Johnny is restless. He doesn’t seem to pay attention in school, and he is prone to picking fights on the playground. Johnny sounds like a handful, but does he have ADHD?
That’s the question plaguing millions of parents every year. More than 9% of all children in the United States have been diagnosed with attention deficit/hyperactivity disorder at some point in their lives, a number so high it has the medical community engulfed in a debate over whether over-diagnosis is rampant.
Not every kid with a concentration problem, it seems, needs to be popping pills. Two separate studies last year found that teachers and professionals were confusing immaturity with unruliness, erroneously diagnosing the youngest kids in class with ADHD — when they might simply have been acting their age. In one of the studies, Michigan State University researchers found kindergartners who were the youngest in their class were 60% more likely to be diagnosed with ADHD than their oldest classmates.
One of the biggest problems facing doctors, teachers and parents is that the symptoms of ADHD outlined by the National Institute of Mental Health sound an awful lot like a description of childhood itself: “Difficulty staying focused and paying attention, difficulty controlling behavior and hyperactivity.”
“I have a lot of sympathy for parents trying to figure this out,” says Dr. Larry Diller, a Bay Area developmental pediatrician and author of “Remembering Ritalin.” “On the extremes, you know something is clearly off. But it can be a pretty subjective decision on what is normal or abnormal.” In many instances, parents confuse unmet expectations with a medical condition. Bright kids who are not making straight A’s have been dragged into Diller’s office to get prescriptions for Adderall, he says.
“These days if the kid isn’t performing up to expectations, [parents] will drive even a reasonable MD like myself to prescribing medicine,” Diller says. “Our culture has really learned to interpret all forms of child underperformance and a lot of behavior problems as problems of focus and attention. How many times do I talk to a teacher and they say the child doesn’t focus? That is an interpretation.”
Diller suggests asking the child’s teacher to perform a cursory evaluation of the child’s learning ability. Maybe a tutor is all that is needed to do the trick. Maybe the kid’s behavior could be improved with just a good night’s sleep.
“The clear differentiation for ADHD is the fact that it is persistent,” says Dr. Ellie Cannon, a British physician who expounds upon ADHD and other topics on her website http://www.DrEllie.co.uk. “ADHD causes global disruption to a child’s life whereas naughtiness does not — even to the point of having a detrimental effect on relationships.”
Mental health professionals recommend using a system of immediate rewards and consequences to change a child’s behavior. Dole out praise as soon as you see good behavior and ignore, redirect or give a “time out” for any behavior you want the kid to stop.
These interventions might even save these kids’ lives. By learning to control their impulses, children with ADHD could be less likely to engage in risky behavior as teens. Teenagers with ADHD are involved in four times as many car accidents in their first few years of driving than teens who don’t have ADHD, according to the National Institute of Mental Health.
But the crux of the issue is medication. The problem with Ritalin, Adderall, Concerta and the like is that they work. Anyone taking amphetamines will find that they can concentrate better. They’re essentially performance-enhancing drugs, making it nearly impossible for people who take these medicines to objectively determine whether they really need them. “On one extreme, you have people saying Adderall and Concerta are like insulin for diabetics,” Diller says. “On the other, there is this anti-medication position which says, ‘How can you give your kid brain poison?’ ”
Most researchers agree that prescription medication for ADHD does not lead to drug addiction down the line. But people with ADHD are naturally more impulsive and risk-taking, so the condition itself — not the medication used to treat it — could lead to drug use.
Still, drugs should not be the first line of defense, Diller says.
“I prescribe medicine every day, but I believe strongly that before you try medicine you want to try a few things that have been proven to work,” including parenting training, tutoring, therapy and other hands-on approaches.
Still, beond being cautious and asking a lot of questions, Diller admits that even medical professionals struggle with this ambiguous disorder.
“I believe there are a small group of kids who are highly impaired,” Diller says. “For everybody else, the line between normal and abnormal long ago escaped me.”