Are We Paying Attention or is Ritalin Mothers Little Helper
Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) are increasingly being discussed interchangeably. It has captured the attention of researchers everywhere. With this disorder there exist prevailing evaluations, and positive reinforcements, behavior modifications which impact children with special needs. Often times, behavior is associated with learning, for example, out of seat behavior and hyperactivity. The various learning problems, theories, diagnosis, and conventional views of the disorder will be addressed. Testing is being done using psychological in conjunction with and without medication for the treatment of ADD. The widespread use of a controversial drug, Ritalin, and the possible side effects on children are being researched.
According to the Diagnostic and Statistical Manual of Mental Disorders of the American psychiatric Association, Attention Deficit Hyperactivity Disorder (ADHD), also known as Attention Deficit Disorder (ADD) has been diagnosed in epidemic proportions. (Hallowell, Ratey, 1994 Pref). Over the past fifteen years there has been an increase in the diagnosis of ADD. In a report written by Louise Palmer (Star Tribune, Jan 30, 1994 1E+), she writes that doctors, psychologist and social workers say that a media blitz has turned ADD into the buzzword for the 90s, the catchall for overly anxious kids. Members of the community now suspect that a disturbing trend is
emerging. One Doctor, Eugene Arnold, a researcher at the National Institute of Health says ADD is rising, and there are many others who join in his sentiments. (Star Tribune, Jan 30, 1994 1E+). The media has created a controversy by questioning the reality and extent of ADD, medication for, and over diagnosis of this inherited neurological syndrome.
It is estimated that there are over two million children in the United States diagnosed as having this disorder (Newsweek, Mar 18, 1996 pp. 50-56, Psychology Annual edition 1998. 191). This disorder is characterized by behavior that is disruptive and disturbing to others in the childs environment. Children with ADD have a difficult time paying attention, and staying focused. They are least interested in routine tasks and quickly tire of them. In addition, they are impulsive, fidgety restless, and overly active, when it calls for quiet and subdued behavior. While it is generally difficult for the child to remain on task the child he is chastised for his lack of motivation (Ingersoll, Goldstein, 1993).
Children growing up with ADD have problems in school and that is where it is first noticed, because the environment requires the student to sit still and concentrate on material the child usually finds boring. Because of their lack of self-restraint they are often looked upon as a negative force in the classroom. Most ADD kids are generally smart, not to say that some could be below average, but only 10 to 15% of children have a learning disability along with ADD (Phelan, 1993 pg. 25). As a result of the
problems, as well as not being properly diagnosed, most children are destined to be underachievers, and learn at an early age not to like school.
Children with attention problems face a challenge in todays schools. Not only are the children coping with teachers and even parents who do not understand ADD. Parents frequently receive calls from the teacher about the childs behaviors (they cause problems in the classroom when it takes for the child to stay focused.) They need more attention than average children do which bewilders the teacher. They complain to parents about unsuccessful attempts to discipline the child, and often feel at a loss to provide a meaningful educational experience. These teachers end up labeling these children as lazy, unmotivated, or underachievers. This means the child is penalized for his attention deficits. Just as they may be the constant disruption in the classroom, homelife unfortunately produces other general discipline problems, being noisy, sibling rivalry, while most times the child with ADD is the instigator.
There have been a variety of terms used to describe this condition. These terms include minimal brain damage or dysfunction (Hallowell, Rathy, 1994 pg. 10). This disorder could affect adults as well as children, although children are the biggest concern.ADD can be grouped into three categories: Attention problems, impulsitivity, and overactive motor activity. Sometimes all three are not always present, but the majority of the time children diagnosed with ADD have all three symptoms.
