Sunday, February 6, 2011

ADD/ADHD: Why Are We Drugging Our Kids? A Cause for Concern

Anybody that has at all been involved with children or education in the recent ten years will have heard the psychiatric labels ADD and ADHD. ADD/ADHD has become one of the most common labels applied to children and adolescents in the schooling years, a modern plague amongst the youngsters of our age. This was a label that was virtually unheard of during my schooling years and is a recent developmental concern of our times.

ADD and ADHD stand respectively for Attention Deficit Disorder and Attention Deficit Hyperactive Disorder, two very similar disorders that are distinguished mainly by the degree of hyperactivity shown by the child. They are currently the most commonly diagnosed behavioral disorders of childhood in the US, estimated to affect 3 to 5 percent of school-age children. And it would seem that European statistics are following close behind. The main symptoms in relationship to ADD/ADHD are inability to pay attention, difficulty in concentrating, hyperactive behavior, excessive impulsiveness. Translating this in the terms any mother would understand: the child struggles to listen, will not sit still, fidgets, gets out its seat at school, shouts out inappropriately, is constantly running, jumping, wriggling and generally seems to have too much nervous energy. Children with this kind of symptoms can require a lot of patience, no matter how much we love them. When I was a teacher, I taught many children with ADD/ADHD. Sometimes I had to breathe very deeply before entering into class and it took every ounce of patience that I had to navigate through the day.

There is no denying that such symptoms exist and that indeed something is going on.
But throughout my teaching years, I asked myself the question: why these kids and why now? Why is this phenomenon happening now? It was not so prevalent when I was in school, in fact I had never heard of such a thing. Then, as the years passed, some children were given Ritalin. I was not comfortable with idea of young children being regularly given a psychiatric drug. I could share more about my teaching experience, but for the purposes of this article, I would rather share with you instead about some interesting facts about ADD/ADHD that I found whilst preparing a research paper for my MA in Psychology.

The definition and diagnosis of ADD/ADHD

All psychiatric disorders are described in a book called the DSM manual, The Diagnostic and Statistical Manual of Mental Disorders. This is a book issued by the American Psychiatric Association, the main authority in the US for psychiatry. It is a book that describes all psychiatric disorders and all the criteria that indicate that somebody has such a disorder. When a psychiatrist or psychologist in the US tells you that your child suffers from ADD/ADHD, they are usually referring to the list of symptoms described in this manual. So let’s look at this list of symptoms.

To be diagnosed with ADD your child must display at least six of the following behavior for at least six months
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
  • Often has difficulty sustaining attention in 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
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities
  • Often blurts out answers before questions have been completed
  • Often has difficulty awaiting turn
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

The child also must have suffered from some of these symptoms from before seven years of age and the symptoms must have been present in more than one environment - that is in at least two places, such as school and home. Just being inattentive at school for example would not be enough to apply the diagnosis.

For the child to be diagnosed with ADHD, the hyperactive slant of the disorder, you must add Hyperactivity symptoms to the list. That means that the child must also show at least six of the following symptoms for at least six months
  • Often fidgets with hands or feet or squirms in seat
  • Often leaves seat in classroom or in other situations in which remaining seated is expected
  • Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
  • Often has difficulty playing or engaging in leisure activities quietly
  • Is often "on the go" or often acts as if "driven by a motor"
  • Often talks excessively
These symptoms are, to my best knowledge, what is being looked for when deciding if the child suffers from ADD/ADHD. Now, if you notice, there is no mention anywhere in the symptoms list of any kind of measurement or test of brain function or activity. It would seem that the diagnosis is applied by purely observing behavior. It is not necessary, for example, to have the child's brain chemistry tested or to have an ECG in order to apply the ADD/ADHD label. So what is the problem with that, you might say. The problem is that these behavior symptoms could be caused by a variety of factors that might have nothing to do with a brain chemistry imbalance or a psychiatric disorder. These symptoms might have roots in other causes such as allergies, poor nutrition, excessive exposure to electricity, computers, video games, pure and simple boredom, problems at home, symptoms of psychological and physical abuse going on in our outside of the family, bullying and more. Or the child might be very gifted and might have no outlet for its creative energy; or the child might have learning difficulties, and might not understanding much of what is being said by parents or teachers. And then there will certainly be a percentage of kids that really do have a chemical imbalance, a malfunction of sorts. But I suspect that these are in fact a minority. Malfunctions of this kind by the way, used to be diagnosed, very rarely, before the modern label of ADD/ADHD was created. Labels such as Minimum Brain Dysfunction, Restlessness Syndrome and Morbid Defects in Moral Control were some of the old names for these kinds of disorders. They have always existed, but were quite rare.

