Posts Tagged ADD

ADHD Overdiagnosis, Prescriptions a Mental Health Crisis

Published by EducationNews.org — For behavioral issues, drugs should be a last resort — especially for kids.

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In the early part of the 20th century, a pediatrician identified what he called “an abnormal defect of moral control in children.” This described kids who had challenging behaviors, but were otherwise intelligent and normal.  Later in the 1950s, the same behaviors were labeled in the US as “hyperkinetic impulse disorder.”  As you’ve guessed, the label morphed eventually to the more familiar ADHD, or just ADD, depending on how physically hyperactive the kid is.

The disorder was obscure until the late 1990s when the rate of diagnoses started to increase by 3% every year.  Remember that the late 1990s was also the era of “zero tolerance” and the massive spike in school suspensions and expulsions.  The crack cocaine epidemic spawned widespread, and now unfounded fears, of “super-predator kids” who would grow up to be aggressive and violent.

Perhaps most importantly, the traditional family, which had started to dissolve in the late 1960s, began to fray the culture as a whole.  Fewer children were being raised in two-parent families, attached to extended families, consistent neighborhoods, faith-based communities and common norms.  Increasing numbers of kids were coming to school with behavior that was less please-and-thank-you and more rude and defiant of authority.

Then, according to a report by the Centers for Disease Control (CDC), in the mid-2000s new ADHD diagnoses increased by 5% a year.  Most recently the rate mushroomed by 7%, and now fully 11% of the U.S. population between ages 5 to 17 have been diagnosed with just over 6% taking medication to control their behavior.  Some psychiatrists question the healthiness of these rates and ADHD’s biological origins.  Skeptics consider the meds “chemical restraint.”

Personally, I think that we’re caring for a garden by spraying it with weed killer rather than doing the work of pulling the behavioral weeds.

Pills are so easy.

I fully understand the public concern over the horror of the current drug overdose epidemic, but it affects fewer people than we think.  The public seems to take little notice of the spread of ADHD to double-digit proportions of our school-age children, who might be suffering from totally normal attributes of exuberant, play-loving, wriggly childhood.  Yes, a few young people do seem biologically ill-programmed.  But most of the “bad” kids I see desperately need more time to run, scream, play, roam, even wrestle and rough-house.  They need lives that are far more hands-on than eons of time parked in front of electronics.  They can’t sit in classroom seats for literally hours at a stretch.  If “sitting is the new cancer,” why is it okay for kids?

This is personal for me.  From kindergarten to senior year, the schools that one of my three sons attended insisted I medicate him for ADHD.  The diagnostic checklists of symptoms for the disorder included being fidgety, disorganized, and distracted.  That could be you or me on a hectic day.  He wasn’t bad so much as annoying — super fidgety and off in space.  So every year when administrators, psychologists, teachers made the pitch, I asked:  What’s the message?  (Say no to drugs?)  What’s the end game?  (Does he ever wean off?)  What are the side effects?  And since I stipulate that he’s profoundly ADHD, how will he ever learn to deal with it if we mask it with drugs?  (It wasn’t easy, but he’s now a married, successful working professional who still gets scattered.)

Children and youth are not machines who need a tweak, a tune-up or new part.

No one likes irritating or disruptive behavior.  But taxpayers, and many parents and teachers, would like irritating behavior changed in a manner that’s fast, easy and cheap.  That’s not going to happen.  In fact, while ADHD drugs can give support to a few kids, mostly drugs are a short-term fix to deeper problems that will re-surface later on.  Problems like:  Are there routines at home?  Structure to the day?  Caring, but firm adults, who are themselves reasonably functional?  If not, the kid’s likely to broadcast his chaos or distress with misbehavior.  (Most are boys.)

Even so, the CDC reports that fewer than “1 in 3 children with ADHD received both medication treatment and behavioral [talk] therapy, the preferred treatment approach for children ages 6 and older.”  Talk therapy costs time and money.  Many adults resist letting their kids go to therapy asserting they don’t believe in it — which conveniently avoids having a therapist turn the tables and hold anyone besides the kid accountable.

About the babies, the report says, “Only half of preschoolers (4-5 years of age) with ADHD received behavioral therapy… and 1 in 4 were treated only with medication.”  Nuts.

We can’t fix kids’ behavior.  A fix implies a solution that will make whatever problem it is go away.  But conflict and problems do not go away.  They’re baked into life as deeply as death and love, both of which cause a great deal of problematic behavior that mostly need attention and empathetic care.  Drugs should be a last resort — especially for kids.

 

Julia Steiny is a freelance columnist who also blogs about Restorative Practices and Restorative Justice. After serving on the Providence School Board, she became the Providence Journal’s education columnist for 16 years, and has written for many other outlets. As the founding director of the Youth Restoration Project, she’s been building demonstration projects in Rhode Island since 2008. She analyses data and provides communications consulting on Information Works! and the RIDataHUB, through The Providence Plan. For more detail, see juliasteiny.com or contact her at juliasteiny@gmail.com or 24 Corliss Street #40022, Providence, RI 02904.