ADD may be caused from brain injury or abnormal brain development resulting from trauma, disease, fetal exposure to alcohol and tobacco (Barkley, 1992). Research
shows heredity is a factor. Twenty-five percent of parents of ADD children also have been diagnosed with ADD (Barkley, 1995). Other scientist suggest that certain
neurotransmitters, chemical in the brain that permit nerve cells to transmit information to
others cell are deficient in these with ADD (Barkley, 1995, pg. 58). ADD is diagnosed in a multifaceted approach through a variety of test and evaluations. The American Psychiatric Association has guidelines about how psychologist can make a diagnosis (Annual Review of Psychology, 1987, pg. 497), and serve as a step towards identifying the assessment and treatment of ADHD. The guidelines are as follows:
1. Evaluate and treat the whole person.
2. ADHD should be suspected not presumed.
3. Comprehensive assessment is necessary for accurate diagnosis.
4. A qualified professional evaluates and treats.
5. Diagnosis should be standardized according to DSM-IV ADHD criteria.
One doctor who runs the University of Chicago Hospitals attention disorder clinic rest the blame on parents, saying that they are incapable of giving the attention and time the children need. He states that a parent would much rather hear that their child has ADD than social-emotional problems. If the blame lays with the schools, doctors or pediatricians, it is often because they do not have the knowledge or resources to diagnose, and with every passing year we come closer to learning more about this phenomena.
ADD has been referred to as over-diagnosed misdiagnosed, an excuse for poor parenting. In the February 1997 issue of ADHD Report, Dr. Russell Barkley reports on a
research article published in the December 6, 1996 edition of Pediatrics entitled Increased Methylphenidate Usage for Attention Deficit Disorder in the 1990s. Dr.
Barkleys research indicates a rise in medication due to longer treatment, and an increase in adolescents being diagnosed he further states that results of this study help to correct misleading information from the media that medication use is rising. The findings indicate or rather suggest that only 50-60% of children diagnosed are receiving medication, seriously questioning the perception that the United States is over medicating. If the latter were the case, prevalence rate for use of stimulants would exceed the base rate for the disorder. In addition, Dr. Barkley states (1992, pg. 13), although inattention, overactivity, and poor impulse control are the most common symptoms, he suggests that non-compliance is a primary problem. However, some health care professionals, researchers, and experts in the filed have not been able to separate the behavioral from the cognitive. As Russell Barkley states he believes there is something wrong with these children, and is a strong supporter of medicating them, blaming them for the conflicts they have with parents, and school.Mr. Barkley acknowledges these symptoms in the children; he does not question the authorities in the childs life, such as parents and teachers. Equally important because they have much more control over the conditions that govern the childs life and consequently their mental condition.
In regards to treating the core symptoms of inattention, hyperactivity, and impulsivity, it has been shown in numerous studies that stimulant medication provides
significant benefits to between 70 and 80% of children with ADHD. The most commonly prescribed medication used to treat ADHD is Ritalin (the generic form is
called methylphenidate), although numerous other medications are also used. (Ingersol, Goldstein, pg. 88) It is not known exactly how the medication works, but available evidence suggests that it works by correcting a biochemical condition in the brain that interferes with attention and impulse control. The beneficial effects of stimulant medication treatment can be dramatic. Attention to assigned class work can be improved to the extent that the child is no longer inattentive; activity level can decline to within normal limits and impulsivity can be substantially reduced. (Armstrong, 1995, pg. 55) Interactions between parent and child and between the child and his or her siblings have also been shown to improve. (Hallowell, Ratey, 1994, pg. 239) Academically, children who respond positively to medications show improvements in the quantity and quality of work they complete. It remains to be seen however, if the effects on childrens academic, behavioral, and social functioning improve. The safeties of Ritalin for treating ADHD have been documented in over 150 controlled studies. Despite this amount of support for stimulant treatment, several cautions need to be kept in mind. These include:
? The majority of these studies were conducted with school age children and the available evidence with other age groups is much more limited.
? Over 80% of studies done prior to 1997 examined the efficacy of Ritalin.
? Almost all studies are very brief not more than a few in duration.
? Over 80% of studies done prior to 1997 examined the efficacy of Ritalin
? Almost all studies are very brief not more than a few in duration.
? Most studies have been restricted to caucasian males. (qtd. In Hallowell, Ratey 250)
As with any medication the side effects include sleep difficulties,
stomachaches, headaches, loss of appetite, drowsiness, irritability, nervousness. In very rare cases, the medication can lead to nervous tics, hallucinations, and bizarre behavior. There are however, a number of myths concerning medication that discourage many parents from considering its use. These myths include the following:
? Children treated with stimulant medication will become addicted to it and are more likely to abuse other drugs.
