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Marilyn Wedge, Ph.D. Headshot

Could Stress Cause an ADHD Diagnosis?

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Turning to medication when a child is having trouble at school or feeling sad has become as American as apple pie. Medicating a difficult child became even easier last month, when the American Academy of Pediatrics lowered the age at which a child could be diagnosed with ADHD. Now 4-year-olds can be diagnosed and medicated with amphetamines like Ritalin. This is one more testament to drug companies' phenomenal success in marketing their "chemical imbalance" theory of childhood problems.

Lately, however, an alternative point of view has been gaining more acceptance. This is the notion that family stress -- marital problems, financial issues, illness or injury of a parent, and so forth -- can be toxic to children and is at the root of many childhood emotional and behavioral problems. Family therapists have been working with this idea for half of century. But now, many people who are not family therapists but who are concerned with the well-being of children are taking this view seriously. Huffington Post writer Lisa Belkin, for example, discussed this topic in a recent Parentlode column.

Instead of viewing a child's problem as strictly a biological disorder -- whether genetic, epigenetic or biochemical -- family therapists find that they can help children best by looking at the child's nurturing environment. A family is a complex system and, as in all complex systems, a change in one part of the system affects the other parts. For example, a few weeks ago, 4-year-old boy Paulie was in my office because his preschool teacher thought he had ADHD. Paulie had had a personality change seemingly overnight. From a sweet well-behaved child, he changed into to a little monster who wouldn't obey his teacher's simplest request. When I asked Paulie what was troubling him, he said he was worried about his father because his father had lost his job and cried all day.

Some people may be amazed that a 4-year old child could be so tuned in to his father and have behavior problems because of a father losing his job. To a family therapist, however, this kind of situation is business as usual. We see it every day.

So what can be done to protect Paulie from feeling his father's troubles and acting them out? Paulie's parents were having frequent arguments because of the financial strain on them. So the first thing they could do was not to have arguments where their son could overhear them. In fact, I asked them to have their arguments in their car with the windows rolled up after their children had gone to bed. Second, since Paulie was worried about his father's sadness, I asked the father to take care not to cry or look sad in front of his son anymore. In fact, every day the father had to tell Paulie two good things about his day.

Even in a bleak situation after a lay-off, there are always some positives. Without much trouble, Paulie's father was able to find a few good things about his situation: he had time to go mountain-biking for two hours every morning and he also had time to do the minor repairs around the house that he hadn't had time for when he was working. When Paulie's father reassured the boy that he was fine and that he would surely find a new job soon, the burden of worry was lifted from the boy's shoulders. After a few weeks of reassurance from his father, Paulie was back to his old cheerful self.

Parents can do a lot to protect their child from family stress just by adopting a healthier communication style. This means not arguing in front of the kids, telling them one or two positive things about your own day, praising the other parent in front of the children, and not airing out serious financial or other problems in the children's presence. In terms of emotional impact, it's one thing to tell a child: "We can't buy that new game right now," and another thing entirely to say: "We don't have enough money to buy it because daddy lost his job."

Along with a healthy communication style, parents should be cognizant of keeping a healthy family structure. This means that parents nurture their marriage so that they remain emotionally close. They spend quality time together without their children and don't allow their kids to sleep in their bed. If parents drift apart and one parent becomes overly close to a child, this puts excessive pressure on the child and can lead to his developing serious problems --even autism or ADHD.

In recent decades, drug companies have been very successful in convincing parents that pills are the only solution to their child's problems. Now the pendulum is starting to swing the other way. Parents are becoming empowered take charge of their children's mental health themselves rather than entrusting their children's well being to drug companies and child psychiatrists.

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