me because I obviously would not consider any treatment other than medication.

At age ten, our daughter was diagnosed as having ADHD. She is not hyperactive, loud, or intrusive like her brother, and so, by comparison, did not attract attention the way he did. Over the years, teachers suggested she had some learning problems, because her grades, although not bad, did not seem to reflect her level of intelligence and understanding of the material. The teachers could not be specific about what the problem was, and we thought she was not as interested in the material as she needed to be to earn better grades. My daughter had more insight than her teachers or her parents. When I would talk about how distractible her brother was, she would often interject, "I'm distractible too." And I would say, "No, you're not." Compared with her brother, she seemed okay to me. Everyone is entitled to some denial.

As our daughter got older, she started complaining about subjective problems with studying and paying attention in class. We had her tested to put this bothersome, recurrent issue to rest. The psychologist told me our daughter's results were consistent with ADHD. "No way," I said, still leading with denial. I suggested that the psychologist was overpathologizing. She suggested retesting on medication. Sure enough, retesting demonstrated impressive and statistically significant improvement when my daughter was taking a stimulant. We started her on medication. Just like our son, from the beginning the medication made a marked difference in her ability to function academically.

But if support and understanding regarding our son's use of medication had not been overly forthcoming, the comments about my "jumping to medications" with my daughter were even worse. So she had trouble following instructions, completing assignments, keeping track of her homework, and staying organized—but so what, people said. Lots of kids are like that. She would outgrow it. No need to medicate that.

Because our daughter's ADHD was primarily the inattentive type, her deficits were subtler, and family, friends, and even teachers questioned our decision to use medications. Our daughter reported positive effects from the medication, and her academic functioning improved. Nevertheless, many people let me know that they thought I had "gone too far" when they learned that I was allowing my second child to take medication. The message was all too clear: you are medicating your daughter because you are a psychiatrist, not because you have made a considered decision about how best to help her.

I have had to accept the fact that both of our children have ADHD and associated learning disabilities, despite, thank goodness, being intellectually gifted. This is all the more difficult because many people, including family, friends, and educators, do not accept this. They see the gifts but can't integrate the concept that intelligent kids may have learning disabilities. Kids like ours actually are now referred to as "twice exceptional," or "2e," and some public school systems have special education programs that accommodate this "category" of kids who need accommodations. Unfortunately, our school system does not, and our fights to get appropriate and effective accommodations have been overwhelming and exhausting and have not infrequently left me in tears. Parents of kids with similar problems report similar experiences, both with schools and with lack of support from family and friends. Many of us stop talking about it, because people simply don't get it.

I was shocked some years ago, when a prominent television commentator, who had been a psychiatrist earlier in his career (and so should have known better), said that ADHD was a diagnosis pushed and overutilized by parents so that they could get educational advantages to improve their kids' SAT scores. Is it true that ADHD is overdiagnosed and many kids who don't need to be on stimulants are prescribed medication unnecessarily? I am not weighing in on that debate. Do psychiatrists sometimes overprescribe medications, regardless of diagnosis, neglecting to consider alternative treatments? I am not weighing in on that one, either.

Like the former-psychiatrist television commentator, some people still deny the existence of ADHD and its associated learning disabilities and blame children and their parents for behavior neither can control. Family, friends, and educators have been variously accepting, understanding, empathic, helpful, obstructive, dismissive, and—unbelievably—at times sabotaging and malicious. But as a psychiatrist-mom, I have experienced the added stigma associated with stereotypes of psychiatrists. I have been accused, directly and indirectly, of overpathologizing our kids' "normal," developmentally appropriate behavior, which they would surely outgrow; of letting my professional bias "to use medication to solve every problem" outweigh my children's best interests; and of being unwilling to consider alternative treatments (even though we also use these) because it goes against my assumed belief in the "gods of psychopharmacology."

Despite my cultural (and perhaps genetic) vulnerability to feel guilty for just about everything, I totally reject the psychiatrist-mom stigmatization. I do not medicate our children because I have a vested interest in overpathologizing normal behavior. I do not believe medication is the answer to every problem. I am a mom who has two kids with ADHD. The diagnosis of ADHD is not a fictitious invention; it is an identification of certain types of learning disabilities. Children with ADHD benefit from multiple therapeutic interventions, including medication. My kids need all the help they can get, including medications, to overcome their ADHD and related learning disabilities so that they can take advantage of and capitalize on their strengths. Helping them do this is my responsibility as a parent.

In fact, I am happy that because I am a psychiatrist, I can distinguish a reasonable medication suggestion from an unreasonable suggestion. I know what side effects to look for and can catch them when they arise. I know which adjunctive pharmacologic and nonpharmacologic therapies have the highest success rates, and I pursue them. I know which educational interventions are most effective, and I insist that the schools implement them.

I applaud any and all efforts to eradicate stigmatization of families in which a child has a diagnosis of ADHD. Stigmatization of any psychiatric disorder does nothing but create barriers to obtaining any kind of appropriate and helpful treatment. However, as a psychiatrist, I have found myself vulnerable to additional stigmatization in regard to my children's ADHD because of negative stereotypes about my profession. Regardless of professional background, we parents whose children have ADHD need all the help and support we can get to assist our children in reaching their potential.




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