We are overdiagnosing attention-deficit hyperactivity disorder (ADHD) in kids and giving many of them stimulant drugs they don't need. Some kids, especially boys, are more active than others; most of what passes for ADHD these days is really no more than normal variation or developmental difference.
The numbers tell a shocking story. The rate of ADHD in the U.S. has tripled to a ridiculously inflated 11 percent. Sales of ADHD medications are approaching an obscenely profitable $10 billion a year. It makes no sense that one in five teenage boys gets the diagnosis, or that one in 10 is on medication.
The overtreatment is caused by careless diagnosis by clinicians, misleading marketing by drug companies, overreaction by worried parents, and schools with overcrowded classes and too few gym teachers.
The most carefully done study estimates that ADHD should only be diagnosed in about 2 to 3 percent of children. And paradoxically, ADHD was both over- and undertreated. The kids who really need help don't get it, while those who don't need help get too much.
Another startling study showed that a good predictor of a child getting tagged with ADHD is his date of birth. The youngest kid in the class is almost twice as likely to be diagnosed as the oldest. We have turned immaturity into a disease.
In a previous blog post, world expert Keith Connors provided his advice on how parents can protect kids from the fake epidemic of ADHD.
In this blog post, we offer a better way of understanding and handling normal differences in activity. We mustn't jump to the assumption that every active kid is mentally disordered. Laura Batstra, Ph.D., is the leading expert on demedicalizing hyperactivity. Here are her tips for parents facing the difficult task of containing a rambunctious kid:
1) Trust your own instincts. Nobody knows your child better than you do. Schools sometimes pressure parents to have their child diagnosed and medicated. For some children this may be the best thing to do, but in many cases it only benefits the overburdened schools if medicated children sit at their desks all day long and listen attentively. You, the parent, are in the best position to judge whether your child's problems are severe, persistent, and pervasive enough to warrant medical attention.
2) Get information on ADHD from resources independent from drug companies. Drug companies and professionals paid by drug companies usually describe ADHD as a chemical imbalance that requires correction with medication. This is a misleading sales pitch. We now know that ADHD medication does not benefit most children in the long run and should only be prescribed for severe problems.
3) If you decide to seek help for your child's inattentive and hyperactive behaviors, start with parent and teacher courses. This may avoid the need for treatment altogether and allow reduced doses even when medication is needed. Lower medication dosages mean fewer risks and side effects.
4) Some children can be very demanding, but always keep seeing and enjoying the positive behaviors and interactions. Try to relabel hyperactive behavior as enthusiastic and energetic. At the end of the day, discuss with your child what you really appreciated that day.
5) Spend at least 15 minutes a day alone with your child, in which you give him close attention. Allow him -- within limits -- to take the lead and determine what the two of you will do. Praise his ideas. Following your child at certain points of time will increase the likelihood that he will listen to you at other times in the day.
6) If you tell your child to stop a particular unwanted behavior, tell him also -- in detail -- which behavior you would like to see instead. For example, do not just say "Stop jumping around in the living room", but add; "Go to the backyard and run and jump over there". Know that many children need to move their bodies a lot to feel well. So make sure the child has sufficient time and opportunities to let his hair down.
7) Most children get nervous and hyperactive in new or unstructured situations. If you worry your child will lose control at his own birthday party, tell him in detail who is going to be at the party and what will happen after what. For example "First we welcome everybody at the door, then we will have drinks and pie, then you may unpack your presents, after that we'll go walking to the swimming pool, etcetera etcetera". You may even write the order of events down for your child. Also, let your child know in detail which behavior you would like to see from him. For example: "You should welcome everyone by shaking hands; they will congratulate you and then you say "thank you"; if you want to move don't run around in the living room but go to the backyard and start an outside game; when we eat cake, you sit at the table with the other children; this will take about 15 minutes and then we walk to the swimming pool where you can run as long as you stay on the sidewalks; etcetera". If necessary, write this down for your child and ask him to repeat what the party will be like and which behavior is appropriate.
8) Listen to your child. Ask him for ideas in dealing with his hyperactive behaviors. Children are more likely to adhere to interventions they thought of themselves than to interventions that adults impose on them.
9) Run with your child. If you can't beat the hyperactivity, join it.
10) Ask your child regularly how he feels and whether he's suffering from his hyperactivity. If he is, find out whether he suffers because he feels restless all the time or mainly because other people -- for example the teacher -- react negatively to the energetic behaviors. If the latter is the case, talk to the teacher and explain how reinforcing the positive is usually more effective than focusing on the negative. Perhaps your child and the teacher can make some kind of a deal: 'If you try to run and jump on the schoolyard only and not in the classroom, I will allow you to go to the schoolyard twice a day for ten minutes to get rid of extra energy.
11) Give yourself a break. If you have an easygoing child, it's not hard to be an easygoing parent, who is always nice, rested and consistent. Temperamental children bring out the worst in caretakers, you will often meet your darkest side and weakest spots. That's legitimate -- give yourself a break when you lost your temper. Apologize to your child after being unreasonable with him, and set an example in doing so. Remember that children do what you do, not what you say. Teach him that everyone makes mistakes and can make-up by apologizing.
12) Last but not least, take good care of yourself and your relationship with your spouse. Parents can only take good care of their children if they first take good care of themselves. Raising children is a difficult task, and raising hyperactive or otherwise demanding children is even more difficult. Eat well, sleep well, make sure you get enough rest. Don't be afraid to ask for help. It takes a village to raise a child and we need to be there for each other and for each other's children.
Thanks so much, Dr. Batstra, for the wise advice. I plan to use it in my never-ending efforts to grandparent and partially tame my pair of identical, 9-year-old, ball-of-fire twin grandsons. Parenting has never been a piece of cake, particularly if you are raising kids who never sit still and are always into everything and seem to suck the air out of the room with their expansive energy and untiring vitality.
However hard we try, we can't change a kid's temperament very much. Luckily, most of the time we don't have to, because time does a great job of this: Most kids mellow out as they mature. Parents have to set limits, protect from danger, and teach skills, but they shouldn't expect perfection from their kids or from themselves.
And we shouldn't want to transform our kids into well-behaved, well-medicated little zombies. The 2 to 3 percent of kids with severe inattention and hyperactivity will require more extensive behavioral treatment, and some will require medication, but most hyperactive kids will do just fine with good-enough parenting.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.
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