Why is ADD so controversial?
Attention Deficit Disorder (A.D.D.) has become one of the most controversial and emotionally charged subjects in medicine, education and child rearing. The public and even the medical profession are divided into several groups. One group says that A.D.D. really doesn’t exist, it’s just bad parenting, bad environment, poor social skills and not enough discipline. This group feels that medical treatment is not only unnecessary but it is a cruel way of suppressing a child and excusing the parent or teacher from their child rearing or teaching responsibilities. Another group feels that A.D.D. is a common physical handicap that needs to be treated medically just like poor vision is treated in children. Yet another group feels that it should only be treated with natural herbs, vitamins and diets.
There is no test
Just as in every other area of psychiatry, the root cause of the controversy is our inability to measure mood, thought speed and concentration. We have no reliable, objective test to tell if a person has A.D.D. or any other mental health condition. Whenever something cannot be proven, it will be the subject of speculation. Once again we rely on a checklist of symptoms that when present, indicate a high likelihood that a chemical imbalance is present. There are many in medicine and in the public who cannot accept that a checklist of symptoms is sufficient grounds to initiate drug treatment in a child or adult.
What is A.D.D?
Attention Deficit Disorder (A.D.D.) simply means that a person has a chronic inability to concentrate or focus their mind. It usually presents in one of two ways, with hyperactivity (A.D.H.D.) or without. This is the most common thinking problem in children and it is estimated that six percent of children suffer from it. It is a leading cause of school failure and underachievement. At least fifty percent of the affected children will never be diagnosed or treated so that they remain disabled, often for life.
The normal brain seems to have filters or gates which allow you to block useless information or stimuli that could distract you from an intended task. In A.D.D. the filters are so weak that the child is bombarded with useless and irrelevant thoughts which are continuously distracting them from learning and remembering. It is very much like being in a small room with many loudspeakers all shouting instructions and not being able to tell which voice is the important one.
The child finds that their brain tells them too many things at once and they don’t know how to process all the commands. For example, as you read this page, you are likely not aware of the street noises or even the buzz of the lights or fans in your room until I draw your attention to them. Your thoughts are focused on what you are reading. In A.D.D. a person’s thoughts are going so fast that they are not able to concentrate on the page and the environmental noises are just as important as what they are reading. The brain can not prioritize what the most important stimulus is at any moment. The street noise becomes as important as the page and the mind is distracted to the noise so the reading is never completed. That is why distractibility is such an important symptom in A.D.D.
A learning handicap
A.D.D. is a significant handicap to learning and is often found in addition to learning disabilities. When new information is learned by a person with normal concentration, it is stored in the memory at a location where it can be easily retrieved for future use. You might say the information is filed in a drawer labeled with the appropriate subject so when it is needed, the memory can be easily retrieved since it is well marked. In A.D.D. there is no such filing system. New information just seems to be tossed over the shoulder into a pile of memories. It is virtually impossible to retrieve the information even though you know it’s in there somewhere.
This inability to concentrate is caused by an inherited chemical imbalance in the brain, just like the one which causes adult mood disorders. Children have the same racing of thoughts but they are less likely to have the mood symptoms. Their thought clutter is of a more random nature where the adult pattern has more anxious and depressing thoughts. It is very common to find both A.D.D. and mood disorders clustering in families since they are closely related conditions which are both inherited.
What to look for
There are many symptoms of A.D.D. and not every affected child will have all of them. Children may have any of the following symptoms: not finishing what they start, fidgety, distractible, hearing but not listening, unable to concentrate on school work, making noises in class, falling grades, acting like they are driven by a motor, unable to sit still, loud, always talking and impulsive. They are excitable, unable to share, impatient and demanding of their own way with wide mood swings.
In a classroom they appear to be daydreaming or disruptive, unable to apply themselves to a task and easily confused by details. They rarely follow instructions and have exceedingly short memories. There is usually considerable moodiness with extreme emotional responses to events. The irritability, impulsivity and immaturity make it hard for them to make or keep friends so they become socially isolated. This causes great frustration which leads to impulsive and socially inappropriate behavior.
They usually have poor grades since school is such a struggle. They need constant supervision and assistance to complete a task or learn a skill. They are often in trouble with authorities and are automatically blamed for anything that goes wrong. These pressures cause the child to lose all self esteem and feel rejected. They become sullen and withdrawn as they get older. In this way A.D.D. is often seen with depression, anxiety and learning disabilities. Twenty five percent of learning disabled children also have A.D.D.
These children are usually of normal intelligence but they are unable to perform and make use of their abilities. This condition is much like having a high performance sports car ready to go inside a garage but having no driveway to get it on the road. There’s great potential but no performance.
How can A.D.D. be treated?
Fifty to eighty percent of A.D.D. children are never diagnosed or treated. For those who are identified, the treatment involves a multifaceted approach. I have not found dietary restrictions to be consistently helpful but medications are extremely useful. As in adult mood disorders, the drugs will correct the chemical imbalance and restore normal thought speed and sequence. There are many medications that are helpful including stimulants and antidepressants. Many drugs may need to be tried before the right combination is found, though eighty percent of children will respond to stimulants like Methylphenidate (Ritalin).
The medications will reduce impulsivity and hyperactivity by slowing down the speed of their thoughts. At a more normal thought speed, it is easier to control thoughts and behavior. Concentration, learning, self confidence and mood will improve as thought control increases. Treatment can release a child from the prison of thought bombardment so that he is able to choose his own thoughts at his own speed and focus his attention at will.
Parents are reluctant
Parents are generally very reluctant to accept the diagnosis or give pills to their children for this condition. This is very understandable since no one wants to see their child on medications. The fact is however, that with medications the child will be happier and calmer with better performance and self esteem. This will greatly improve home life and family relationships. I encourage parents to consider Methylphenidate (Ritalin) to be equivalent to eyeglasses or insulin which no parent would deny their child. It must be understood that A.D.D. is a medical problem with behavioral symptoms which will respond to treatment.
Physicians who treat A.D.D. with medications are widely criticized for medicating children “needlessly.” Having seen the family disruption, educational failures and the personality injury to those children who have not been treated, it is my opinion that it is more dangerous and unfair to deny treatment to an A.D.D. child than to give them medications. When I am in doubt of the diagnosis, I choose to err on the side of offering hope and treatment, than to tell a parent there is nothing that can be done for their child. The risks of medications are very low but the consequences of missing the diagnosis and leaving a child untreated to face the long term disability of A.D.D. are enormous.
The education professionals can be very helpful in tailoring a program for the affected child. Limiting distractions in a classroom and seating the child at the front of the class can be very helpful. Giving instructions frequently and in clear simple terms will help these children respond better. Firm and consistent discipline is necessary though rarely effective if used alone. A.D.D. children need lots of praise and encouragement for the tasks that they do well. Self esteem must be preserved.
How can we help?
Parents are usually exasperated and very embarrassed by their children’s behavior which they seem to have no control over. We must reach out to these parents and try to assist them, rather than join the many friends and neighbours who condemn them for poor parenting. Individual and family counseling is very helpful for these troubled families and individuals. Support groups like “Children and Adults with Attention Deficit Disorder” (CH.A.D.D.) can be a lifeline of help for parents struggling to cope and understand. There are many helpful parenting strategies which can be learned in support groups. Medications are but one of many helpful interventions in A.D.D.
To see the self assessment checklist click Attention Deficit Disorder (ADD).
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