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Only 1 in 12 Kids Has Normal Balance and Core Strength

Published by EducationNews.org — Children are constantly in an upright position these days.  They’re not moving nearly enough, and that’s a problem.

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Angela Hanscom is a pediatric occupational therapist.  A very worried occupational therapist.

And who are they, anyway?  These therapists help kids (and adults) get over or mitigate the barriers to daily occupations — bathing, toileting, social functioning, gaining more independence — if they’re injured, developmentally delayed, or otherwise disabled.  They help people on the autism spectrum interact with others.  They understand how to teach a Down Syndrome child to take as much care of herself as possible.

Occupational therapists are also among the people who work with America’s 6.4 million kids between ages 4 and 17 who’ve been diagnosed with ADD or ADHD.  That number has grown to 11% of the age group.  We’re the only country to break double digits in this sad stat.  Most countries barely make it over the decimal point.  England, usually second after the U.S. in worst-in-the-developed-world social health statistics, has about 2.4% diagnosed.

So, among her other clients, Hanscom’s include kids who have the occupational difficulty of tolerating schools.  Most are boys.  Many have had their fidgeting calmed by medication, but they still need strategies for how to sit still all day and resist the noise coming from their bodies begging for movement.

While working in classrooms of wriggly kids, Hanscom started seeing what she thought must be physical anomalies among them.  So she solicited others to help her conduct research.  To their horror, they found “that most of the children in the classroom had poor core strength and balance. In fact, we tested a few other classrooms and found that when compared to children from the early 1980s, only one out of twelve children had normal strength and balance.”

A kid’s body is designed to train its own vestibular (balance) system.

Balance involves a sophisticated integration of sensory data — sight, sound, movement — that helps people control their motion, equilibrium and spatial orientation.  Young bodies learn to regulate balance by moving in every possible direction.  This is why kids like to play with speed, twirl until they’re dizzy and fall down, dance, jump, swing, skip.  Their seeming physical madness is evolution’s way of helping a kid calibrate the physics of staying upright while walking, running, etc.

And the “core strength” Hanscom refers to is what the Pilates people often call the “girdle of muscle,” around the abdomen and the lower back.  The core supports everything else that uses gross motor skills.

Ironic, isn’t it, that as people age, their core strength and balance are the two things that become universally weaker.  And here we are creating a younger generation starting life with those weaknesses right out of the gate.

In the school off-season, Hanscom runs a camp, Timbernook, which for all the world looks like a forest kindergarten or nature-focused adventure playground.  In other words, it looks like a place where kids can actually play.  Not surprisingly, when ADD kids go to Timbernook, their symptoms disappear.  They no longer have to battle the crummy feeling of being a constant nuisance to the teacher, because at camp their fidgeting is free to erupt into full-on thrashing about.  ADD is considered a neurological disorder, but increasingly some of us believe that some kids’ bodies scream for attention so loudly that the noise ruins kids’ ability to concentrate for long.  At Timbernook, kids’ bodies are finally learning a form of basic education that the very structure of regular school forbids.

What subject is so valuable that it’s worth sacrificing learning balance?

Picture a typical classroom.  Consider what Hanscom says:

“The problem: children are constantly in an upright position these days. It is rare to find children rolling down hills, climbing trees, and spinning in circles just for fun. Merry-go-rounds and teeter-totters are a thing of the past. Recess times have shortened due to increasing educational demands, and children rarely play outdoors due to parental fears, liability issues, and the hectic schedules of modern-day society. Let’s face it: Children are not nearly moving enough, and it is really starting to become a problem.”

“Starting?”  I dunno.  That 11% statistic begs to differ.

Yes, schools are part of the problem.  But schools are only a reflection of the larger society.  Parents are absolutely insane for safety these days.  They’ve heard the line that “sitting is the new cancer.”  They know that clinging to electronics, indoors, for hours at a stretch can’t be good for kids.  But…  Even kids who are involved in sports tend to sit the rest of the time.  They don’t work on cars, create pick-up games, build stuff or ride bikes to a fishing hole.  They get a shot of activity.  And then sit.

So while we fuss about nuances of Common Core, we stop children from learning the most basic things they’ll need to support their daily occupations.  Drugs and therapy only mask the body’s biological need to cavort about.  Is this really working for the kids?

Hat tip to Valerie Strauss for reprinting Hanson’s blog on her Answer Sheet.

 

Julia Steiny is a freelance columnist who also blogs about Restorative Practices and Restorative Justice. After serving on the Providence School Board, she became the Providence Journal’s education columnist for 16 years, and has written for many other outlets. As the founding director of the Youth Restoration Project, she’s been building demonstration projects in Rhode Island since 2008. She analyses data and provides communications consulting on Information Works! and the RIDataHUB, through The Providence Plan. For more detail, see juliasteiny.com or contact her at juliasteiny@gmail.com or 24 Corliss Street #40022, Providence, RI 02904.

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