ADHD is on the rise.
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.
6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. – New York Times
There are arguments that our lifestyles and increased use of devices are the cause of this dramatic rise in ADHD. Others believe that the rising diagnosis rates is evidence that the disorder is being better recognized and accepted.
The third group that believe the increased prevalence of ADHD is more likely the result of an over-diagnosis of an ambiguous condition that is not fully understood. This third perspective also suggests something far sinister – that millions of children may be taking a psychostimulant medication to calm what is actually “normal” behavior and to help them do better in school. And that wouldn’t be a problem except for the fact that these drugs have side effects. They cause addiction, anxiety and occasionally psychosis. There is no denying that these drugs can drastically improve the lives of individuals with ADHD, but these are some pretty serious side effects to be bearing if your child is taking the drug when he does NOT have ADHD.
According to the New York Times, “two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall”. That’s two thirds of 6.4 million children in the US alone, taking a drug that can cause addiction, anxiety and occasionally psychosis when it is questionable how many of them really need it.
Over-diagnosis of ADHD
Now that information is so readily accessible via the Internet and any Tom, Dick or Harry can be a resident expert on a subject, the average parent today knows a lot more than the average parent in our parents’ day. While our parents went to the real professionals to find out what was wrong with their children, parents today often seek the advice of their “more knowledgeable” peers and parents’ community. Even if they sought professional advice, parents today know they are not required to accept that advice. Some may challenge, and others seek second opinions. And I’m not knocking that – it is a good thing. However, access to all this knowledge, also makes parents today more susceptible to Medical Students’ Disease – except that we should call it “Parents’ Referred Child Disease” or something like that.
Just in case you aren’t familiar, “Medical students’ disease” or “nosophobia” (the fear of disease) refers to the phenomenon in which medical students notice something innocuous about their health and then attach to it exaggerated significance. It often corresponds to a disease they have recently learned about in lectures or encountered on the wards.
It’s not just the parents. Schools and educators are making the diagnosis and insisting that parents take their “troubled” children to see specialists.
“There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood,” said Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of “How Doctors Think.” – New York Times
A.D.H.D. has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood. – New York Times
According to the CDC, these checklists help parents identify ADHD:
Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
- Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Often has trouble keeping attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (loses focus, gets sidetracked).
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
- Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- Is often easily distracted.
- Is often forgetful in daily activities.
Hyperactivity / Impulsivity
Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
- Often fidgets with hands or feet or squirms in seat when sitting still is expected.
- Often gets up from seat when remaining in seat is expected.
- Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble playing or doing leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor”.
- Often talks excessively.
- Often blurts out answers before questions have been finished.
- Often has trouble waiting one’s turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
Depending on how you interpret these questions, I could easily identify both my sons as having ADHD. They have certainly displayed 6 of more of these symptoms over a six month period. What would you consider inappropriate for developmental level?
when Tzippora entered preschool, she did not listen to the teacher or sit in a circle. “I had never in my life thought that a three-year-old could get sent to the principal’s office,” recalls her mother, Sara Gold of New York City, a graphic designer. “But she was. I pulled her out in the middle of the year because they couldn’t handle her. And this was supposed to be a top-of-the-line preschool.”
While this is just a snapshot of Tzippora and not a full account of the extent of her “ADHD” condition, based on this description alone, I would have to say that G1 was exactly like that. When G1 entered preschool at 3 years, he did not listen to the teacher, he did not sit in a circle, and I had many conversations with the principal regarding G1’s behaviour in school. I never once thought he was a child with ADHD, and certainly, judging from his behaviour at school now, I dare say he is not, but I could easily see how he might have been misdiagnosed in those early years. I won’t even get into G2’s behaviour because if his brother could be misdiagnosed with ADHD, he most certainly would be.
Even if the diagnosis of ADHD is correct, shouldn’t drug treatment be the last line of defense? Especially given that the drug that is intended to be given to children has such serious side effects and that there has been research indicating that some children do “grow out” of ADHD (albeit, not all). With the stakes being so high, I think we owe it to our children to find other, non-pharmacological methods to manage ADHD.
There is an article in Scientific American examining whether it is possible to prevent ADHD and to reduce reliance on medications. A group of psychologists from Queens College are exploring whether addressing the signs of ADHD early—before the disorder has even been diagnosed—can help to change children’s brains so that they never get ADHD or, if they do, are less seriously afflicted. Their treatment is a five-week series of games designed to strengthen focus, planning ability, memory and impulse control – now doesn’t that sound an awful lot like brain training? The games they use are variations of Simon says, I spy, Jenga and freeze dance. Parents and children are instructed to play the games frequently – almost daily. Although the trials are small, the results are impressive.
Personally, I am much more in favour of this non-pharmacological approach for managing ADHD because even if a child is mis-diagnosed as having ADHD, he would still benefit from playing such games that will only serve to further strengthen focus, planning ability, memory and impulse control – what child, ADHD or no, wouldn’t benefit from that kind of improvement?
Activities that help children with ADHD:
- activities that develop working memory
- games that encourage delayed gratification, such as using a timer so children know how long they must wait, and then increasing the waiting time (activities that develop self-control also help with delaying gratification)
- games that develop attention – such as those puzzles where you have to find the hidden object in the background
- meditation, relaxation, and sensory awareness exercises
In fact, these are all games that any child can benefit from. Before we start dispensing the medications – which are really only a band-aid solution – don’t we owe it to our children to see if we can help them using non-pharmacological methods first?