David Katzenstein, LCSW
There is no shortage of armchair psychiatrists and therapists who espouse their beliefs on the mental health system and where its egregious faults lie. Some of these sideline professionals have legitimate concerns they would like addressed and others merely enjoy stirring up controversy on blogs or other avenues of media. It is subsequently difficult to parse out concrete professional and scholarly researched knowledge from chatter that permeates throughout our community. One of the most commonly debated mental health issues is the treatment, often pharmacologically, of ADHD (sometimes more popularly known as ADD).
Before we tackle the debate, let us first understand what ADHD is. There are two distinct components of the disorder: one is inattention and a lack of focus and concentration, the other, a significant and often troubling amount of hyperactivity and impulsivity. A good clinician (not your mother-in-law’s neighbor whose grandson in California has the diagnosis) would be able to delineate a clear distinction and map out a treatment plan of action, possibly including the use of medication. Some children (and now adults as well who are increasingly diagnosed with the disorder) have the unfortunate struggle of having both inattention and hyperactivity/impulsivity and are diagnosed accordingly with ADHD, Combined Type. Now let us keep in mind that every one of us has moments of inattentiveness or lack of focus, or periods of impulsivity and hyperactivity. But that does not mean we qualify for the diagnosis.
When properly diagnosed however, the symptoms of ADHD are causing significant impairment in life functioning: behaviorally, socially, and academically. If a child cannot pass a standard exam because he cannot focus for the requisite 30 minutes or he has difficulty controlling impulses to jump out of his seat or talk out in class, there may be an issue of ADHD. I say “may be” because often the symptoms associated with ADHD can stem from adjustment challenges, reactions to trauma, childhood anxiety or depression, lack of confidence, or a learning disability (often kids with learning limitations will act out and be known as a “behavior problem kid” rather than be known for academic shortcomings; it’s less embarrassing). The discerning clinician can, after extended evaluation, accurately assess whether your child meets the criteria of an ADHD diagnosis. We can always blame the rigid school system for creating environments in which those children slightly outside the behavior norm get pegged as “ADD,” but that only muddles the conversation instead of fostering (readily welcome) ideas for change.
It is increasingly known to the field, and to psychiatrists I work closely with who research the topic, that the causes of ADHD appear to be largely connected to biological, genetic and organic factors, unrelated to learned behaviors. Meaning, in the nature vs. nurture debate, nature appears to win this one. Heredity is currently accepted as the most common cause of ADHD. (Please don’t misinterpret this to mean that I believe nurture is unimportant, it just may be less so in this case.) I, too, had originally believed that the overwhelming influx of technology in our lives, as well as poor parenting, plays a prominent role, but research suggests otherwise. This does not mean you can go ahead and allow your children unlimited and unfiltered access to technology or become terrible parents because it makes no difference. And please do not punish your child for having ADHD or force them to sit quietly for extended periods of time as your own personal treatment modality to control your child’s hyperactivity. It will fail miserably and frankly borders on abuse. What you need is a professional and experienced clinician to assist you and treat your child.
There are numerous ways to treat or combat ADHD, and one of the most proven is the use of medication. At least in my experience, a child will not be prescribed medication right away unless requested so by the child’s parent (despite the usually uninformed opinions of those believe we rush to medicate). Some parents are not even amenable to therapy and only want the medication (they often view it as a cure-all to their child’s problems). Some parents request therapy and don’t want to entertain the possibility of medication.
I believe this is a mistake. Many may be fearful of the stigma they may be placing on the child and are worried about future dating prospects, while others go online and read endless stories of kids who had severe ADHD but were miraculously cured by a steady diet of spelt flour and vitamin B. And I’m not discounting the importance of diet in promoting positive behavior. However, sometimes, and it may be more often than we would like, medication is the best and most effective method of treatment. We cannot allow our personal biases and what we read on the comments section of a blog to dictate what the most appropriate course of action is.
The reality is that, yes, there are many children who have been helped by therapists without the use of medication. Others, however, remain in a place where the only attention they receive is negative, and they know they are viewed as “different” or a “problem” by their parents, teachers and peers. But due to a culture where personal opinions matter more than medical indication and fear of stigma takes precedence over the welfare of a child, there are countless children suffering without the help they desperately need. No one said the decision to have your child take medication is easy, but in many circumstances, it remains the right one.