The New York Times recently published its analysis of raw data from the Center of Disease Control's latest Attention Deficit Hyperactivity Disorder survey. We don't get the CDC's official analysis until later this summer, but the NYTimes was happy to publish its own conclusions now. In the NYTime's opinion the data indicate that ADHD is grossly over diagnosed, enabling the pharmaceutical industry to develop sales of ADHD medication into a multi-billion dollar business. The paper cited 'experts' who attribute this excess to a three-fold cause: a) general practitioners who either don't know or don't care to complete the complicated and time intensive diagnostic process; b) overzealous pharmaceutical advertising bent on bolstering the western pill-popping approach to wellness; c) parents so desperate to give their children an edge toward success that they demand stimulant medication unnecessarily.
I'll start with C. As a parent who agonized over the decision to give her children stimulant medication, I'm almost insulted by the NYTimes' third suggested cause. Even though this was the item they used an expert to ratify with official comment; no one I've ever known who has children with ADHD has ever been eager let alone demanding to put their children on medication. Medication is expensive and inconvenient; only works for about 60% of the population; and always comes with the potential for serious side-effects. Never mind the fact that by itself, medication is not anywhere close to enough to counteract all the effects of ADHD on a person's life. I resent the accusation that parents are now eager to drug our children to make them academically successful.
Parts of A & B, however, have some merit, but not entirely in the way the NYTimes suggests.
At the time of Daughter #3's diagnosis (the first in the family) we had a pediatrician who frankly told me, when I asked for an ADHD evaluation, that he wasn't comfortable assessing a three-year-old. He suggested that we wait until she was school-aged. I understood his concern. Now that I know what to look for I realize that D3's ADHD came into play when she was 18 months old. But when I'd asked for our pediatrician's help, she was three and I had been struggling for a year and a half to sort out what was typical toddler/preschooler and what was an item for concern. It's hard to tell with ADHD. After that year and a half of observation, however, I was confident that something was wrong and I wanted someone to put a name on it so I could research solutions.
We found a psychiatrist in a clinic that specialized in children with ADHD. He took the time to interview us extensively, noted our observations over the previous year and observed her behavior himself (I turned her lose on his poor office). After the diagnostic visit, and over the next several years, he worked with us to fine tune her medication to her issues and abilities; and pointed us in the direction of a huge quantity of additional research. He very rightly taught us to understand that medication was only one small part of a very broad treatment plan for her. It took months to identify what was needed and put it in place, and has taken continual refining over the years. Managing my family's ADHD means specific rules for our diet, exercise, sleep hours, physical environment, screen time, medication, behavioral therapies and learning styles. It needs constant updating as the children grow and their chemical/hormonal composition changes.
Daughter #2 was school-aged when I began to recognize symptoms of ADHD in her behavior; so we thought we'd have our pediatrician work with us on her diagnosis. It became quickly apparent that although our pediatrician was wonderful with physical complaints, he didn't know anything about ADHD's diagnostic process beyond filling out a questionnaire and prescribing a popular medication. After my year's worth of serious research, I knew more about what an effective ADHD treatment plan should look like than he did. It wasn't that he couldn't be bothered or didn't care; but, ADHD doesn't lend itself easily to the 'jack-of-all-trades' skill-set of general practitioners.
Every pediatric clinic should have a designated ADHD and autism specialist; a psychiatrist or psychologist who has the specialized training to understand the nuances of diagnosis and treatment of those disorders. Someone who knows you can't just throw meds at ADHD and expect the child to be fine.
I'm not convinced that Big Pharmacy is fueling this billion dollar demand for ADHD medication. I'm more certain that it's the way we educate in the United States. School is an environment where ADHD most interferes, and I do know of many instances where school systems have insisted that a 'problem child' be evaluated and medicated. These are children who do just fine at home, but at school, they go nuts.
The real problem is that despite decades of access to 'learning styles' research (kinesthetic, auditory, visual, etc.) the American educational system continues to insist that the best way to teach is the 'sit still and learn' model. It is definitely the easiest way to reach mass quantities of children; but it's definitely not the best way to get each child to learn. Not only that, but in the last decades, our national effort to increase American children's absorption of math and science, school systems across the country has made it even more difficult for kinesthetic learners. To increase the amount of time spent learning math and science, we've eliminated recesses, shortened lunch breaks, and cut physical education to once or twice a week. Then, to add insult to injury, the most common consequence for infractions of school rules is to take away recess minutes.
It's insane to limit children's access to active exercise which would otherwise enable their brains to think more clearly and then insist that they 'hold it together' for eight whole hours of 'sit still and listen' learning. This would seem obvious; and yet our school administrators have the nerve to be shocked, shocked I tell you, when a child cannot learn within those parameters. They insist that if a child cannot learn within this teaching environment, it must be the child who has a problem (not the teaching model) and therefore the child should be 'fixed'. Special education teachers across the country know this is ridiculous. Parents know this is ridiculous. And yet school boards across the country have yet to see that increasing sedentary instructional time at the expense of physical activity makes American children no more brilliant at math/science we were before. It's like trying to open a solid oak door by leaning against it; and when that doesn't work, insisting that I just need to spend more of my day doing it and eventually it'll open. If I really looked at the door, understood which way it opened and the opening mechanism (hinges/lock/handle) I'd develop a much more useful strategy for opening it.
