Thomas Fiffer exposes three inconvenient truths about adults and wonders if children’s “attention deficit” is nothing more than the lack of a compelling message?
At the end of March, Esquire published an article titled “The Drugging of the American Boy.” Author Ryan D’Agostino opens the piece with a startling line: “By the time they reach high school, nearly 20 percent of all American boys will be diagnosed with ADHD.” He goes on to question the mass diagnosis of ADHD, to lament the prescription of dangerous stimulants for millions of children who may not need them, and to list some of the devastating side effects of these drugs, which include: symptoms of bipolar disorder and psychosis, weight loss and insomnia, paranoia and facial tics, suicidal ideation and sudden death. Most powerfully, he cites the often shockingly brief and inadequate diagnostic process that physicians employ.
Imagine you have a six-year-old son. A little boy for whom you are responsible. A little boy you would take a bullet for, a little boy in whom you search for glimpses of yourself, and hope every day that he will turn out just like you, only better. A little boy who would do anything to make you happy. Now imagine that little boy—your little boy—alone in his bed in the night, eyes wide with fear, afraid to move, a frightening and unfamiliar voice echoing in his head, afraid to call for you. Imagine him shivering because he hasn’t eaten all day because he isn’t hungry. His head is pounding. He doesn’t know why any of this is happening.
Now imagine that he is suffering like this because of a mistake. Because a doctor examined him for twelve minutes, looked at a questionnaire on which you had checked some boxes, listened to your brief and vague report that he seemed to have trouble sitting still in kindergarten, made a diagnosis for a disorder the boy doesn’t have, and wrote a prescription for a powerful drug he doesn’t need.
This week, my colleague at The Good Men Project Neil Hill posted a video from the Citizens Commission on Human Rights (CCHR) called “Labeling normal kids ‘mentally ill,” that highlights how normal behaviors of boys, particularly those with high energy, can result in an ADHD diagnosis and subsequent medication. My favorite part of Neil’s article, titled “America, Please Stop Drugging Your Children,” is his list that redefines some common personality disorders as valuable personality attributes.
Social Anxiety Disorder – Humanitarian
Oppositional Defiant Disorder – Leader
General Anxiety Disorder – Activist
Attention Deficit Disorder – Inventor
Attachment Disorder – Healer
Bipolar Disorder – Artist
Personality Disorder – Philosopher
Conduct Disorder – Revolutionary
…and many times for ADHD we can just say – Kid
I’ve often complained about my younger son’s leadership qualities being labeled as oppositional or defiant, and I’m fond of saying to my older son, who has been diagnosed with ADHD, that a deficit of attention is nothing more than the lack of a compelling message. When the Esquire article hit The Good Men Project’s writer’s group, I offered to write a response from the angle of why as a society we seem so eager and willing to medicate our kids. Yes, big pharma’s marketing and desire for profits are a factor. Yes, schools’ zero tolerance policy for any sort of behavior they consider disruptive plays a role. Yes, children are subject to different stimuli than they were 20 or 30 years ago, when I was growing up and my mother didn’t allow me to go the new video game arcade in town and play Pac-Man, because she was afraid it would ruin me for schoolwork and put me in with the wrong crowd. Yes, kids diagnosed with ADHD often get more time to take their college entrance exams. And yes, we have, on the whole, become medically and psychologically more sophisticated.
On this last point, however, it’s important to keep in mind that many personality and behavioral “disorders” and conditions have not been proven to exist independently in nature or our neural biochemistry. You can’t see them under a microscope or reveal them with a CAT scan. They are, for the most part, a group or package of behavioral traits on a checklist that appear together in enough people to cause psychiatric professionals to assign them a label. In this sense, they are not much different from talents—such as athletic prowess—or aptitudes—such as math skills—that also characterize certain groups of boys and young men. When society views something as a benefit, we call it a talent, an aptitude, or a skill. But when we view something as a detriment or likely to interfere with a person’s ability to operate in our established systems, play by our rules, and function within our prevailing boundaries of behavior, we are all too quick to label it a disorder or a disease. Talents, aptitudes, and skills are innate characteristics to be developed and enhanced through learning and practice, while disorders and diseases must be treated and cured. So much of our problem lies in the label itself. D’Agostino doesn’t question whether ADHD is real diagnosis, which I also don’t dispute. But the best “prescription” for a high-energy or spirited child might be a high level of physical activity and encouragement of participation in sports, an appropriate diet, sleep regimen, etc., while the Rx for a child with ADHD is inevitably Ritalin or Adderall.
