Is it just me or have you also noticed that our children no longer just have different personalities? No, they have a “disorder” or a “deficit” or “cooties”. Especially if the personalities are, shall we say, difficult to live with. When I was my daughter’s age I was considered the class clown (oh, don’t act so surprised!). I’m afraid now I’d be diagnosed with ADHD, Attention Deficit/Hyperactivity Disorder. A Double whammy, both a deficit and a disorder! ADHD, the New Bratiness
ADHD is when your child (or you adults can have it, too) can’t seem to concentrate. He gets bored easily with things that don’t interest him. He may become disruptive and act out. He has trouble controlling himself. He isn’t always “nice.” You get notes from his teacher. It’s a disorder that millions of Americans suffer from, kids and their parents. And it’s been classified as an official disability under the Americans With Disabilities Act (so you’d better cut your employees some slack when they can’t get that report to you because they’ve spent all day shopping on E-Bay…they’re not goofing off, they’re coping with a debilitating illness).
I heard one expert say that people afflicted with ADHD are unable to stay focused enough to complete boring tasks, but if they are doing something they enjoy doing they can concentrate for hours. My question is, is this really a disorder? To me it sounds like complete sanity.
I know my daughter's mother and I are not alone in having been asked to have our daughter tested. We’ve compared notes with our fellow parents and her teachers. Nearly everyone in our daughter’s class was also nudged about this. So we had her tested. She had two days worth of tests by professional psychologists with actual PhD’s from accredited institutions. A week later we got back voluminous reports and incomprehensible scores which informed us that she may show tendencies toward attention deficit and that further evaluation may be warranted.
May have? Further evaluation? I want to know now, is she or isn’t she?
These things take time.
This is when I found out that there is no such thing yet as a quick test for ADHD…you know, like when you stick your arm in that machine at the pharmacy and it tells you your blood pressure and your likelihood of having a learning disability?
Altogether I’ve consulted with four psychologists and a psychiatric nurse who specializes in ADHD. Unlike me, all of them were reluctant to leap to conclusions. They were maddeningly responsible. All tried to calm me down and point out that such a diagnosis often takes months of old-fashioned observation and study (family dynamics, mental health history, and stuff). And all said the same symptoms could be masking other things; you know, all the more boring and unfashionable disorders like depression or anxiety. (Actually the psychiatric nurse wasn’t so reticent about her opinion about whether Ellen had it, “Pffft. You want to see kids with real ADHD? Come to my clinic.”)
Lengthy evaluations? I don’t have time for that!. My child may have a disorder!
Of course the big question on my child-of-the-sixties brain was DRUGS. I talked to a lot of parents (who shall, for obvious reasons, remain nameless) who swore by Ritalin. “Difference between night and day,” was a phrase that came to mind frequently. “Suddenly he could concentrate,” was another. “Helped her get through the day…and me, too,” was still another. Sounded good. Get us some of that good stuff.
Gimme That Drug, NOW!
But then that high pitched voice in my head (no, not that one, the other one) spoke up and started nagging me. “Drugs bad. Drugs bad. Just Say No. Redrum. Redrum.,“ and some other stuff I couldn’t quite make out. But I did stop to think (something that does happen occasionally to us ADHD sufferers) about the implications of putting my daughter on long term meds. Reading on about Ritalin I learned that it’s related to amphetamines (on its mother's side). Hmm. But everyone I talked to says it’s not addictive. Hmm again. It seems I distinctly remember some popular wisdom in the eighties that described another psychotropic drug as being non-addictive. What was that drug? Anyway, not important.
Then I read about a five year University of Maryland study of some 200,000 kids in which they found a 300% increase in the prescription of Ritalin. This drug was being given to 2 and 3 year olds for crying out loud (literally). And you can’t get much more ADHD than a typical 3 year old. The study also revealed that the drug was usually prescribed by pediatricians on the recommendation of the children’s teachers. A New York Times article (NY Times, Feb 20, 2000) on the subject said, “… experts speculated that the reasons might include the reluctance of HMOs and subsidized medical care programs to pay for counseling or other treatments that do not involve drugs, the pressures from parents and schools to diagnose children with attention disorders, the rise of drugs as the preferred mode of treatment and the fact that most prescriptions in subsidized settings are written by primary care doctors rather than specialists.”