The way doctors and educators approach children with autism is similar; and yet it too, has treatment plans every bit as complex as ADHD and often more so. Doctors and educators need to take seriously the results of ADHD research; they need to seek out that research and use it. Changing the way we approach diagnosis and education would significantly reduce the quantity of stimulant drugs these children now need to effectively interact in our society.
I'll start with C. As a parent who agonized over the decision to give her children stimulant medication, I'm almost insulted by the NYTimes' third suggested cause. Even though this was the item they used an expert to ratify with official comment; no one I've ever known who has children with ADHD has ever been eager let alone demanding to put their children on medication. Medication is expensive and inconvenient; only works for about 60% of the population; and always comes with the potential for serious side-effects. Never mind the fact that by itself, medication is not anywhere close to enough to counteract all the effects of ADHD on a person's life. I resent the accusation that parents are now eager to drug our children to make them academically successful.
Parts of A & B, however, have some merit, but not entirely in the way the NYTimes suggests.
At the time of Daughter #3's diagnosis (the first in the family) we had a pediatrician who frankly told me, when I asked for an ADHD evaluation, that he wasn't comfortable assessing a three-year-old. He suggested that we wait until she was school-aged. I understood his concern. Now that I know what to look for I realize that D3's ADHD came into play when she was 18 months old. But when I'd asked for our pediatrician's help, she was three and I had been struggling for a year and a half to sort out what was typical toddler/preschooler and what was an item for concern. It's hard to tell with ADHD. After that year and a half of observation, however, I was confident that something was wrong and I wanted someone to put a name on it so I could research solutions.
We found a psychiatrist in a clinic that specialized in children with ADHD. He took the time to interview us extensively, noted our observations over the previous year and observed her behavior himself (I turned her lose on his poor office). After the diagnostic visit, and over the next several years, he worked with us to fine tune her medication to her issues and abilities; and pointed us in the direction of a huge quantity of additional research. He very rightly taught us to understand that medication was only one small part of a very broad treatment plan for her. It took months to identify what was needed and put it in place, and has taken continual refining over the years. Managing my family's ADHD means specific rules for our diet, exercise, sleep hours, physical environment, screen time, medication, behavioral therapies and learning styles. It needs constant updating as the children grow and their chemical/hormonal composition changes.
Daughter #2 was school-aged when I began to recognize symptoms of ADHD in her behavior; so we thought we'd have our pediatrician work with us on her diagnosis. It became quickly apparent that although our pediatrician was wonderful with physical complaints, he didn't know anything about ADHD's diagnostic process beyond filling out a questionnaire and prescribing a popular medication. After my year's worth of serious research, I knew more about what an effective ADHD treatment plan should look like than he did. It wasn't that he couldn't be bothered or didn't care; but, ADHD doesn't lend itself easily to the 'jack-of-all-trades' skill-set of general practitioners.
Every pediatric clinic should have a designated ADHD and autism specialist; a psychiatrist or psychologist who has the specialized training to understand the nuances of diagnosis and treatment of those disorders. Someone who knows you can't just throw meds at ADHD and expect the child to be fine.
I'm not convinced that Big Pharmacy is fueling this billion dollar demand for ADHD medication. I'm more certain that it's the way we educate in the United States. School is an environment where ADHD most interferes, and I do know of many instances where school systems have insisted that a 'problem child' be evaluated and medicated. These are children who do just fine at home, but at school, they go nuts.
The real problem is that despite decades of access to 'learning styles' research (kinesthetic, auditory, visual, etc.) the American educational system continues to insist that the best way to teach is the 'sit still and learn' model. It is definitely the easiest way to reach mass quantities of children; but it's definitely not the best way to get each child to learn. Not only that, but in the last decades, our national effort to increase American children's absorption of math and science, school systems across the country has made it even more difficult for kinesthetic learners. To increase the amount of time spent learning math and science, we've eliminated recesses, shortened lunch breaks, and cut physical education to once or twice a week. Then, to add insult to injury, the most common consequence for infractions of school rules is to take away recess minutes.
It's insane to limit children's access to active exercise which would otherwise enable their brains to think more clearly and then insist that they 'hold it together' for eight whole hours of 'sit still and listen' learning. This would seem obvious; and yet our school administrators have the nerve to be shocked, shocked I tell you, when a child cannot learn within those parameters. They insist that if a child cannot learn within this teaching environment, it must be the child who has a problem (not the teaching model) and therefore the child should be 'fixed'. Special education teachers across the country know this is ridiculous. Parents know this is ridiculous. And yet school boards across the country have yet to see that increasing sedentary instructional time at the expense of physical activity makes American children no more brilliant at math/science we were before. It's like trying to open a solid oak door by leaning against it; and when that doesn't work, insisting that I just need to spend more of my day doing it and eventually it'll open. If I really looked at the door, understood which way it opened and the opening mechanism (hinges/lock/handle) I'd develop a much more useful strategy for opening it.
The way doctors and educators approach children with autism is similar; and yet it too, has treatment plans every bit as complex as ADHD and often more so. Doctors and educators need to take seriously the results of ADHD research; they need to seek out that research and use it. Changing the way we approach diagnosis and education would significantly reduce the quantity of stimulant drugs these children now need to effectively interact in our society.
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