ADHD: Part 1 of 3
ADHD - "TO DRUG OR NOT TO DRUG?" - Part I
ADHD (Attention Deficit Hyperactivity Disorder): What is it? Does it exist? How is it diagnosed? What are the conventional treatments available? Do they work? Do they do harm? Are there natural alternatives? Can it be beaten? These are the sorts of questions that must be answered if you are the parent of a child who has been diagnosed with ADHD.
ADHD "AKA" hyperkinetic reaction of childhood, hyperkinetic syndrome, hyperactive child syndrome, minimal brain damage, minimal brain dysfunction, & minimal cerebral dysfunction, among others. ADHD is defined as "inappropriate impulsivity, attention, & in some cases, hyperactivity". It affects ~5% of school age kids (although some articles claim up to 16%!). It affects 10 times more boys than girls. The "abnormal behaviours" are long lasting & arise in early childhood. 3 subtypes are described: Inattentive, hyperactive/impulsive & combined.
Now here's the biggest question there is about ADHD: Does it exist or is it just "normal" behaviour exhibited by a minority of boys? The American Psychiatric Association stamped its authority over this syndrome when it defined ADHD as a mental illness in 1987. This opened the doors to the use of psychoactive drugs as the main treatment of choice. Other experts do not agree with this approach. According to Dr Peter Breggin, Psychiatrist & author of numerous books on the issue, ADHD is "a bunch of behaviours that make it difficult to teach kids in a big classroom".
So, if their is some controversy about the existence, has science been able to settle the argument. "The majority of research suggests a neurobiological basis." That is, something going wrong in the child's brain. And yet, even though ADHD is "1 of the best researched disorders in medicine", the actual cause & mechanism remains a complete mystery. Acording to the National Institutes of Health expert panel in 1998, "we don't have an independent, valid test for ADHD; there are no data to indicate that ADHD is due to brain malfunction; existing studies come to conflicting conclusions as to whether use of psychostimulants increases or decreases the risk of abuse; & finally after years of clinical research & experience with ADHD, our knowledge about the cause or causes of ADHD remains speculative".
How then is ADHD diagnosed, if it is such an illusive "illness". There is "no single test to diagnose ADHD". This is not a problem to be diagnosed by a parent, a teacher, or a GP, although all these should be involved in assessment. Assessment should include academic, social, emotional functions & developmental levels. The majority of diagnoses though are made on the basis of the DSM IV "checklist". This is a questionnaire that reviews the 3 main symptoms; inattention, hyperactivity & impulsivity. To be diagnosed, the child needs at least 6 of the symptoms of inattention, or at least 6 of the symptoms of combined hyperactivity/impulsivity list.
The inattention checklist consists of: 1) Often ignores details; makes careless mistakes. 2) Often has trouble sustaining attention in work or play. 3) Often does not seem to listen when directly addressed. 4) Often does not follow through on instructions; fails to finish. 5) Often has difficulty organising tasks & activities. 6) Often avoids activities that requires a sustained mental effort. 7) Often loses things he needs. 8) Often gets distracted by extraneous noise. 9) Is often forgetful in daily activities.
The impulsivity/hyperactivity checklist consists of: 1) Often fidgets or squirms. 2) Often has to get up from seat. 3) Often runs or climbs when he shouldn't. 4) Often has difficulty with quiet leisure activities. 5) Often "on the go", as if driven by a motor. 6) Often talks excessively. 7) Often blurts out answers before questions have been completed. 8) Often has difficulty waiting his turn. 9) Often interrupts or intrudes on others.
For the skeptics, most could confess to suffering from many of these symptoms. And keep in mind that many boys are now being judged by this standard before school age. I have to say that my own son who is only 3 would struggle with passing the inattention test. But how could we expect any boy under 6 or 7 to live up to this standard?
But there's is actually more to the DSM IV, & these issues are pivottal to the decision as to whether a child's behaviour is "abnormal". 1) The symptoms must be present in 2 or more settings (e.g. home & school), 2) the individual must show "clinically significant impairment", & 3) the individual must not suffer from another mental disorder that could explain the symptoms. With this in mind, it would appear difficult to me to diagnose a child with ADHD before they are old enough to be assessed for dyslexia or some other problem. And yet many kids are being treated for ADHD before the age of 6!
So, beware of the label of ADHD being attached to your child too easily. My main question at this point is "how thoroughly has your child been assessed?" Have they had thorough medical evaluation, educational evaluation, behavioural history, vision & hearing checked, & have other potential emotional causes of your child's behaviour been ruled out?
Next week we will explore how ADHD is managed &/or mis-managed.
