Don’t Mistake High Energy for ADHD
Excerpt from Boy Smarts by Barry MacDonald B.Ed, M.A., R.C.C.
Recently a mother of two very energetic boys visited my office with her concern: “It was recommended that boys sometimes need medication to help settle them down so they can learn properly. Don’t they just need to move more?” Another parent reported: “My son appears to be terribly bored and is not doing that well in school. He has trouble sitting in one spot for long periods of time and gets up and moves around the classroom more than the teachers like. Someone said he might have ADHD?”
Any thoughtful discussion about the learning needs of boys must consider the controversies around Attention Deficit Disorder (ADD) and Attention Deficit and Hyperactivity Disorder (ADHD). ADD and ADHD are marked largely by impulsivity and the inability to pay attention. ADHD is also marked by hyperactivity, although ADD could actually manifest as lethargy (zoning out). Students with ADD or ADHD have difficulties with organization, staying on task, and following through. They are also forgetful. Even if they do their homework, they may forget to turn it in. Some consider ADD and ADHD to be neurobiological, while others see it as an artificially manufactured syndrome. Whatever we think about its etiology, it is something that we, who are concerned about the academic performance of boys cannot ignore.
The Vancouver Sun, December 4, 1997, reported that Dr. Thomas Millar, author of The Myth of Attention Deficit Disorder, found that prescriptions for Ritalin in British Columbia soared 430% in a four-year period between 1993 and 1997. At the same time the American Drug Enforcement Administration reported a 600% increase between 1994 and 1999. Millar’s article goes on to claim “…the process by which ADHD is diagnosed is as flawed as the invented category. That process starts with teachers checking items on a list, then telling the parents about ADD/ADHD and what magic Ritalin has worked in their classroom.” Millar criticizes the way that the process of diagnosis of ADD and treatment by prescription de-emphasizes the parental role. He strongly urges parents to get on with the challenging task of learning how to provide leadership for high-spirited children who are difficult to parent.
It turns out that Millar is not alone. In 2001 The World Health Organization declared the use of stimulant drugs to manage behaviour to be at epidemic levels internationally. We must ask whether spontaneity, inquisitiveness, imagination, boundless enthusiasm, and emotionality are being discouraged to create calmer, quieter, more controlled environments. Michael Gurian, an American therapist, educator, and author of several books about boys, claims that nearly two-thirds of those diagnosed with ADD or ADHD have probably been misdiagnosed.
Parents become alarmed when they learn that drugs prescribed for ADHD are central nervous system stimulants and share many of the pharmacological effects of amphetamine, methamphetamine, and cocaine. Does Ritalin and its variants actually help boys perform better academically – or does it merely make the boys and the classroom environment easier to manage in a traditional way? Although the interests of the larger group may be served, I have heard parents say anecdotally that their son’s marks do not necessarily go up. Despite mixed reports about effectiveness of medication to actually boosting academic performance, I suspect that teachers and parents may be so relieved to have more docile boys that stimulant drugs have a certain halo effect.
Surely the medical community cannot be completely off base with ADD/ADHD and the associated prescribing medications. Medical doctors explain that the neurobiological condition of ADD or ADHD does exist. They also have empirical evidence to support the effectiveness of chemical intervention. Additionally, recent brain science confers that a boy’s brain produces less serotonin and so some doctors seek to provide substitute chemicals to make up the deficit. They claim that many boys diagnosed with ADHD and ADD would, without medication, pose a problem to themselves, their family, and community.
Hypothetically speaking, let’s reverse the situation. Let’s say a bunch of medical doctors got together and decided that about 20% of women were overly emotional and lacked the ability to think objectively. They also discovered that these women had higher levels of estrogen. Would we give these women medication to reduce their estrogen levels?
Given the current hardship ADD and ADHD behaviours cause for many families, educators should avoid offering medical advice and instead encourage parents to seek the counsel of their family doctor along with other professionals qualified to comment. Teachers can, however, take steps to help children who show ADD and ADHD behaviours through a few adaptations such as breaking large tasks down into smaller ones, making expectations and instructions clear and succinct and demystifying study and organizational skills by making them very explicit.
My survey of the literature associated with ADD and ADHD has found that drugs should not necessarily be the first option in the treatment of behaviour characterized as such. Often children who struggle with attention problems respond favourably to consistent and structured environments. The medical literature additionally indicates that drugs should only be used in combination with other therapies such as counselling intervention. Counselling support can be especially helpful with boys who are struggling with unresolved trauma that can later present itself as ADHD. Sometimes, rather than counselling boys to become more attentive and focused I advocate that parents seek consultation to learn about additional ways to support their son’s behaviour.
Regardless of the diagnosis, both teachers and parents still need to maintain a positive and understanding connection with a boy exhibiting attention difficulties while also providing a clear and structured environment with ample opportunity for movement and active learning. Most importantly, we need to embrace a boy’s high-spirited nature and not see him as abnormal or defective.
The diagnosis of ADD and ADHD does not exist from a Chinese medicine perspective. Instead, the individual is viewed as having an unsettled heart. The book, Raising Boys tells a wonderful story about a father who was told that his son had Attention Deficit Disorder. In the trucking industry such a term rarely crossed his path at work, but being intuitive, and wanting to help his son with the diagnosis, the father concluded that it meant his son was not getting enough attention. He was determined to help his son by making sure that he got plenty of it. After school the father made great efforts to pick up his son and include him on his last trucking run. They got to know each other better as they discussed their lives and interests. The spatial stimulation and constant movement of their journeying together seemed to free them to discuss previously hot issues. During the holidays they would spend even longer periods of time chatting as they crisscrossed the country. Several months passed before the teacher informed the father that the ADD problem had completely disappeared.
This story makes me wonder if understanding and moral guidance is the real help for ADD for some boys. Perhaps a question we need to consider if we are to respond to a boy’s attention problem is: “What are the needs of the boy and his particular learning circumstances?” While some boys need activity to facilitate learning, some boys need more reassurance to feel valued and appreciated, and some boys need both.
The most precious gifts we can give our boys are love – and time.
Note from One ADD Place owner:
I recently heard Barry MacDonald speak to a group of parents and educators in Vancouver, BC, and was SO impressed by his insights and wisdom around bringing up boys. As a mother of 2 boys and 2 girls, I would strongly recommend that you read this book..
Please contact me at firstname.lastname@example.org if you have any further questions or would like to order the book. I am certain that you will receive great value from the information in this book, as I have!
Thanks and hope to talk to you soon!