ADHD is back in the news!
Several recent NY Times articles highlight some alarming realities about children in the United States.
One of those articles focused on the latest findings of the CDC in their recently published National Survey of Children’s Health.
Here are the essential findings.
Nearly 20% of high school age boys and 11% of school-age children over all have been diagnosed with ADHD. That’s about 6.4 million children and adolescents!
During the past decade, the number of children diagnosed with ADHD has risen by 41%! That is, by definition, an epidemic.
Roughly 66% of those children diagnosed with ADHD are treated with stimulant drugs! Our friend and colleague, Psychiatrist Dr. Peter Breggin, years ago called this “a massive experiment in pharmacological engineering the likes of which no society or nation has ever seen before”.
The situation has gotten so bad that even some ardent proponents of the ADHD diagnosis and drugging of children are becoming alarmed. Dr. Ned Hallowell who once wrote, I kid you not, that ADHD is so prevalent in the US because it is part of our national DNA, is now having second thoughts. As recently as a year ago Halloway wrote in a NY Times editorial that Ritalin and other stimulants were “safer than aspirin”. Last week, he said, “I regret the analogy and won’t be saying that again.” He still thinks that many children with ADHD go unrecognized and untreated, but now admits that the high rates demonstrate how the diagnosis is being handed out too freely.
So, what is the real deal with all of this? Do we really have an epidemic of the disease ADHD? If so, why? If not, why are so many children being diagnosed with it? In either case what is the best way to deal with it? And better yet, how can we prevent it? Well, those questions are far too complex to tackle in one short blog so this is going to be a multi-blog effort. Do stay tuned for more reflections on this very important topic in the coming weeks.
One of the striking aspects of the ADHD phenomenon is that it is a distinctly American “illness” or “condition”. I spoke on the subject 13 years ago at the Vatican to a largely international, professional audience and most of those in attendance knew very little about ADHD at a time when it was old news here in the US. I warned them that the train was headed their way and, sure enough, today one finds talk of ADHD throughout Europe and South America.
[callout title=Hallmarks of Homo sapiens…]Creativity, entrepreneurship, independence and vision are some of the finest expressions of the human brain when developed to its fullest potential.[/callout]
Nonetheless, the highest rates of diagnosis and treatment, by far, are in the United States. So why is that? Could Dr. Halloway be right about there being a distinctly American gene for ADHD? He suggests that people who were distractible, impulsive and restless but also creative, entrepreneurial, independent and visionary were the ones who colonized this country. Since all of those are traits (good and bad) of ADHD, ergo, they all had ADHD!
So the reason we see such an epidemic of ADHD in our country and not in others is because we attract those who carry DNA with the same traits of our colonial ancestors! WOW!
While that might be an entertaining subject for conversation at a cocktail party it is ridiculous from a scientific standpoint. And, of course, there is not an ounce of scientific proof. To begin with, the idea that distractibility, impulsiveness, restlessness, creativity, entrepreneurship, independence and vision are indicators of a genetic condition that needs treatment is preposterous on the face of it.
There are a thousand reasons, none of which have the slightest connection to genetics, why I might be distracted, might react impulsively or become restless. The stress of work, insufficient sleep, too much ice cream, lack of self-control… all of these things can affect how I respond to the requirements of daily living.
As for creativity, entrepreneurship, independence and vision, these qualities are indeed part of our DNA. They are some of the finest expressions of the human brain when developed to its fullest potential. They are the hallmarks of Homo sapiens, not of ADHD!
Part of the problem may be an inability of the education system to handle “younger” students in a class. Any parent can probably acknowledge what a difference a year can make in the development of their child. Every classroom essentially has a year of difference in their student make-up. Unfortunately, the younger, “less mature” students are now categorized as ADHD so they can be prescribed a drug and make the problem go away. While not the complete solution, we need to re-think the ages of students in a class and how we handle the spectrum of maturity. Don’t believe, check out these stats from a recent article: http://nyti.ms/UG8wxV.
The trend for youngest students in a class to be prescribed ADHD meds is alarming!
Thanks for your input Eric. It’s scary stuff indeed! When I read your comment the first thing that occurred to me was Malcolm Gladwell’s book “Outliers”in which he describes just such a disparity in functional ability amongst the youngest and oldest children in a wide variety of endeavors from academics to sports. To those of us who view the world through the lens of the human brain and the progressive development of functional ability this makes perfect sense. Sure enough the article you cite mentions Gladwell.
Your suggestion that we need to rethink what we do in school is right on target. We really need to completely dismantle the entire school system and start over again! Check out John Taylor Gatto (http://www.johntaylorgatto.com/) and Ken Robinson (http://sirkenrobinson.com/) for more on that.
However, as important as I think that overhaul is, the ADHD problem is far deeper than that and it will take far more to solve it than simply adjusting what we do in the classroom. Stay tuned to this blog for more on that.
Estoy de acuerdo,hay que desmantelar por completo el sistema escolar por completo y volver a empezar de nuevo,eso que le llaman transtorno ,son las locuras de los dones divinos,y hay que romper la barrera espiritual que no cualquiera lo logra.
Bien dicho, Rodolfo! Todos nacemos con tanto potencial. Es una tragedia cuánto se pierde.
