My last post, and the brief comment discussion that followed, made me think again about Attention Deficit Hyperactivity Disorder (ADHD). I'm a clinical psychologist and though I didn't work with young kids, I saw teens and adults who evidenced ADHD symptoms. I believe ADHD exists as a neurological issue (I hesitate to say disorder because maybe it's adaptive in some way).
That being said, I think ADHD is a relatively rare phenomenon, like schizophrenia or multiple personality disorder. Granted, we may be better at diagnosing things today but the explosion of ADHD kids simply doesn't make sense. We're probably better at diagnosing schizophrenia today too but the prevalence rate is still about 1%, just like it was in the 1950s. If kids were having such serious problems sitting in their seats in school or paying attention to teachers or talking out of turn in the 1950s, believe me, we would have come up with a name for it. The truth is that kids simply weren't permitted to behave like this.
Even when I was in elementry schools in the 1970s, no one challenged or talked back to teachers. We didn't have kids just popping out of their seats or being constantly disruptive with inattentive behavior (with the exception of a boy named Todd Morse who, unfortunately, had more problems than ADHD). No, in most of my classes in elementary school everyone came into class, shut their mouths, and listened to the teacher. Sure, sometimes kids doodled or passed notes or whispered but it was rare to have any out of control disruptions. And this was back when almost no kids were medicated.
So what's happened? Why are 20% or more of our kids taking psychotropic medication? I don't believe it is because there was some vast undiagnosed population of kids. Even if there wasn't a label for it, they still wouldn't have been able to control themselves and yet, for the most part, they did. So what's changed? It can't be genetic because this explosion of ADHD and bipolar disorder in our kids has happened in only one generation, far too quickly for our genes to have changed.
I think, like many of these changes, it is multidetermined. First of all, there's a cottage industry in ADHD. So called "experts" making a good living writing books and giving seminars on a disorder that is difficult to diagnose, has few if any proven biological markers, and no truly agreed upon treatment. In fact, a recent study showed that more than 50% of ADHD kids had dramatic improvement just by having their tonsils out. Hmm...bet Russell Barclay didn't see that one coming.
I also think that kids lives are more unstable today. More than half of our kids grow up in single-parent homes and while many of these parents do a great job, a lot of these kids are caught between two parents at war or one or both parents being too caught up in their own lives to really be involved with their kids. Many parents are very overindulgent today. Kids are infantalized and used to getting what they want on demand. Stimulation and gratification are immediate and rapidly changing. We are not a society that teaches our kids how to sit still and concentrate for an hour at a time in class anymore.
Again, all this is not to say that some kids, and adults from previous generations, do not suffer from something called ADHD. But when we start throwing any kid who has some behavior problems or doesn't do well academically or appears bored in school into the same junk category, it just doesn't mean much diagnostically. And it's not helpful to the kids. Some kids have ADHD. But some kids just hate school. It bores them and they'd rather be doing something with their hands or playing sports or drawing. Some kids are just dumb. It's not politically correct to say that but it is thr truth. Some kids will never be good at school because they're just not very smart. That's okay. They can still be great, successful people. They just might never do well at school or go on to an Ivy League college. It doesn't mean they have a neurological problem. Remember folks, the greatest mathematical concept in the world is the standard normal curve. Intelligence, like many traits in humans is a bell curve. Most of us are in the middle. Some are really smart. But that means some have to be dumb. It's not abnormal. It is exactly as you would would predict it to be.
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5 comments:
Oh Don, this post is a fucking GODSEND. I understand what you meant in your last post, but truly, the kids I know who have had behavioral issues attributed to ADHD kids are all really exceptionaly bright. Maybe I'm in touch with the wrong group. They really are bright. But your point is still really well taken. There is no way all these people are ADHD. They just don't know how to behave, because as you say, no one is paying any goddamn attention and therefore not correcting the behavior. The kids I know who are in this category also spend a GINORMOUS amount of their time with electronic entertainment of one form or another. They have zero social skills and no attention span to speak of. I know of one family in which ALL THREE MEMBERS have been "diagnosed" with ADHD, including the parent. It's really out of control.
This post is one that could, should be an op-ed piece. Especially with school starting, teachers and parents will do anything to just get a quick fix to calm down their classrooms and households. Your article is a real wake-up call. Parents need to start parenting, holding their kids accountable, teaching them some basic manners and the concept of respectful conduct, and assigning them some responsibility. They also need to tell kids that school matters so that teachers don't have to battle the inevitable.
Thanks for this great post. You're a voice in the wilderness, eh.
MM
This is giving me something to think about...my nephew takes meds for ADHD. From the beginning I was against it, but not my child, not my decision.
He is very smart, but has trouble concentrating. He told me once that it's like there's a sandstorm in his head. He was six at the time. Now that he's 12 and starting middle school, I hope that he is getting old enough to be taken off his meds.
I admit, I am totally biased, but my sister has done an outstanding job raising her kids. They are very polite, can carry on a conversation with just about anyone, they are both on the honor roll at school, they'd rather read a book than watch television, they might grumble a bit but they will do what they're told the first time... but I totally agree that most kids are entirely too spoiled and that's the fault of the parents.
KC & Mando - Thanks for the great comments. I feel very strongly about the overmedication of kids in our society. Here's another interesting tidbit. For most agreed upon disorders, like schizophrenia, the prevalence rates are fairly uniform across the globe. But ADHD (and some other disorders) are more prevalent in the U.S. That doesn't make any sense if it truly is a biological disorder. And we all know that the U.S. leads the world in prescription drug use, for kids and adults.
KC, you raise an interesting point. I think there are definitely kids who have these kinds of concentration difficulties (adults too) and for many of these folks, the meds have been a godsend. But the potential problem I see is that there isn't a lot of research on the long-term impact of these medications. It used to be that people thought patients "outgrew" true ADHD by about age 16. Now that does not appear to be the case. So, do we still take a kid off of meds in their late teen years? What does that potentially do to them if they really are getting benefit? Do we leave them on the meds the rest of their lives? What's the long term effects of that?
I don't know. I just think we've been running some pretty scary experiments on our kids in this country for the last decade or two. We're not really going to know how that all plays out. I just think that people sometimes forget that taking any medication alters the chemistry of your brain. Are we always doing that because there's a "defect" or are we sometimes doing it because we want everyone to conform to the way we think they ought to feel and behave? I'm not sure.
KC, it sounds like your sister is really tuned in to her kids' needs, and also committed to responding to them, which takes work, but it's the best way. They're kids and still do kid things but they're not going to go out in the world and make a nuisance of themselves.
And to Don's point, too, about broken families, I think kids absolutely fare worse in those situations. I don't think my kids get the attention at their Dad's that they do with me, and X already has attention issues. So it definitely raises the stakes and the likelihood that a child will develop attention problems whether organic or environmental. If a child is "spirited," very smart and very high energy and also very sensitive to change, that just adds to the mix. So there can be zillions of reasons why a child seems to have trouble paying attention, but generally we don't treat the child, we throw a label on the behavior and treat that. Or, we feel ashamed so the relationship with the child becomes about the perceived/alleged condition rather than with the child. Now THAT'S crazy. Folks who pay attention, who work on improving attention and behavior through interactive means, and who don't load their kids up on junk are seen as fringe.
Give me strength.
Mando - Very good points. As I said, some kids may have problems that no amount of attention or discipline are going to solve. But others are given a diagnosis as an excuse. Like you said, treat the label and not the kid. It's really too bad what's happening.
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