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April 1999 - Volume 2 - Issue 4
Approximately 5 percent of children in the United States have been diagnosed with a condition known as "attention-deficit hyperactivity disorder" (ADHD). These children (mostly boys) are destructible or impulsive, and overactive. Not surprisingly, they have few friends and are at high risk for school difficulties. Between one and two million children in the United States are being given drugs for this condition. The drug of choice is Ritalin (methylphenidate), an addictive stimulant similar to amphetamines ("speed") that has a paradoxical calming effect on children. The U.S. consumes five times more Ritalin than all other countries in the world combined. On the surface, it looks as if Ritalin is the perfect solution for a child with ADHD. When Johnny is labeled a problem by the schools, the parents feel pressured to get a medical diagnosis and treatment. There is no doubt that the jobs of parenting and teaching become easier when children sit still and do what they are told. No wonder these drugs are so commonly prescribed! Let's look beneath the surface. It is not known how Ritalin works or exactly what it does to the brain, nor has the safety and efficacy of long-term use been established. It is an addictive substance that the Food and Drug Administration has placed in the same category as cocaine. Ritalin has potentially dangerous side-effects, including suppression of growth, vision problems, nausea, loss of appetite, abdominal pain, nervousness, insomnia, skin rash, dizziness, headaches, drowsiness, and increased blood pressure and heart rate. There have been reported cases of serious tics, anemia, and scalp hair loss. Drug withdrawal often results in a return of symptoms, in some cases more severe than before. The status of ADHD as a medical disorder has not been established. In the majority of cases, no neurobiological factor has been found to be the cause of these children's behavior. There is no medical or psychological test to diagnose this "disorder." Instead, the diagnosis is based exclusively on teachers' and parents' subjective observations. The checklist for diagnosis in the Diagnostic and Statistical Manual of mental Disorders includes such behaviors as "Often does not seem to listen when spoken to directly," "Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)," and "Often has difficulty awaiting turn." Are we justified in giving children powerful, mind-altering drugs to make them docile, simply because their behavior is annoying? While Ritalin tends to help children sit still longer and focus on school-related tasks, studies have shown that the drug has absolutely no effect on improving children's learning, as measured by achievement tests. Other studies have revealed that Ritalin does not totally eliminate problem behavior in the majority of children, nor does it guarantee improved social relations. What kind of message are we giving to children when we teach them that their behavior and feeling should be altered with drugs? Are we not setting them up to become drug addicts later in life? There is growing abuse of Ritalin on high-school and college campuses, where students are taking this easily available drug as an all-night study aid or a cheap "high." There have even been reported deaths from Ritalin overdose. Millions of parents are led to believe that their children need Ritalin. But giving Ritalin to children is a superficial solution that changes children's behavior without searching for the possible underlying social or emotional causes. Maybe our schools are not geared to the needs of these children. There is research indicating that many hyperactive children function "normally" in less rigid, open classroom settings with opportunities to learn through hands-on activities, creativity, movement, and games. Many children's symptoms disappear, as if by magic, when the children are engaged in activities of their own choice outside of school. Rather than give drugs to children to make them sit still in school, why not search for ways to make school more interesting or relevant for these children? Another possibility is that children who can't pay attention have ben affected by watching too much television and videos. The rapid shift in images on a TV screen causes children to lose their ability for sustained focusing. Also, the activity, violence, and impulsive behavior of cartoon and live characters in children's programming serve as a role model for similar behavior. Children are forced into unnatural passivity while watching TV, and this is often followed by a rebound effect: a burst of pent-up energy as soon as the TV is turned off. Let's not overlook the importance of diet. What are these children eating? Do they have vitamin deficiencies, food sensitivities, or allergies? Finally, one should always consider the possibility that an ADHD child is suffering from an overload of stress or the effects of trauma. There is evidence that major family stresses (such as parental mental disorder, divorce, or hospitalization) correlate with ADHD, and many of these children also show symptoms of depression, anxiety, and conduct disorders. Trauma caused by a difficult birth, major medical procedures, sexual or physical abuse, or multiple foster care placements should also be considered. Dr. Van der Kol, a psychiatrist at Harvard, has found that hyperactivity is a common symptom of Post Traumatic Stress Disorder. Unfortunately, very few researchers or practitioners bother taking a trauma history of ADHD children. When stress or trauma are suspected, every effort should be made to reduce stress for these children and their families, and to offer psychotherapy that allows the children to release tensions and resolve past trauma. There is no simple answer. In fact, there might be as many different causes for ADHD as there are children diagnosed with it. Meanwhile, let's not settle for a deceptively easy solution in which the only real winners are the drug companies.
Ten Suggestions For Parents of ADHD Children:
1. Find a school that offers plenty of choices and self-directed learning through movement, games, and hands-on activities.
Copyright© 1998 by Aletha Solter, Ph.D., excerpts reprinted with permission from The Aware Parenting Institute web site: www.awareparenting.com Aletha Solter is an internationally known developmental psychologist, consultant, founder of the Aware Parenting Institute, and the author of The Aware Baby, Helping Young Children Flourish, and Tears and Tantrums (Shining Star Press, P.O. Box 206, Goleta, CA, 93116)
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