I am sure that many good psychiatrists and psychologists will be taking all of these aspects and factors into account when making the diagnosis of ADD/ADHD. And I am sure that some will be testing kids to find out the true cause of the symptoms. However there is growing concern with many parents and educators that the diagnosis of ADD/ADHD is being applied too easily. A popular blanket label to apply to any child with attention problems of any kind, independently of the causes behind the symptoms. And the concern grows even larger when we start to examine the most commonly applied cure for such disorders: psychoactive drugs.

The drug solution

Psychoactive drugs are the most commonly prescribed treatments for ADD/ADHD. The most commonly prescribed are psycho-stimulants such as Ritalin and amphetamine-like substances such as Dexedrine®, Dextrostat®, and Adderall®. Children that show poor response to psycho-stimulants are sometimes also prescribed with anti-depressant. Short-term studies would seem to have established the safety and efficacy of stimulants for alleviating the symptoms of ADHD. However I am personally not convinced.

All the drugs mentioned above belong to the amphetamine family, the same family of drugs that used to be nicknamed "Mama's little helpers" in the sixties (some of us might remember stories of housewives addicted to "uppers" during those times). The most common street version of the amphetamine family is known as "speed". Of course the drugs that are given to the children and the doses in which these drugs are being prescribed are not as harmful as street amphetamines (or at least one hopes so). But the fact that in some schools adolescents are selling their meds to other youngsters that snort them, should give us an indication that maybe these medications and street amphetamines are not so far apart as some might think.

It can seem strange that kids with hyperactivity symptoms are being prescribed stimulants. It would seem like a contradiction. A stimulating drug that makes a hyperactive child calm down. One would think it would have the opposite effect! Critics of the drug solution argue that it is not quite clear how these medications works. What has been known since the late 1930's is that if you give a child who has not yet entered puberty a stimulant, it has an opposite effect to the effect it would have on an adult. Instead of "speeding" the child up, it apparently overwhelms the child's central nervous system and cuts the child's motor responses. The child goes into a state of stupor. It is this “stupor” that would be interpreted as an improvement on the hyperactive/inattentive symptoms. But is this real improvement? The critics of Ritalin, for example, observe that no study has ever shown an increase in a child's ability to learn while on Ritalin. However studies have shown that any amount in excess of .5 milligrams per kilogram of body weight is a detriment to learning. The higher the dose, the greater the impairment of the child's ability to gain, retain and use data. Almost all children on the drug are given doses far in excess of this amount.

Is it morally acceptable to prescribe drugs that have the effect of taming a child through the crashing of their nervous system? Short-term studies have been carried out pertaining to the use of psycho-stimulants, but have sufficient studies been carried out regarding the daily and long-term use of these drugs? If the effects of street amphetamines are anything to go by, there are severe long term effects caused by long term use of amphetamine-like substances: liver and kidney damage, heart failure, amphetamine induced psychosis are the most well known consequences of prolonged amphetamine street use. Some of these incidences such as heart problems and an increase in psychiatric hospitalization in children have already been observed. Other controversial issues could be possibly associated to withdrawal symptoms when stopping the medication.

In closing…

The point I am intending to make with this brief article is, in a nutshell, the following: the drug solution to ADD/ADHD might not be as safe as it sounds and sometimes might not even be appropriate. If your child is displaying the symptoms of ADD/ADHD you might want to consider ruling out all possible causes of these symptoms before deciding that the child is actually suffering from a psychiatric disorder. Demand a deep, thorough and convincing investigation. Consider possible food allergies. Observe how much time the child is spending playing with electronic devices, such as computers, electronic games etc (boys beet girls in the ADD/ADHD statistics 3 to 1, there must be a reason why). Consider all possible options when helping your child to become a stable and integrated being.

As mentioned here in the Children of the New Earth, our children are changing. The educational methods that used to work for us, might not work for them. Sitting still in a chair listening to an adult talk might not be the way these kids learn. In my experience as a teacher I found that when switching to right brain teaching methods ( such as singing, dancing, games, guided imagery, etc.) the children improved. It took some rethinking. Teaching mathematics through dance competitions was quite an interesting challenge, but eventually I had a good working classroom. I urge you to not give up on your kids, try new things, explore all options. ADD/ADHD might not be so hard to conquer after all and it might prove to be quite fun too.

©2004 Katie Gallanti. All rights reserved. This article was first published in Children of the New Earth Magazine in January 2004. The article was also translated and republished in Latvia, on a specialized parenting magazine.


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