But there is also another factor at work. Parents, not children, are responsible for the decision to medicate minors. And some, as I did with my older son, agonize over that decision. In my case, we did not go with a stimulant but with a blood pressure-reducing medication that is said to help calm impulsivity. And it helped. His ability to focus and performance in school—both academically and socially—improved. But the cause of the impulsivity remains unclear, and I will tell you that this kid can focus for hours and apply himself diligently to any topic that interests him.
— Tom Fiffer (@tomaplomb) April 4, 2014
So why are many parents, millions of them, all to ready to trust the primary physician’s 12-minute diagnosis and start their kids on pills? I believe it’s because as a society, we tend to overprescribe medications that have proven helpful for serious conditions when we encounter minor versions of those conditions that are simply inconvenient. Al Gore showed us how much we don’t like inconvenient truths and the efforts we expend to sweep them under the rug. If as studies and articles suggest and experience dictates adults are willing to take anti-depressants for a quick lift when they are not clinically depressed; take anti-anxiety medications to deal with the stress of weddings, job changes, or the college admissions process; and take Viagra not to address ED but simply for better, longer-lasting sex, it’s not surprising that these same parents might be willing to medicate their children instead of looking into therapeutic and behavioral approaches to make them more docile and easier to discipline at home and try to improve their attention and performance in school. Overprescription of adult medications is a serious problem, and one that has ripple effects for kids.
Here are three inconvenient truths we don’t want to face.
1. Parents’ work schedules result in children getting less of the healthy attention they need, and a great deal of parent interaction with children today is driving them back and forth to their various scheduled activities.
2. School curricula, schedules, and physical facilities have not kept pace with rapid changes in technology, student access to information, and research on styles of learning, and much of what happens in today’s classrooms —in particular teaching to the test—is uninteresting and surely not compelling, especially for bright students.
3. Sometimes hard work that takes time, as opposed to an easy fix from a bottle, is the healthier long-term solution to a problem.
The focus of the second half of D’Agostino’s article is on Howard Glasser, whom D’Agostino describes as “one of those countercultural clinicians who, as American society has become inured to giving psychotropic drugs to kids, has built a practice predicated on opposing the very idea.” Glasser, who grew up with the typical profile of ADHD—hyperactive, defiant, difficult—calls his method the Nurtured Heart Approach.
You nurture the child’s heart. If a child is hyperactive and defiant and has trouble listening and concentrating, Glasser feels it is our responsibility as a society—as grown-ups—to do everything we can for a child’s heart before we start adding chemicals to his brain, because what if his brain is fine? What if the diagnosis isn’t right? And even if it is, what if something else works?
D’Agostino describes the brilliance of Glasser’s counterintuitive approach, which focuses on positive reinforcement instead of negative consequences, using the metaphor of those “dangerous” video games my mother prevented me from playing.
What if he told the children how great they were when they didn’t break a rule? It would be like a video game. When you do something great while playing a video game—when you simply do what the game expects—you get points and you get to keep going. When you go out of bounds or break one of the game’s rules, no one yells at you or reminds you what rule you’ve broken. You simply miss a turn or lose points. And there is no grudge once you pay the fine.
The Esquire article is laced with statistics, rich in detail, and worth reading in its entirety, though a video like the one Neil Hill put up has more immediate and visceral impact. My purpose in writing this piece, besides drawing attention to the issue, is to encourage us, the same way Howard Glasser does, to view the problem of overmedicating children through a different lens, one that might help us understand its causes and promulgate appropriate and effective solutions.