Meeting The True Needs of Children Diagnosed As ADHD
How should one look upon Attention Deficit Hyperactivity Disorder (ADHD) and what is the effective way to aid those who are given this diagnosis? There has been considerable debate as to whether or not ADHD is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an examination by Hartmann in 1993 felt that ADHD is actually normal variant of human behavior that doesn't fit into cultural norms.
In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the TOVA (test of variables of attention), a test where the client must use a computer and hit a target at various points. This test is designed to measure the person's response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the diagnosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of ADHD, he states, medications alone do not provide adequate or full treatment in this disorder.
Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for ADHD is that about 1% of these children will develop tics and or Tourette's Syndrome. Hedaya asks the question,"One might wonder-, why use methylphenidate at all?" Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects include nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of ADHD lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of ADHD are lessened.
However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same effect in both those diagnosed as ADHD and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children's Hospital of Philadelphia commented at the National Institutes of Mental Health Consensus Conference in 1998 that the behaviors exhibited by those considered ADHD were normal behavioral variations. A Multimodal Treatment Study was conducted by the National Institutes of Mental Health in 1999 in regards to ADHD. Psychiatrist Peter Breggin and the members of the International Center for the Study of Psychiatry and Psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the analysis conducted of behaviors in the classroom of those children studied showed no significant differences between those children receiving stimulant medications versus those who only were utilizing a behavioral management program (MTA Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no control group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication management group, they numbered only 144 of which Breggin finds to be enormously small. Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a significant factor by the investigators. Breggin also believes that the study was flawed in that drug treatment continued for 14 months whereas behavioral management was utilized for a much shorter duration. Breggin argues that the behavioral management strategies, which involved mainly a token economy system, were ineffective as well and did not take into consideration family dynamics but regardless, the study still showed that there was no difference between the populations treated with drugs versus those undergoing behavioral management solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents. The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of academic performance or social skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have almost identical adverse reactions and have the potential for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often become robotic and lethargic and that permanent neurological tics can result.
In his textbook, Attention Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of ADHD, notes that there is little improvement in academic performance with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can affect growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a diagnosis of ADHD
Dr. Sidney Walker, III, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large number of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children actually become psychotic?Ehe fact that many hyperactive children respond to Ritalin by becoming calmer doesn't mean that the drug is treating a disease. Most people respond to cocaine by becoming more alert and focused, but that doesn't mean they are suffering from a disease treated by cocaine.?EIt is interesting to note Walker's analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, ?EMP (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration produces a high?Esimilar to that of cocaine.?E Walker (1998, pg. 14-15) that in addition to emotional struggles of children leading to ADHD-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette's syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be considered ADHD?Ehowever Walker feels that these issues are most often overlooked and the person is considered to be ADHD. F. Xavier Castellanos states at the 1998 Consensus Conference that those children with ADHD had smaller brain size than those of children who were considered to be normal. However, Castellanos reported as well that 93% of those children considered ADHD in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with ADHD since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse effect of this treatment.?E Physician Warren Weinberg and colleagues stated, a large number of biologic studies have been undertaken to characterize ADHD as a disease entity, but results have been inconsistent and not reproducible because the symptoms of ADHD are merely the symptoms of a variety of disorders.?EThe Food and Drug Administration has noted (Walker, 1998, pg. 27) that ee acknowledge that as of yet no distinct pathophysiology (for ADHD) has been delineated.?E
There has been concern as well about the addictive component of psychostimulants. The Drug Enforcement Administration (1995c) reports that it was found that methylphenidate's pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse potential as these Schedule II stimulants.?E
Breggin states that psychiatrist Arthur Green in the Comprehensive Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be linked to abuse and/or neglect. abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with limited attention span and hyperactivity. (Breggin, 1991, pg. 274)