Relating to your comment that “One of the striking aspects of the ADHD phenomenon is that it is a distinctly American ‘illness’ or ‘condition'”, I offer the following statement from World Psychiatry. 2003 June; 2(2): 104–113.
The predominance of American research into this disorder over the past 40 years has led to the impression that ADHD is largely an American disorder and is much less prevalent elsewhere. This impression was reinforced by the perception that ADHD may stem from social and cultural factors that are most common in American society. However, another school of thought suggested that ADHD is a behavioral disorder common to children of many different races and societies worldwide, but that is not recognized by the medical community, perhaps due to confusion regarding its diagnosis and/or misconceptions regarding its adverse impact on children, their families, and society as a whole.
A total of 50 studies were identified … for the years 1982 to 2001. 20 were studies in US populations and 30 were in non-US populations. Analysis of these studies suggests that the prevalence of ADHD is at least as high in many non-US children as in US children, with the highest prevalence rates being seen when using DSM-IV diagnoses. Recognition that ADHD is not purely an American disorder and that the prevalence of this behavioral disorder in many countries is in the same range as that in the USA will have important implications for the psychiatric care of children.
Putting the question of the ADHD diagnosis aside for a moment, I will grant you that the incidence of children with attention issues is universal. One can say the same thing for the incidence of children with learning difficulties, coordination problems, etc. The human brain is the human brain no matter where it is located. A child growing up in China can end up with developmental issues just as easily as a child growing up in Chicago.
However, the diagnosis of ADHD is not universal. At least not yet. I have worked in France with children with developmental difficulties for 29 years. Only recently are we hearing talk of ADHD in France. How do you explain that? For nearly 29 years nobody in France knew what ADHD was and now all of a sudden tons of kids have it and are being treated with stimulant drugs.
All this statement really shows is that the international psychiatric establishment is trying to cast its net as widely as possible. WPA activities receive substantial funding from pharmaceutical companies who are interested in selling their products. This automatically makes anything they say suspect. Their statement “Recognition that ADHD is not purely an American disorder and that the prevalence of this behavioral disorder in many countries is in the same range as that in the USA will have important implications for the psychiatric care of children”, says it all. “Psychiatric care of children” is code for selling more drugs.
The increase in ADHD and ADD, is related to the lack of need fulfillment in gestation, birth and the first years of life. These are the most formative years and the effects of trauma and deprivation have the most deleterious impact on development. This is not to say that later trauma and deprivation do not cause severe suffering, because they do. And it is not to diminish the positive impact of later relationships. My point is that as the nervous system matures the capacity for mediating and the options in response to deprivation and trauma increase. For example an infant that is hungry has few options for need fulfillment. They are limited in making their biological and life sustaining needs know to the caregiver. The infants first response is to show discomfort and then to cry. Hopefully, the infants communication will be responded to immediately and the infant maintains homeostasis as their needs are fulfilled. In the situation where the biological needs are not met the infant suffers. The crying may not continue though the infant is in a high state of stress. If this pattern of deprivation of biological need happens again and again the infant suffers immensely, which means the infant will be in pain with elevated cortisol levels affecting the Entire System. Being touched, to be held, is another biological need in which the same pattern of pain/stress/cortisol response will occur when deprived. We all know that an infant/child can be conditioned to not respond to internal states of need fulfillment. This lack of expression of need does not mean that the need has gone away. Rather the infant or child will just not emote the feeling of need. Deprivation of a calm environment promotes the same pain/stress/cortical response. Biological needs are not many though when fulfilled or not fulfilled, early in life, shape who we become.
I am not writing this to cast judgment or blame on parents/caregivers. My intent is to add understanding as to the consequences of need deprivation in the earliest years of life and why fulfillment is paramount to healthy physical, emotional and mental growth.
Great points, Ken. The answer to the ADHD question is multi-faceted and there is no question but that early experiences and their impact on the developing brain and attachment are part of the puzzle. When we look for explanations for the ADHD epidemic we must be honest. Clearly, pharmaceutical companies are trying to sell drugs, doctors are all too often complicit and teachers just want kids to sit still. So it is easy to toss the blame onto others for their part in this. And they all have their share in the blame. But that still does not explain why so many children truly are having difficulties with attention and learning. One simply cannot deny the reality that a lot of children today are struggling. And if we are going to be honest, we must face the truth that part of the problem is the way that we are raising our children. Much has changed in the last 50 years and the changes have not been good for children. While there is a great need for reform in education there is an equally great need for parenting reform! Creating awareness about what babies actually need early in life, particularly from a biological/anthropological perspective, and encouraging parents to fulfill those needs is an important part of the solution.
I have two brain injuries and I’m on Ritalin. It is really helping me to be focused, alert and to concentrate and pay attention.
Lisa, I am so glad you found some help for the symptoms of your brain injuries with Ritalin. There is no question but that for some people there is improvement in ability to focus when they take it. That is often at the price of other issues but if focus is the objective sometimes medication works. I would suggest, however, that there are many other things you can do to improve brain function that are even more effective than Ritalin. We use them in our work with brain-injured children all of the time.
That being said, there is a big difference between you as an adult with a developed all be it injured brain, making a conscious decision to take a Schedule II psychostimulant amphetamine-like drug, and a child who has a still developing brain and no say in the matter.