The Great A.D.D. Debate

Percent of Youth 4-17 ever diagnosed with Atte...
Percent of Youth 4-17 ever diagnosed with ADD

There is an interesting article in today’s New York Times titled “Drugs to Treat A.D.H.D. Reach the Preschool Set”.  Being someone who was diagnosed with A.D.D. in Elementary School, and someone who took Ritalin for seven years before deciding I didn’t want to take pills everyday anymore, I had to read this article.

The main point of the article is that the American Academy of Pediatrics has approved the use of prescription drugs to treat A.D.D. and A.D.H.D. (Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder, for those who may not be familiar with these acronyms) in children under 6, which was the age limit prior to this decision.

Some may be outraged by this new decision, and see it as another example of Americans being too quick to embrace medication to solve all of our problems.  Some also, legitimately, bring up the point that it is difficult at such a young age to “tell the difference between a healthy, active 4- or 5-year-old and one with A.D.H.D.”, as the article states.  The article quotes Rahil Briggs, a psychologist working with the Children’s Hospital in the Bronx, “You’re trying to differentiate what may be normative, somewhat disorganized, active, distractible behavior in a 4-year-old, that to an adult may look difficult to control, from something that would qualify as a diagnosis of A.D.H.D.”

What I liked about this decision, though, is the fact that, according to the article, it does not give physicians free rein to prescribe drugs to whomever they want.  The article states, “The American Academy of Pediatrics revised its A.D.H.D. treatment guidelines, giving doctors a green light to prescribe drugs even to preschoolers with A.D.H.D. if behavioral efforts fail” (Emphasis added).  I like that they look first to behavioral efforts.

I will say, though, that sometimes medication is required.  The article detail the account of a young boy whose parents and doctors had tried everything before they medicated him, but nothing was working.  Then they started him on medication, without telling his teacher, and the teacher called asking what they had done differently, because he was so much better in class.  That is exactly my experience with Ritalin, as well.  My teachers could tell on which days I had forgotten to take my pills, and I could, too.  I could tell that I was getting out of control, that I was talking too much, fidgeting too much, being a distraction to myself and others.  But I couldn’t stop myself.  That is a strange feeling, to know consciously that you do not want to do something, and then have your body do it anyway.  That is what A.D.D. and A.D.H.D. is about.

I do admit that these disorders seem to be over diagnosed, it seems to be an easy out for parents or teachers who want order and nice disciplined children without putting in the effort to teach or train children properly.  Just because a kid doesn’t like sitting still at his desk at school does not mean he has A.D.D., it may just be that he’s bored, uninterested in the subject matter or the teaching method, or it may be that he’d rather be outside playing ball.  Perfectly normal. Just because a child is fidgeting or talking a lot does not mean there is anything wrong with him.

But at the same time, a child who is a little disruptive does not mean that parents or teachers have failed him.  There very well could be a legitimate medical reason and medication could be both helpful and necessary.  I will tell anyone who asks that I took Ritalin for seven years in school, and that I needed it.  I could tell, and my teachers could tell, when I had not had my medication, and I noticed a significant difference in my behavior and my grades.  I was a smart kid, but I found it hard concentrate and do my work.

A.D.D. and A.D.H.D. are complicated disorders that are not completely understood.  The debate will continue.  Should we medicate our children or should we tell parents to toughen up and learn how to control their children?  Or should we find the harmonious middle ground – parents should do more to help their children, and not look for excuses to blame others, and sometimes it is necessary to use medication.

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5 thoughts on “The Great A.D.D. Debate

  1. Ted

    One way you can tell if your child has something that is actually biologically based (rather than just a perception of the mind or culture) is the fact that several ADHD medications are actually stimulants, not depressants as most people think. The fact that stimulants wind your child down, rather than wind your child up as would be expected, reveals that there is probably a biochemical deficiency in the child (which is no different than a child who has diabetes because of an insulin deficiency; no need to stigmatize).

    The issue is a very personal one, and should be the matter between parents, child, and physician. Glad to see medication is being provided at an earlier age with the right restraints to try and prevent over-medication.

  2. dteeps

    True comment, though I had a childhood development class at BYU and the professor mentioned that recent research seems to suggest that the reason why stimulants work to calm children with ADD or ADHD is that they are bored and their brains need more stimulation, which is why they cannot sit still and pay attention. So, giving them a stimulant is enough to keep their brains happy and engaged.
    From my own experience, this seems to be, at least in part, true. I know that I could sit still for hours, as long as my mind was engaged, with a book or something else interesting. But my brother, who had ADHD, did not find books engaging enough to keep him occupied.
    I think ADD and ADHD are a spectrum of disorders and they manifest themselves differently in different children. Some solutions work for some kids and others for others.
    Also, because the drugs that treat ADD and ADHD are stimulants, that causes problems when doing a placebo test to diagnose. That is what they did a lot with Ritalin in the early 1990s, they would give a kid Ritalin and see if he could concentrate better – of course he could! Ritalin is a stimulant, which is why there is an underground drug selling scene in some high schools and colleges, with kids buying these drugs to help them do better on tests. There are ways of diagnosing ADD and ADHD, but a strict placebo test is not as effective as we previously thought.

  3. Ritalin ’round the board to make it fair for all? Kidding, of course. Reminds me a bit of my article last year (http://sociopolicom.lotsaoxen.com/2010/11/our-societys-preoccupation-with.html). I do think there are real reasons for medication/diagnosis, but more so at an older age than a younger one. ADHD to me is much like autism. It exists, but I’d say in far, far lower numbers than you see in that map (probably closer to 1%). If you get much higher in frequency for any diagnosis, it’s often no longer a disorder, but simply a normal behaviour.

    1. As a side note, since ADHD is less of a disease, and isn’t “cured” per se beyond growing out of it and getting older, I don’t see the benefit of medication for those younger (i.e. before K-12). At very young ages, that’s where the benefit of having a mother at home comes in. If the child can’t handle focus in preschool, don’t put them in preschool. Keep them home another year. I survived without it.

      Once the child reaches an age where they require focus in the school structure, then it can be a consideration.

      1. dteeps

        Good point, I don’t know if I would ever advocate medicating my children before 2nd or 3rd grade. I started Ritalin in the 2nd grade, but it wasn’t just the concentrating and focusing, I was very socially deficient and was a large disruption in class. So, for the sake of my children’s classmates, I would consider it as well.

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