Being that ADHD is a subjective diagnosis and that stimulant treatment has been shown to have risk as detailed above, what is the effective alternative to aiding those who have been diagnosed ADHD and what actually is underlying the difficulties that these individuals may be manifesting? Psychologist and educator Michael Valentine (1988) suggests that it is necessary to "love your children, care about them, do as much as possible to have them grow and develop, teach them social skills, and teach them how to identify and express their feelings and to become uniquely human; but at the same time, care about them and love them enough to give them guidance, structure, limits, and control as they need it.?EValentine advocates a psychosocial approach to aiding children and adolescents who would be considered to be ADHD. Psychiatrist Peter Breggin also advocates this approach and feels that it is necessary for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is necessary to examine the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of ADHD?Eitself). It is necessary to examine the experience of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an appropriate educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them. Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, ?Epediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don't like it as having attention deficit disorder or attention deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it's better to use drugs than to try to apply their prestige and clout in the community to the real problem: improving our school s so that students find them enjoyable enough to pay attention and learn in an environment where drugs are not needed. This misguided psychiatric effort has created an epidemic of drug treated mental illness?Ein the schools.?EBreggin continues that it is also necessary to examine the environment the child lives in and the stressors around them. It is necessary to build relationship and collaboratively design structure and limits with the child or adolescent (Breggin, 1998, pg. 318) Breggin feels it is necessary to train parents in relationship building with their children and in working through situations of conflict. He states, parent management training has consistently proven successful in improving parent self-esteem, in reducing parent stress, and in ameliorating ADHD-like symptoms, especially negative attitudes toward parental authority and aggression.?EDr. David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as ADHD who Stein prefers to call highly misbehaving?Echildren. In this program, known as the Caregiver's Skills program, Stein states it is necessary to treat your child as normal and not diseased.?EHe states that the children should not be taking any medications, as they are risky for the child's health and merely blunt behaviors. Stein argues, if the behaviors don't occur, we can't help (them) learn new habits.?EThe program encourages social reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The program encourages development of target behaviors and consistent encouragement and social reinforcement as well as consistent consequences for misbehavior. The program encourages the self-assessment and evaluation of the child of their own behaviors.
Barkley, Russell, Taking Charge of ADHD, Boys Town, NE, Boys Town Press, 1995)
Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, MA, 2000)
Breggin, Peter R., Talking Back to Ritalin,Common Courage Press, Monroe, ME, 1998)
Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)
DuPaul, Barkley, and Connor, Stimulants (article appearing in text Attention Deficit Hyperactivity Disorder, 1998).
Glasser, William, Psychiatry Can Be Hazardous to Your Mental Health, Harper Collins, New York, 2003)
Hedaya, Robert J., Understanding Biological Psychiatry, W.W. Norton, New York, 1996)
Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)
National Institutes of Mental Health Consensus Conference Statement, 1998
Stein, David, Unraveling the ADHD Fiasco, Andrews McMeel, Kansas City, 2001)
Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)
Weinberg, Warren et al., Attention Deficit Hyperactivity Disorder: A Disease or a Symptom Complex, Journal of Pediatrics, 130, 665-6
Dan L. Edmunds, M.A.,B.C.S.A.Mbr>
Doctorate of Education candidate in Pastoral Community Counseling
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Kids may say the darndest things, but parents tweet about them in the funniest ways. So each week, we round up the most hilarious 280-character quips from ...
How parents are helping one another through the furloughs The Washington Post
Sophie Geyer, a mom of one who lives in Springfield, Va., belongs to a running group that includes many women whose families are being affected, financially ...
Harvard professor, journalist discover ‘formula’ for raising successful kids WTOP
Ever wonder what it takes to raise a hardworking humanitarian, a distinguished musician or an inspiring community leader? Researchers find that in many cases ...
Gillette’s new ad asks us to redefine ‘best’ for our boys. What could be wrong with that? - The Washington Post
Gillette’s new ad asks us to redefine ‘best’ for our boys. What could be wrong with that? The Washington Post
In the right light, my 15-year-old son is on the fuzzy cusp of a glorious mustache. The spacing is natural, the length manageable and the hue a perfect ...
Harsh Nazi Parenting Guidelines May Still Affect German Children of Today Scientific American
Renate Flens, a German woman in her 60s who suffers from depression, tells her psychotherapist that she wants to love her children but just can't. She and the ...
Gaming, social media are good for children, says a professor The Indian Express
In a new book titled The New Childhood: Raising Kids to Thrive in a Connected World, Jordan Shapiro, assistant professor, Temple University, argued that ...