? Stimulant medication stunts growth.
? Stimulant medication works by turning children into zombies. (qtd. Ingersoll, Goldstein, pg.92)
Some children do become sluggish and withdrawn, but these symptoms indicate that the dose is too high. Studies have shown an increase in social behavior in the children
treated, which would not be the case if it simply turned children into zombies. ( Ingersoll, Goldstein pg. 93.)
It has been documented that as many as 20-30% of children do not experience significant benefits. Due in part mainly to some children receiving a placebo. (Ingersoll, Goldstein pg. 105.) The most common required medication is 2-3 doses per day. The effects of the medication usually wear off within 3-8 hours. For children whose symptoms are mild, a medication during the school day is all that is needed. Unfortunately, more severe forms,
where the child still has difficulty behaving may require medication outside of school hours.Most experts agree that medication should be used in moderation. Some parents, who were only administering medication during school hours, have noted that the desired behavior was achieved in school, but terrible behavior at home.
In a journal article written by Dr. Peter Breggin, (Breggin, pg. 55-72), he believes that symptoms will disappear when the children have something interesting to do, or when they are given a minimal amount of attention. In Dr Breggins experience he feels that most children are not receiving enough attention from the their parents. His theory is that when treated with respect, the children tend to respond respectfully. When loved, they tend to love. These are areas that should be discussed during the evaluation process for diagnosing; most doctors dismiss this intrinsic diagnosis. When parents of children with ADD are asked about abnormal psychosocial relations, they may not readily report unhappiness or discord, lack of warmth or physical abuse, either because they are not aware of these problems or because they may want to hide their own negative interactions
with their children. Yet, so quickly in great numbers these children are being diagnosed with a mental illness (and just as quickly prescribed Ritalin)a label that can follow them into adulthood, to ruin their future lives.Dr. Breggin states the cure for these children is more rational and loving attention from their parents. Most people today
crave the attention of a parent, who is caring, relaxed and firm role model. Most contemporary experts agree that Ritalin affects all children the same. The effects have a
paradoxical effect, at the doses prescribed children are spaced out, not in touch with their
feeling, and that is how they are able to concentrate on schoolroom tasks. In contrast to Ingersoll, Goldsteins, beneficial effects on medication, Dr. Breggin states quite the opposite:
Drug induced compliant behavior may be accompanied by isolated, withdrawn, and overfocused behavior. Some medicated children seem zombie-like: and the doses make ADHD children more somber, quiet, and still. May produce social isolation by increasing time spent alone, and decreasing time spent in positive interaction on the playground. (45)
Parents are seldom told that methylphenidate is speed and that it is pharmacologically classified with amphetamines and causes the very same effects, side effects, and risks. Yet this is well known in the profession. For example, Treatments of Psychiatric Disorders observes that cocaine, amphetamines, and methylphenidate are neuropharmacologically alike (American Psychiatric Association 1989, p. 1221).
Children can benefit from guidance in learning to be responsible for their own conduct; but they do not gain from being blamed for the trauma and stress that they are exposed to in the environment around them. They need empowerment, not diagnoses and mind disabling drugs. Most of all, they thrive when adults show concern and attention to their basic needs as children.
All in all the controversy of ADD is that there has been difficulty in agreements on basic characteristics, and the issues concerning whether treatment should focus on the behaviors of these children, or should treatment with stimulant drugs be used. Conflicts
arise because each child is unique, and more research is needed so those doctors can at least know what type of child are the subject and the underlying problems that surface in order to diagnose correctly. The label is attached to children who probably are only missing love and attention from an adult. As a result the prescription medication to children is largely justified on the basis of initial diagnosis. Although in a vast majority of cases where medication is felt to be appropriate treatment Methylphenidate (Ritalin), is the drug of choice. Each childs symptoms need to be managed effectively through other means including behavioral interventions, which should always be tried first. In short, our children relate to us mostly through home and school. In both places we need a new devotion to parenting and giving our children a more caring connection with us. Conflict can be more readily resolved as it ideally should be through solutions rather than through promiscuous overdiagnosing just to clear anxiety and frustration. Therefore Ritalin alone is not enough to straighten out a hyperactive, short attention span child.