Judith Warner Q and A: Kids, Medications, Pesticides and ADHD

A nationwide study linking Attention Deficit Hyperactivity Disorder in children and exposure to pesticides from fruits and vegetables has fired up moms in the blogosphere.

"I need to buy more organically. Especially the fruits my kids eat," wrote Tylersmommy at www.momslikeme. "I DO, however, soak ALL produce in water with baking soda, then I rinse it. Started doing this after suggested by MamaP & am so glad that I do."

In the study, researchers who measured the level of pesticide byproducts in the urine of 1,139 children found that those with above-average levels "had roughly twice the odds of getting a diagnosis of ADHD," according to the study, which appears in the journal, Pediatrics.

My reaction to the news was Hallelujah . . . a ray of hope for families afflicted with the mysterious disorder.

My second thought: What would Judith Warner think? Warner, an influential writer and voice in the field of modern parenting, is perhaps best known for her "Domestic Disturbances" column for the New York Times. She is also the author of "Perfect Madness: Motherhood in the Age of Anxiety," and, more recently, "We've Got Issues: Children and Parents in the Age of Medication."

In "We've Got Issues," Warner exposes what she calls the myth of the overmedicated child (Ritalin, Prozac). Kids today, in general, are not being force-fed pills by overanxious, over-involved parents, Warner writes. In fact, the case is often the opposite -- kids with real emotional and mental problems not getting the quality help they need.

After news broke of the pesticide-ADHD findings, I e-mailed Warner at her home in Washington, D.C., where she lives with her husband and children. Her response came moments later:

"I think the pesticides story could be good news, if it led to the discontinuation of these pesticides, but for parents of children with ADHD, it's likely just to lead to guilt (if only they'd bought organic!) and who knows if the guilt will turn out to be justified, long-term, as clearly these results will have to be validated by other studies. ADHD is very highly heritable, so this is clearly just one element in a complicated picture. And, of course, it's only the best-off parents who will be able to afford the organic produce so, as always in our country, everyone else will just have to muddle through . . .

"So I guess I have no comment . . . only questions. Clearly, we all should buy organic produce."

Warner did not win her reputation as a fierce intellect for no reason.

That fact was further verified during a phone interview I conducted with Warner earlier this month on the topic of her book, "We've Got Issues: Children and Parents in the Age of Medication":

PD: What message do you want to give readers in this book?
JW: I want to send the message that the way we've been talking about mental health issues in children in America over the past decade -- the story line that kids are being grossly over-diagnosed and overmedicated and that lazy, competitive parents are basically acquiescing and pathologizing and drugging their kids in order to give them a competitive edge or in order to save themselves the time and trouble of real parenting -- is false. And that this story line, which so many of us believe in -- which I used to believe in and which was supposed to be the narrative driving this book -- is not only false, but also it's really prejudicial, really hurtful, not only because it's insulting to these kids and parents, but because when parents internalize it, it actually keeps kids who need mental health care from getting it because parents don't want to fit that stereotype and question themselves and their own instincts about whether something is going wrong with their kids. So it's really harmful to both children and parents.

PD: We applaud adults who face up to their mental health issues. Why don't we want to acknowledge the same issues in children?

JW: I think there's still a resistance to believing that kids can have serious mental health issues. On the one hand, we know it's true, and we have horrible stories about some kids who are, say, violent. We believed for a long time that the Columbine High School shooters were either mentally ill, or their anti-depressants had driven them to do what they did.On the other hand, we're really kind of doubtful when people say a child has an anxiety disorder or is depressed. The first reaction so very often is to say, "That's an exaggeration -- all kids are anxious sometimes, or all kids are down sometimes"... And I think that a lot of that stems from the feeling that these kids weren't around a generation or two ago, that the idea that kids have mental health disorders is something new and fabricated or that it's just symptomatic of the times we live in.

PD: Did autism and ADHD exist in our great-grandparents' day?

JW: They must always have because we see the results in adults, right? We have parents or grandparents who suffer from depression or anxiety disorders or whatever. It's harder to say with autism because they would have been diagnosed with something else and they would have been known to their families as having something else. Today's adults, certainly, if you look at our generation, we can see a full range of mental health disorders, and when people are surveyed, at least 60 to 80 percent remembered their symptoms started when they were children -- so we know that retrospectively, but at the time we were growing up, we didn't hear about kids who were diagnosed, partly because until relatively recently, it wasn't believed that certain disorders could exist in children, like depression, or because the definition of disorders were so much more narrow than it is today. When we talk about autism spectrum disorders... a much smaller number of children would have had a label like that that then. Even something like ADHD. We have descriptions of hyperactivity in children going back to the 18^th century. Through the late 60s and 70s, you just talked about the problem of hyperactivity, and it was a relatively small number of kids. But you didn't have this wider understanding of the disorder and all the kinds of cognitive disorders or social deficits . . . all that wasn't labeled before. So these kids 'didn't exist.' They didn't exist under any kind of diagnostic umbrella.

