There seems to be an onslaught of attention regarding ADHD lately, due to the recent reports of psychopharmaceutical overuse within the foster care system, mixed with the shortage of generic Adderall. I thought it was a good time to blog about ADHD, and recalled an article I read on the Huffington Post by Dr. Lawrence Diller regarding children, ADHD diagnoses, and prescription medications. Dr. Diller had been berated for his middle of the road stance, neither advocating meds nor discouraging them.
In general, everyone seems to have an opinion about what causes ADHD. And for every opinion on the cause, there are ten more on the "solution". The truth of the matter is there is seldom a blanket answer or quick fix in mental health. There are mitigating factors to consider such as family history, home and school environment, and past trauma or abuse. If you combine these complex factors with the daily social demands placed upon us all (adults and kids), an ADHD diagnosis can be confusing and riddled with questions.
There are several strong points made by Dr. Diller, who has eloquently coined the term, “Adderall Wars” to describe our nation’s unique dependency on this drug. These are a selection of Dr. Diller’s arguments regarding the roots of ADHD. I chose to list these in particular because I believe they are, outside of the neurobiological reasons, the most impacting and contributing factors of ADHD.
His arguments include the following: (I’m paraphrasing and will provide a direct link at the end of this blog)
- Poverty, racism, adult violence and substance abuse are the main reasons for all children's mental health problems, including ADHD.
- Class sizes are larger, yet the pressures and expectations are higher. In 1991, a kindergartner was expected to “sing” the ABCs. In 2011, that same child would be expected to read and do simple math prior to first grade.
- The American standard is a two-income family. Preschool and latch-key are the norm, creating long days for both children and parents. Managing within the structured bureaucracies of preschool and after-school programs sets up behavioral demands that many children cannot meet.
- ADHD became “official” in 1980 in the DSM-III, making it an easy target for the root of misbehavior or poor performance.
- Pharmaceutical companies, because they are very wealthy, fund research and continuing education within the medical profession. These companies, in turn, become highly influential.
- Pharmaceutical companies advertise to physicians first, then parents. These companies are also offering free samples (vouchers for drugs like Adderall) to physicians.
- Therapy, when offered to ADHD children, is often individual play therapy, which is not effective for this problem. What works is family/parent oriented counseling for behavioral management strategies and support.
As Dr. Diller noted, many children who struggle with mental health disorders or other mental health challenges come from or live in environments that are less than ideal. As a society, we are quick to throw on the ADHD label, prescribe meds and call it a day. However, a child living in a home with an abusive parent is probably going to have problems at school. To be honest, the source of a child’s behavioral problems can stem from a multitude of sources.
Think of a time, as an adult, in which you had an argument with your partner and had to go to work. Perhaps you’ve been through a difficult financial time with the holidays around the corner. Or maybe you have been the adult victim of abuse, and have attempted to carry on a normal daily life. As a rational adult, it is difficult to stay focused during these times. A child who lives in a frenzied, callous, and/or abusive environment falls easy to distraction and disappointment. This environment may be home, school, the community, or all three.
The only point I will disagree with Dr. Diller on is the final bullet regarding play therapy. As a proponent of child-centered play, I do not dispute that behavior management intervention is a likely choice to manage ADHD symptoms. However, as Dr. Diller indicates, ADHD is typically a result of a deficient environment. Deficient in these terms can include affection, emotional attachment, love, nurturing, or other essential human needs. In turn, ADHD usually presents as a co-morbid disorder. For those reading who are not familiar with the term, co-morbid means that the client has ADHD and something else that is clinically significant, such as depression.
Here’s what I have seen. When kids have ADHD to the extent that requires medication, it’s usually a no-brainer. There are noticeable symptoms. Does that mean the parent/guardian should medicate? That’s up to the individual and their belief system, finances, ability to monitor, willingness to monitor, child’s health, etc.
Furthermore, not all ADHD diagnoses are the same. If the hyperactivity component is missing, you may feel the child is just lazy. An ADHD diagnosis that falls under the inattentive-type may not garner the same attention as the other two. Hyperactivity and impulsivity, which are a part of the combined-type and hyperactive-impulsive ADHD, are much more obvious and well, annoying to say the least.
My point is this: the symptoms of ADHD parallel other difficulties or disorders. Is ADHD real? In my clinical opinion, yes. Is it as prevalent as reported? Probably not.
I believe it is important to step back and take an objective, and individual, look into the child’s world. Here are some steps to take as a parent or guardian to help establish a baseline of your child’s behavior, as well as a chance to get to know your child a little better.
- Take a moment to think about your child’s schedule. Write it down. Is it consistent or haphazard? Is your child getting enough sleep? How much television is he or she watching? How much time are you spending in one-on-one interactive play/engagement?
- Talk to your child and your child’s teacher(s) about school. Do you know what is expected of your child? The sooner your child knows you are there to help, the better. Ask to sit in on the class if you are allowed. Go to parent-teacher conferences.
- Talk to your child about bullying, drugs, alcohol, and sex. All in an age-appropriate manner and provide them with tools to protect themselves. You also can let you child know that you are there for them to talk to about any of the above, no matter how difficult, and will help them. If you can’t make this promise, don’t say it.
ADHD can be confusing and scary. Children with ADHD may exhibit severe aggression, irritability, withdrawal, or many other symptoms. The decision to put a child on medication for ADHD should be well thought out and monitored closely at home and by the child’s prescribing doctor.
It’s also important to keep in mind that what you think may be ADHD may be a clue to a different problem. Sometimes a child may have slight tendencies of ADHD, but a bullying problem serves as a magnifying glass. As always, the most important act you can do as a parent or guardian is engage, 100%. No phone, no TV, one-on-one. Ten minutes a day will create a miracle, I encourage even ten minutes a week to start.
Link to Dr. Diller post: http://tinyurl.com/692p48h
Children and Adults with Attention-Deficit/Hyperactivity Disorder: http://www.chadd.org/