HERE'S A THOUGHT:
"The famous Olympic champion Jesse Owens said that 4 words made him: Determination. Dedication. Discipline. Attitude." (Norman Vincent Peale)
ADHD (Attention Deficit Hyperactivity Disorder): What is it? Does it exist? How is it diagnosed? What are the conventional treatments available? Do they work? Do they do harm? Are there natural alternatives? Can it be beaten? These are the sorts of questions that must be answered if you are the parent of a child who has been diagnosed with ADHD.
ADHD "AKA" hyperkinetic reaction of childhood, hyperkinetic syndrome, hyperactive child syndrome, minimal brain damage, minimal brain dysfunction, & minimal cerebral dysfunction, among others. ADHD is defined as "inappropriate impulsivity, attention, & in some cases, hyperactivity". It affects ~5% of school age kids (although some articles claim up to 16%!). It affects 10 times more boys than girls. The "abnormal behaviours" are long lasting & arise in early childhood. 3 subtypes are described: Inattentive, hyperactive/impulsive & combined.
Now here's the biggest question there is about ADHD: Does it exist or is it just "normal" behaviour exhibited by a minority of boys? The American Psychiatric Association stamped its authority over this syndrome when it defined ADHD as a mental illness in 1987. This opened the doors to the use of psychoactive drugs as the main treatment of choice. Other experts do not agree with this approach. According to Dr Peter Breggin, Psychiatrist & author of numerous books on the issue, ADHD is "a bunch of behaviours that make it difficult to teach kids in a big classroom".
So, if their is some controversy about the existence, has science been able to settle the argument. "The majority of research suggests a neurobiological basis." That is, something going wrong in the child's brain. And yet, even though ADHD is "1 of the best researched disorders in medicine", the actual cause & mechanism remains a complete mystery. Acording to the National Institutes of Health expert panel in 1998, "we don't have an independent, valid test for ADHD; there are no data to indicate that ADHD is due to brain malfunction; existing studies come to conflicting conclusions as to whether use of psychostimulants increases or decreases the risk of abuse; & finally after years of clinical research & experience with ADHD, our knowledge about the cause or causes of ADHD remains speculative".
How then is ADHD diagnosed, if it is such an illusive "illness". There is "no single test to diagnose ADHD". This is not a problem to be diagnosed by a parent, a teacher, or a GP, although all these should be involved in assessment. Assessment should include academic, social, emotional functions & developmental levels. The majority of diagnoses though are made on the basis of the DSM IV "checklist". This is a questionnaire that reviews the 3 main symptoms; inattention, hyperactivity & impulsivity. To be diagnosed, the child needs at least 6 of the symptoms of inattention, or at least 6 of the symptoms of combined hyperactivity/impulsivity list.
The inattention checklist consists of: 1) Often ignores details; makes careless mistakes. 2) Often has trouble sustaining attention in work or play. 3) Often does not seem to listen when directly addressed. 4) Often does not follow through on instructions; fails to finish. 5) Often has difficulty organising tasks & activities. 6) Often avoids activities that requires a sustained mental effort. 7) Often loses things he needs. 8) Often gets distracted by extraneous noise. 9) Is often forgetful in daily activities.
The impulsivity/hyperactivity checklist consists of: 1) Often fidgets or squirms. 2) Often has to get up from seat. 3) Often runs or climbs when he shouldn't. 4) Often has difficulty with quiet leisure activities. 5) Often "on the go", as if driven by a motor. 6) Often talks excessively. 7) Often blurts out answers before questions have been completed. 8) Often has difficulty waiting his turn. 9) Often interrupts or intrudes on others.
For the skeptics, most could confess to suffering from many of these symptoms. And keep in mind that many boys are now being judged by this standard before school age. I have to say that my own son who is only 3 would struggle with passing the inattention test. But how could we expect any boy under 6 or 7 to live up to this standard?
But there's is actually more to the DSM IV, & these issues are pivottal to the decision as to whether a child's behaviour is "abnormal". 1) The symptoms must be present in 2 or more settings (e.g. home & school), 2) the individual must show "clinically significant impairment", & 3) the individual must not suffer from another mental disorder that could explain the symptoms. With this in mind, it would appear difficult to me to diagnose a child with ADHD before they are old enough to be assessed for dyslexia or some other problem. And yet many kids are being treated for ADHD before the age of 6!
So, beware of the label of ADHD being attached to your child too easily. My main question at this point is "how thoroughly has your child been assessed?" Have they had thorough medical evaluation, educational evaluation, behavioural history, vision & hearing checked, & have other potential emotional causes of your child's behaviour been ruled out?
Next week we will explore how ADHD is managed &/or mis-managed.
HERE'S A THOUGHT:
"The famous Olympic champion Jesse Owens said that 4 words made him: Determination. Dedication. Discipline. Attitude." (Norman Vincent Peale)
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