PD: You say in your book that in the past, "We didn't have eyes" to see emotional and mental disorders in children. What do you mean?

JW: That is really such an important part of this. We don't have hard, fast data to indicate to us whether or not the number of children with various disorders is different. What we do know is more children are diagnosed than ever before. We know that these diagnostic categories have changed. And we know the stigma about mental health has lessened and that people are generally more willing to look at acknowledge what is going on in children.

PD: How were such children treated in the past?

JW:The ones who were severely affected were institutionalized. You had kids in the 1960s and even to an extent into the 1980s who were sent away to mental institutions for long periods of time. In 60s, they were sent away for years, and in the 80s, they still were sent away for matter of months, but then you also had changes in insurance policies. Insurance companies were not willing to pay for long stays anymore. Also, you had changes in way the profession operated. Psychiatrists no longer believed that the best way to treat a child was to perform a parentectomy -- to remove a parent from a child's life for a long period. So all of those things happened at the same time you had more and better medications, and it meant that kids with serious mental problems became more visible because they were at home. Their use of medication became more visible because it was happening at home, in their communities, and not in a mental hospital.

PD: Talk about the time in our history when bad parenting was considered the cause of problems in children.

JW: This was just the received wisdom. It's what everyone believed, psychiatric professionals also, through the whole period of Freudian ascendancy in the United States, which was basically the 1930s through the 1970s and early 80s. Most people still have that reflex. In casual conversation, when the subject of a child's problem comes up, almost always the first thing they think is 'Well, of course he's like that because his mother is x, y or z.' I think in many ways, that is still the default setting. But within the psychiatric profession there came to be more interest in genetics and in the biological processes behind different disorders. It's an oversimplification to say, as some people do, that we live in the age of just "blaming the brain," and that environmental causes and parenting have just dropped out of the equation. That really isn't true. You have this paradigm now that genetics load the gun, environment pulls the trigger -- that there is this interplay between what a child comes into the world with and the environment, and to really understand what's going on with the child, you really have to look at the whole picture.

JW: That statistic was thrown around for years and years . . . and it turned out to be without merit. It stemmed from a study done by one researcher in Virginia whose methods were later highly criticized . . . when the state of Virginia tried to replicate this research, it was never able to replicate those numbers. (Virginia researchers) came up with some other numbers that weren't good -- in some areas, as many as 10 or 11 percent of boys were taking stimulants. On the other hand, in other areas, 1 percent of boys were taking stimulants. Later, that 20 percent figure that was so eye-catching and was repeated so often in the media and even ended up in congressional testimony -- it just wasn't found to be valid.

PD: Are children from affluent families more prone to depression and emotional disorders?

JW: There are some psychologists who believe they are, who write about about "affluenza" as a specific problem of the wealthy. There is an interesting book, "The Price of Privilege," that talks about this. I think that it's a theory that many would agree with up to a point, but what others would say is that these are the children who are most likely to be diagnosed and these are the communities where the parents have the resources and wherewithal and money to seek psychiatric care... Money is just such a key part of it. And also, the parenting style which makes them very attuned to and worried about what's going on with their kids. So, I think there may be particularly toxic elements of affluent communities, but in addition you certainly have a money factor playing a role in who gets diagnosed and who gets service.

PD: In your book you talk about "assortative mating." What is it and what does it have to do with mental disorders?

JW: It's a concept that always fascinates people . . . it's the theory that when you have like-minded people mating with each other, coming together and having children, their children are getting a kind of double genetic load. In recent decades, as people have started for the first time ever to meet at work and marry marry people whose minds are very much like theirs . . . there is a possibility that you're getting a greater dose of genes that leads to certain disorders like autism. It's just a theory, but it's of great interest to the leading autism researcher in Great Britain.

JW: The good news is that for many children, they work really well. Stimulants work for 70 to 80 percent of children, anti-depressants for 60 to 80 percent. That said, they're not a panacea. They very often have side effects. There are children for whom they don't work at all, and there really is a problem with children who too frequently are being given medications without being given therapy and proper followup and proper monitoring, without their lives in a more universal way being taken into account, their life stories, hearing what's really going on with them. Unfortunately, the kinds of thorough evaluations children ought to have done are not done as often they should be because they're incredibly expensive. And depending on where you live, you may not have access to the kind of specialist you need.