I read in the medical description of methylphenidate hydrochloride (as Ritalin is known to its close friends) from the online drug database, RXList, and found these possible side-effects, “Nervousness and insomnia are the most common adverse reactions but are usually controlled by reducing dosage and omitting the drug in the afternoon or evening. Other reactions include hypersensitivity (including skin rash, urticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vasculitis, and thrombocytopenic purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia; drowsiness; blood pressure and pulse changes, both up and down; tachycardia; angina; cardiac arrhythmia; abdominal pain; weight loss during prolonged therapy. There have been rare reports of Tourette's syndrome. Toxic psychosis has been reported” Hm, “toxic psychosis?” That doesn’t sound good. Though I’ve been assured that Ritalin is not addictive, I read on, “Careful supervision is required during withdrawal from abusive use, since severe depression may occur. “ But it’s not addictive.
Oh, I just remembered the name of that other drug in the eighties that promised increased performance without the risk of addiction. Cocaine.
But…let’s assume that popular (as opposed to professional) belief about Ritalin as being non-addictive is true and that it can help our kids’ performance. What about when they get more active in sports and want to take a little something to enhance their performance there? Steroids for instance. What do we say then? “Well, honey, that’s completely different.” You see where I’m going here.
Something’s not right. Is there really a sudden epidemic of ADHD going on? The DEA (a really credible source) estimates that 15% of American school children are on Ritalin, a 700% increase in the last decade. But research to date indicates that the incidence of actual ADHD in the population is somewhere between 3 and 5%. Which would mean that 5 to 3 times as many kids are on Ritalin as really need it. Did I say there would be no math?
What could be causing this seeming over-prescription of Ritalin? It couldn’t be a conspiracy of the drug companies in collusion with the HMOs. What would they have to gain by it?
You could have it. Your neighbor could have it.
Then it hit me. Maybe ADHD has an evolutionary advantage.
I happened to see this entertaining video by this cool and funny psychologist, Daniel Amen (isn’t that a great name?) who can instantly spot an ADHD sufferer just by looking at the inside of their car (long term evaluation, my foot!) He’s that good. According to Dr. Amen, there are several clear signs of ADHD. An incomplete list runs like this:
- A sense of underachievement (That’s me!)
- Poor organizational skills (It’s like he’s known me all my life!)
- Chronic procrastination (Me again)
- Uncompleted projects (But it was raining!)
- Poor handwriting (I was pre-med in college for just that reason)
- Tires easily (yawn)
- Tactlessness (have you gained weight?)
- Easily distracted, short attention span (what was this list for?)
- Impulsive (let’s sell the house!)
- Restless, fidgety (yeah, yeah, yeah)
- Difficulty waking up (I’m not a morning person)
- Trouble getting to sleep (I’m a night person)
- Performs worse under stress (I thought it was just me!)
- Often creative, intelligent, successful (something I’d like to fix in my life, I can tell you)
- Frequent use of parentheses (uh….)
- The list goes on (ad infinitum)
Holy Ubiquity, Batman! That could mean any of us! What’s more, Dr. Amen says, many ADHD sufferers tend to be very creative, brilliant, accomplished people. Einstein, it is speculated, had ADHD. And Mozart. But, says, Dr. Amen, think of how much more creative and successful they could have been if they’d had the tools (drugs) to manage their ADHDness. Okay, Dr. Amen, I’m thinking. That’s probably why Einstein was so stupid he couldn’t reconcile his theory of general relativity with quantum mechanics. Of course! It’s all so simple now. Thank you, Ritalin!
But… But… Dr. Amen, sir, what if it’s the ADHDness itself that is responsible for creativity? Does anybody really know? Getting back to my original theme, is it really a disorder after all? What if it’s actually a survival advantage in this frenetic culture we’ve built around ourselves? I mean, if it’s really getting more widespread, it must have some useful purpose. The gene that causes sickle-cell anemia, for instance, was also important in combating malaria. Maybe the gene that is responsible for ADHD was important in discovering general relativity and writing the Jupiter Symphony. And maybe it’s the rest of the non-ADHD population that should be taking drugs to keep up. (Just kidding, officer, it’s my Tourette’s Syndrome talking.)
Years ago, I read an Arthur C. Clarke novel, Childhood's End, about what happens when the human race experiences an evolutionary leap in a single generation. The new children were almost a different species; smarter, quicker, more creative, and without patience for the slowness of the old world. Maybe that’s what we’re experiencing now. The world’s environment is rapidly changing. Why should we be surprised if our species adapts to it? And haven’t you noticed that the kids seem to be getting taller?
But I never finished the novel. So I don’t know what happens.