Creating Optimism

 A little while ago I was asked to speak to parents and teachers at a large private school in Sydney on ADD/ADHD. Many schools in Australia and the US have a serious drug problem due to the over prescription and school-yard sale of Ritalin, a form of speed.

I told the audience that I didn't believe that Ritalin, and similar drugs were the only, or even the best, form of treatment for the apparent ADD symptoms that their children presented. As with other audiences where I have said the same thing, most of them were looking for something which would 'fix' their kids without looking too closely at the family dynamic or taking too much time away from the earnest business of making a living or teaching a class.

For some reason Western Australia has the highest proportion of its child population diagnosed with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) of any Australian state. Twice the number of WA kids (6% of the entire school-age population) are on anti-ADD drugs (mostly Ritalin) there as compared to half that number in New South Wales. Is there something in the Western air which leads children there to breathe in the disorder? I think not.

The same pattern of variation in diagnosis and prescription occurs in the USA. The difference lies in the climate of opinion in the local medical/psychiatric profession rather than in the children. The problem is that it's not just aggressive marketing by the pharmaceutical companies that is to blame, it is the aggressive demands of parents for a chemical fix for their unruly kids and the willingness of local doctors to comply.

What, exactly is ADD/ADHD? There are really no agreed diagnostic formulas for the disorder though the American Psychiatric Association lists fourteen signs which include:

• Having difficulty remaining seated when required to do so
• Having difficulty awaiting a turn
• Having difficulty in sustaining attention
• Talking excessively
• Often shifting from one uncompleted task to another

Almost any child could be classified as having the disorder on the basis of these criteria. The difference between an ADD/ADHD kid and a normal youngster is often, in the final analysis, in the eyes of the parents and their physician. Often the diagnosis will be made on the basis of one brief visit to a doctor. An adequate assessment cannot possibly be made under these conditions. Unsurprisingly the disorder seems to affect boys more than girls!

However there is a real problem, and a growing one. Even allowing for the variation in diagnosis. The number of children in the US diagnosed with the disorder has risen by 600% since 1990. In the UK the numbers on Ritalin have risen from 2000 in 1993 to 90,000 today.

Recent research shows that there seem to be two distinct causes of ADD/ADHD, one neurological and the other environmental. In June of last year the British Medical Research Council published a finding that some (but by no means all, or even the majority) children with ADD/ADHD have underactive parts of the brain which deal with decision making and planning. The frontal lobes of such kids are, on average, about 5% smaller. This is what you would expect since the disorder is one of control and that is the control centre of the brain. The same deficiency, only to a greater extent, is seen in the brains of some schizophrenics. ADD, then, may be a result of faulty wiring during the critical phase of brain formation while the child is in the womb.

However the majority of cases of ADD/ADHD are not diagnosed until the child has reached school age. This is where the problem lies. A great deal of research is beginning to show that the root cause of most ADD/ADHD lies in the demands that modern society puts upon its children and on their parents. A seminal study recently completed in Georgia, USA, schools by a team led by one of America's leading behavioral psychologists Professor Alan Fridlund found that there was a direct relationship between the incidence of ADD/ADHD and the physical restrictions placed upon students, especially upon play, particularly outdoor play.

In urban areas playing outside can be dangerous and not always possible, yet the equivalent loud and noisy playing in the house leads to parents, themselves under great strain, restricting play even further. The inability to play outside in a natural environment can rob kids of a sense of danger avoidance — they have not had a chance to develop that sixth sense as to what is and what is not dangerous behavior through natural experience. ADD/ADHD kids are prone to inappropriately dangerous activities. Again play helps in socializing and restricting play leads to inadequate social skills — one of the prime symptoms of ADD/ADHD.

Learning, for our species, historically, has been largely a physical activity — following the hunters, walking with and observing the gatherers. Increasingly we ask our children to sit still for long periods of time and simply absorb information. This goes against our genetic heritage.

It is true that Ritalin and similar drugs can help with concentration. Ritalin is an amphetamine closely allied to 'speed'. In people under the age of puberty it has the paradoxical effect of calming and slowing down the cognitive process and thus enabling the child to concentrate. The problem is that if it is used for a long period of time it is highly addictive, as addictive as cocaine, working, like cocaine, on the neurotransmitter dopamine. The US National Institute of Health recommends that Ritalin should only be used for a maximum of 14 months and certainly never over the age of 12 or below six (Australian authorities have laid down similar 'voluntary' guidelines). Ritalin will alter a child's behavior and thus give his or her parents much relief, but psychotropic drugs will also alter the behavior of 70% of healthy people. Normal kids who take Ritalin will have an increase in concentration. However it has another down-side besides its addictive properties — the drug lowers creativity and problem solving skills.

Another environmental cause of ADD/ADHD, I believe is tension between parents. A child will often unconsciously develop a problem — physical illness or a psychological/emotional problem such as Oppositional Defiant Disorder — as a way of uniting the parents around the problem and thus rescuing the family. Also, though no studies have linked ADD/ADHD to child abuse, there is a fair amount of anecdotal evidence that abuse and the disorder are closely linked.

The answer to the majority of ADD/ADHD cases, it seems to me, lies not in drugs, but rather in the way we treat children and in the expectations we have of them. I would recommend that practitioners dealing with children whose parents or teachers suspect that they suffer from ADD/ADHD should adhere to the following guidelines:

• Insist that no child should be diagnosed with ADD/ADHD without first having a brain scan to determine if the frontal lobe of the brain is neuron-deficient.
• Stress that all children, particularly boys, should be allowed time to play boisterously outside.
• Encourage parents to stop comparing their children's development and scholastic achievements with other kids — all children develop and learn at different speeds.
• Children must be given loving boundaries and immediate and known consequences for breaches of those boundaries (As a Fortinberry Murray practitioner and trainer I have taught many parents, child-care workers and therapists how to establish such boundaries using Needs-Based DialogueTM communication tools).
• Only use drugs as a last resort.

The problem is that there is no non-pharmacological 'quick-fix' for ADD/ADHD and the drug approach is fraught with dangers. The real solution for the child lies often in changing the dynamic of the family and reducing school and social pressures. Except in those neurologically engendered cases, the ADD/ADHD kid will respond to treatment provided his or her parents, teachers and psychologists have the time and patience to devote to the child.