ADHD - over diagnosing and over medicating and what we can do about it (part 1)

Bob Dylan wrote:

“Back when I was going to school you would see kids daydreaming and sometimes not paying attention, running around or acting impulsively. I always thought that was being a kid. Nowadays, everybody’s got Attention Deficit/Hyperactivity disorder–ADHD. They say it’s hyperactivity, impulsivity, and all sorts of other things. I’m sure there are kids with real problems. But quite often people just didn’t want to pay attention.

I see parents not wanting to spend time with their kids, and for them, not paying attention or being bored or acting impulsively is the kid’s problem. I don’t think so.

Spend time with your kids. You might find that they don’t have ADHD, they have other needs, a need to see their parents or be supported by their teacher. I’ll tell ya something, I didn’t pay a lot of attention, and I was known to daydream in class and things turned out pretty good for me. I’ll be the first to agree with you that sometime medication is necessary. But maybe we are too often in a hurry to treat things chemically and not look at what the real problem is. Sometimes there is not even a problem there, at least one that couldn’t be solved with a little bit of patience, attention, care, and love”

A growing frustration among my community, the community of counsellors and therapists working creatively with children, is that about 8 in 10 children will be diagnosed with ADHD and, forgive me, and usually by a Psychiatrist (though there a couple wise and wonderful ones working with multi-modal treatments and in coherence with the child's 'team) with a diagnostic check list who has met your child and your family perhaps only once or twice.

Talk to the counsellor, the therapist that has been working with your child and getting to know your family for more than a year and they will likely have a very different perspective on your child’s attention deficit. It is not that we deny that attention deficit is present, it is more about the encouragement of a conversation on the cause of it and how it could possibly be treated, managed, supported.

For some reason, we seem to have less patience with allowing kids to be kids these days in our particular culture. The term ADHD doesn’t exist in some cultures (or even reportedly in some schools where ALL the learning takes place through play). It doesn't take much thought to work out why.

Our children are boxed in at school day-to-day and are experiencing mounting social pressure on top of everything else that comes along with life, and it is only natural that some children are going to act through this struggle behaviourally.

In truth, some of the most efficient and creative young people I know are scatter-brained. Are restless, are sensitive, are passionate. Are deep thinkers and body shakers. These are often the little artists and athletes and innovators of the world.

Yet in typical classrooms, a subject is brought up by teachers at a given time and for a specific period of time. Those in the class who have the ability to switch their attention to what the teacher brings up at a given time and then stay focussed throughout the scheduled time, are often more highly valued by teachers than those students who are less skilled at this. Teachers often urge parents to take children less skilled in attention to doctors to get prescriptions for drugs. As most of you already know, though I am always in support of your exploration around how your child is struggling and how you/we may help, I’m not comfortable with this immediate psychotropic signposting.

Of equal concern is that even before kids start school, many are already being prescribed ADHD drugs. The Centre for Disease Control and Prevention (CDC) recently pointed out in a report that “About 2 million of the more than 6 million children with ADHD were diagnosed as young children aged 2-5 years.” It cautioned that the drugs used as treatment of ADHD should not be the first step in dealing with this condition because ADHD medicine can cause side effects, such as poor appetite, stomach aches, irritability, sleep problems, and slowed growth.

The long-term effects of ADHD medicine on young children are not entirely known however I worked for a period of time in Holland with children in ‘recovery’ from ADHD medication and can share a few titbits…

I worked with parents whose babies were prescribed ADHD medication for crying too much, over working together with the parents and babies through attachment and bonding.

I worked with an 11 year old girl who spoke to me about how when she was on her medication she had an almost constant tummy ache. She told me (and eventually an entire conference room of people) that she felt like she was perpetually trapped in a dark room screaming, but no-one could hear her, yet she did not have the language to communicate this. Only through art therapy, did she find the language and her confidence again.

I work with children with terribly low self-esteem, because yes, their behaviour can be an incredible handful and they have grown up and as naughty children, the difficult children, the trouble-makers. On their medication they start doing better at school and feel more accepted in that way which is a great relief and wonderful to see. However, on the other hand something in them struggles with knowing they were not 100% acceptable with who they were naturally, and the struggles with low self-esteem and self-worth continues.

I have also spoken with young adults who spoke about coming off their medication after 18 or 19 years old, and being overwhelmed with emotions they had never experienced while on medication, and so felt completely unequipped to deal with them, or to deal with their unique struggles with lack of attention and the constant need to move in the workplace. Some of them found acceptance and acquired a toolbox of new skills. Some chose to stay on their medication for life.

Some found addiction…

I have been talking lately - in relation to a different issue but feel it still applies here - about how our children often present with behaviours that look like the shark, but if we look below the water we will realise they are really just scared and/or confused goldfish trying to have a need met. Their behaviours might communicate to us in a way that feels unmanageable, but below the surface is just a growing and developing child that needs our patience, help and support. No-one, least of all me, expects a parent or teacher, exhausted and struggling too, to always respond perfectly however I would hope we can try to the best of our ability to stop over-parenting the shark fin, and look more often below the surface and meet the needs of the goldfish.

I am sharing all this with you not to scare or shame. Not in the slightest. I do feel it is of great benefit for some children to be diagnosed (it offers often some essential extra support and understanding in school) and in some circumstances benefit to be medicated even if it means keeping everyones head above water. We certainly need to keep talking about ADHD behaviours, how they come about and management/treatment options so children get the support they need!

However medication doesn’t work and it truly isn’t necessary, for all. Especially if we haven't tried everything else first. So how can we practically help, without medicating children in a culture that encourages it?

To continue the dialogue here are some things I will be writing about in my next newsletter:

• When ADHD is really anxiety, trauma, dyspraxia or dyslexia dressed up in costume; treating the cause not the symptoms.

• When ADHD behaviour is a cry for connection; building secure bonds of attachment with your children so they can settle down into self.

• When ADHD is a gift; how to nurture the little artist or athlete.

• Behaviour management, family therapies and creative therapies as a first port of call for treatment and support.

• Acceptance over change; how acceptance is the gateway to joy.