Continuing the topic of Judith Miller’s, We’ve Got Issues, Alison Gopnick writes in Slate:

Sometimes, at least, Warner seems to think that her epiphany licenses the conclusion that we should indeed be giving children drugs for this range of psychological problems (though she’s fuzzy about this). But nowhere in the book does she explain or evaluate the scientific evidence that could actually help answer this question. In fact, there are far more references to newspapers than to scientific journals, and she consistently treats an anecdote or an interview as if it has the same weight as a meta-analysis or a randomized clinical trial.

But everything about human beings, cultural or individual, innate or learned, is in our brains. Loss and humiliation change our serotonin levels, education transforms our brain connections, social support affects our cortisol. Neurological and psychological and social processes are inextricable. The work of psychological science is to identify causes at many levels of description—social, cultural, individual, and neurological.

Syndromes like autism, ADHD, or dyslexia are like “fever” or “dropsy,” rather than like malaria or polio. They are names for somewhat incoherent collections of symptoms rather than clearly identified causes.

The trouble is that these therapies take time and attention and funding, and they are actually discouraged by the American health care system: It is almost always easier to get reimbursed for drug treatments than for behavioral ones.

Some comments from readers:

Robyn: Did the reviewer read the same book I did? It sure doesn’t seem so. In any event, at least Ms. Warner supplied references (pages upon pages of them) of her extensive research (including the MTA study to which the reviewer refers, though more thoroughly and in much greater detail). Where are the reviewer’s references?

Gopnick replies: The MTA study had extremely careful and rigorous diagnostic criteria for ADHD and a carefully designed 14-month long drug intervention including placebo-controlled initial trials, as well as carefully designed behavioral interventions. The results are complicated but the bottom line is that 1) all groups improved over time 2) in the short term medication and combined medication and behavior therapy were better at dealing with direct ADHD symptoms such as teacher reported inattentiveness than therapy alone. However, therapy and medication were about equally effective in improving social adjustment and school achievement. 3) The effects were different in different subgroups of children. 4) In the long term, 3 to 8 years, there [were no differences in?] effect of different treatments. 5) This was true even when the degree of continued drug use was taken into account. 6) The best predictor of long term outcomes was the social support and income of parents and the severity of the initial symptoms. 7) Many of the study authors, though certainly not all, had received funding or otherwise worked with the pharmaceutical companies.

So my take as a scientist is that the very best study of the clearest case with the most rigorous diagnoses at this stage has equivocal results at best for long term efficacy of drugs, as compared to other non-chemical intervention or policies.