Dosa to smoothie: 5 broccoli recipes your kids will enjoy The Indian Express
A winter vegetable, broccoli is rich in Vitamin C and high in dietary fibre. Try it in super simple, fast preparations and kids will love it. If it is not yet your child's ...
You Make Me Sick And Other Things Parents Say in Anger
Maryann is so focused she's blind. She's slipped over the edge of responsibility and forgot the real reason she is working so hard.
Should We Apologize To Our Children?
An apology is a sign of strength, not weakness. Sometimes we may believe that if we apologize to our children we weaken ourselves and the rules we are trying to keep.
When Parents Disagree
Moms and dads, are there times you think that parenting would be easier if you didn't have to make family decisions? Having a partner that is not in agreement with your parenting ideas or discipline approaches is more than just frustrating. It can be a cause of division in even the best of relationships.
Parenting Your Teenager: Late vs. Too Late, and 5 More Sure Fire Tips
Late vs. Too LateEvery now and then, I'll hear a parent tell me something like this,"I know we should do something about how we handle our son/daughter, but it's really too late since they are almost 18.
Mommie Moments - Taking Time For Yourself
Being a parent is a role that requires a large majority of our attention and time. Whether you have one child or fourteen children, you are more than likely aware that personal time is at a minimal.
Go Ahead - Make Dads Day
Throughout the year, many days of celebration are tucked capriciously into the calendar. So much so, it is hard to find any day of the year where something or someone is not being observed, which has benefited the greeting card company, you can be sure.
Attention Deficit Hyperactivity Disorder: What Do We Mean by Attention Anyway?
When we talk about attention, we are talking about two different kinds of abilities: The ability to focus on a specific task put in front of us to do, such as school work, and the ability to pay attention in a more global sense to the world around us, to be able to pay attention to the buzz of the lights overhead, and the touch of the clothes on your skin, and the children playing outside of the classroom. These are two different kinds of attention.
Dads, Give them Household Chores
You have a chore to do around the house, and your kids want to help out. You know it might be nice for them to help, but you're feeling a bit impatient.
Public-school Teachers Know Best --- They Send Their Kids To Private Schools
A study done by the Thomas B. Fordham Institute found that nationwide, public-school teachers are almost twice as likely as other parents to send their children to a private school.
Healthy Eating Alone Is Not The Answer
Along with eating healthier we need to be more active. The two go hand in hand.
Camps for Troubled Teens: Disciplines and Wilderness
Parents looking for a quick fix usually choose troubled teen camps. There are two types of teen camps: boot camps and summer or wilderness camps.
Detox To Help Conception
Detox To Conceive..
The Cost of Competition on Kids
The subject of competition is one that provokes some pretty strong feelings in the United States. In fact, even hinting that competition might not be such a great thing can cause one to be labeled un-American.
Parenting Your Teenager: Self-Decorating or Self-Harm - How to Tell the Difference
Q. I need your help with a question about my teen-age daughter.
Top 20 Items To Pack In A Diaper Bag
1. Diapers (5 -7 is a fairly safe supply)2.
Parents Need to Vent Anger! Try These 4 Steps to Serenity
Parents are losing their self-control to anger. A friend called me today and told me a very troubling story.
Confident Kids : Why Some Parents Should Carry a Health Warning
As a hypnotherapist, I am acutely aware of the power of words. A few well-chosen words can induce hypnosis and help my clients with a wide range of problems.
Guide To Choosing Educational Toys For Children
In the last few years, parents started getting more and more interested in choosing all sorts of educational toys for their children. Because a parent wishes the best for his child, a toy that is labeled as educational is very likely to be bought easier than others.
The Different Types, or Styles, of ADHD
Research literature, recent books, and common sense, all point to the fact that there are different types, or styles, of ADHD. In the past we referred to Attention Deficit Disorder: Inattentive Type, or Impulsive/Hyperactive Type, or a Combined Type.
6 Ways to Communicate Clearly with Your Teen
How would you like to have a closer relationship with your teen again?Your ability to communicate effectively with your teen is one of the most precious skills you can develop to achieve this goal.When we think of communication, we tend to think only of the way we can express ourselves.
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