There is currently a raging debate about attention deficit disorder with some saying that this childhood disorder is being over-diagnosed and over-medicated. I find it hard to believe that all those teachers, pediatricians and child psychiatrists are somehow wrong and misguided.
The diagnosis is made when the child shows extremes of carelessness with homework, inability to sustain attention, lack of willingness to listen, poor organization, a dislike of tasks which require sustained attention and forgetfulness. Some exhibit fidgetiness, poor impulsive control and a bad temper.
This disorder was first described in 1902 by Sir George Still, the father of British pediatrics, with some children displaying restlessness, impulsivity and inattention and was referred to as “minimal brain damage syndrome.” By 1937, Rhode Island psychiatrist Charles Bradley published a report showing that amphetamine treatment had a positive effect on both restlessness and concentration in children and a variety of psychostimulants have been used since then, including Ritalin, Adderall and Concerta.
This disorder is now said to affect anywhere between 5 percent to 11 percent of the children in America and as many as 4 percent of adults. The NIH and CDC both consider this to be one of the most common behavioral disorders of childhood and furthermore there has been a 42 percent increase in this diagnosis between 2003 and 2011. The diagnosis is made more often with boys than girls.
Dr. Eugene Arnold, a child psychiatrist and professor at Ohio State University, offers the most persuasive explanation of the recent increases in ADHD. He says greater awareness, modern-day stress and lack of structured discipline are the three primary reasons for the increase. He believes that environmental pollutants, fast food additives, lack of exercise and early childhood experiences also contribute to the rise in attention deficits both in kids and adults.
Cures: The medical field often favors a combination of psychostimulants coupled with parent training and behavior modification. Of course, the key is to make sure one does not over-medicate the child. I recall when I was in my graduate training at an early childhood treatment center, one little boy was so over-medicated he would spend the day lying face down on the grass in a near-zombie-like state. Psychostimulants can be effective, but must be carefully prescribed with follow-up sessions to titrate the doses.
The use of behavior modification and token economies also have some useful impact in that they get the parents to attend to the desired behaviors and provide reinforcement.
One thing I have noticed about some inattentive and impulsive kids who are socially disruptive or class clowns is that they are often gifted and underachieving.
Many years ago, I worked in an early childhood learning center in Suffolk County and a teacher asked me to test one of her 4-year-old preschool kids who was hyperactive and uncooperative. I remember how that 4-year-old came into my office, sat down on the little chair I had for him, crossed his legs and calmly asked, “Well, doctor, what would you like to talk about?” After testing, I discovered he had an IQ of 136, which is in the extremely gifted range. This was a kid who was under-stimulated, bored to death and was disruptive in order to pass the time.
Arnold was right to suggest that there are numerous factors causing the current epidemic of attention deficit disorders. It doesn’t take a genius to understand that we now live in an age where an unremitting flood of information comes at us and that most kids, as well as adults, are now addicted to this and that it taxes our mental processes and distracts us.
In addition, thanks to this economy, nearly all families have both parents who work and this, of course, leaves the children alone and unsupervised. It was once a quaint proposition to suggest all that could be made up for with “quality time,” but research has since proven that to be untrue.
Kids are unable to hide most emotional turmoil because they have yet to develop defensive strategies to cope or compensate. So the result is that they express their emotional disturbance with behaviors like hyperactivity, anger, impulsivity or withdrawal into daydreaming and inattention.
Of course, there is need for medical interventions and also for behavior modification, but the obvious truth is that hyperactive, inattentive and underachieving kids will need help in order to understand the actual causes of their problems.
In fact, children are in many ways needier than adults and what they need is the one thing that is in very short supply. What they need is time given by adults. That is one reason sports are so valuable. Kids get to spend time with adults who teach them rules. All kids crave loving adult supervision, guidance, solace and rules to live by.
The reason that the bestselling book, “Battle Hymn of the Tiger Mother,” became an instant success back in 2011 was because it upheld the idea that strict, demanding, academically oriented, involved parenting was the way to go. But when parents are away working all day long, who has the super human energy to do that? Good question. But that question is the one that must be answered before we will see an end to this epidemic of attention deficit disorder.
Kids need help in controlling diet, sleep patterns, homework time and more. And the tragedy here is that when these things go off track, the social consequences become yet another issue, which lowers self-esteem, produces anger and need for self-medication. Not a pretty picture.
The solution is to give them time to discuss all this. One of the many secrets I have learned as a psychotherapist is that typically kids appreciate, value and enjoy the work of the so- called “talking cure” that is provided in my office or, as the famous ad once said, “Mikey likes it!”
