Meeting The True Needs of Children Diagnosed As ADHD
How should one look upon Attention Deficit Hyperactivity Disorder (ADHD) and what is the effective way to aid those who are given this diagnosis? There has been considerable debate as to whether or not ADHD is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an examination by Hartmann in 1993 felt that ADHD is actually normal variant of human behavior that doesn't fit into cultural norms.
In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the TOVA (test of variables of attention), a test where the client must use a computer and hit a target at various points. This test is designed to measure the person's response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the diagnosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of ADHD, he states, medications alone do not provide adequate or full treatment in this disorder.
Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for ADHD is that about 1% of these children will develop tics and or Tourette's Syndrome. Hedaya asks the question,"One might wonder-, why use methylphenidate at all?" Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects include nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of ADHD lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of ADHD are lessened.
However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same effect in both those diagnosed as ADHD and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children's Hospital of Philadelphia commented at the National Institutes of Mental Health Consensus Conference in 1998 that the behaviors exhibited by those considered ADHD were normal behavioral variations. A Multimodal Treatment Study was conducted by the National Institutes of Mental Health in 1999 in regards to ADHD. Psychiatrist Peter Breggin and the members of the International Center for the Study of Psychiatry and Psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the analysis conducted of behaviors in the classroom of those children studied showed no significant differences between those children receiving stimulant medications versus those who only were utilizing a behavioral management program (MTA Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no control group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication management group, they numbered only 144 of which Breggin finds to be enormously small. Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a significant factor by the investigators. Breggin also believes that the study was flawed in that drug treatment continued for 14 months whereas behavioral management was utilized for a much shorter duration. Breggin argues that the behavioral management strategies, which involved mainly a token economy system, were ineffective as well and did not take into consideration family dynamics but regardless, the study still showed that there was no difference between the populations treated with drugs versus those undergoing behavioral management solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents. The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of academic performance or social skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have almost identical adverse reactions and have the potential for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often become robotic and lethargic and that permanent neurological tics can result.
In his textbook, Attention Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of ADHD, notes that there is little improvement in academic performance with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can affect growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a diagnosis of ADHD
Dr. Sidney Walker, III, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large number of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children actually become psychotic?Ehe fact that many hyperactive children respond to Ritalin by becoming calmer doesn't mean that the drug is treating a disease. Most people respond to cocaine by becoming more alert and focused, but that doesn't mean they are suffering from a disease treated by cocaine.?EIt is interesting to note Walker's analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, ?EMP (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration produces a high?Esimilar to that of cocaine.?E Walker (1998, pg. 14-15) that in addition to emotional struggles of children leading to ADHD-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette's syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be considered ADHD?Ehowever Walker feels that these issues are most often overlooked and the person is considered to be ADHD. F. Xavier Castellanos states at the 1998 Consensus Conference that those children with ADHD had smaller brain size than those of children who were considered to be normal. However, Castellanos reported as well that 93% of those children considered ADHD in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with ADHD since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse effect of this treatment.?E Physician Warren Weinberg and colleagues stated, a large number of biologic studies have been undertaken to characterize ADHD as a disease entity, but results have been inconsistent and not reproducible because the symptoms of ADHD are merely the symptoms of a variety of disorders.?EThe Food and Drug Administration has noted (Walker, 1998, pg. 27) that ee acknowledge that as of yet no distinct pathophysiology (for ADHD) has been delineated.?E
There has been concern as well about the addictive component of psychostimulants. The Drug Enforcement Administration (1995c) reports that it was found that methylphenidate's pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse potential as these Schedule II stimulants.?E
Breggin states that psychiatrist Arthur Green in the Comprehensive Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be linked to abuse and/or neglect. abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with limited attention span and hyperactivity. (Breggin, 1991, pg. 274)
Being that ADHD is a subjective diagnosis and that stimulant treatment has been shown to have risk as detailed above, what is the effective alternative to aiding those who have been diagnosed ADHD and what actually is underlying the difficulties that these individuals may be manifesting? Psychologist and educator Michael Valentine (1988) suggests that it is necessary to "love your children, care about them, do as much as possible to have them grow and develop, teach them social skills, and teach them how to identify and express their feelings and to become uniquely human; but at the same time, care about them and love them enough to give them guidance, structure, limits, and control as they need it.?EValentine advocates a psychosocial approach to aiding children and adolescents who would be considered to be ADHD. Psychiatrist Peter Breggin also advocates this approach and feels that it is necessary for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is necessary to examine the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of ADHD?Eitself). It is necessary to examine the experience of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an appropriate educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them. Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, ?Epediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don't like it as having attention deficit disorder or attention deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it's better to use drugs than to try to apply their prestige and clout in the community to the real problem: improving our school s so that students find them enjoyable enough to pay attention and learn in an environment where drugs are not needed. This misguided psychiatric effort has created an epidemic of drug treated mental illness?Ein the schools.?EBreggin continues that it is also necessary to examine the environment the child lives in and the stressors around them. It is necessary to build relationship and collaboratively design structure and limits with the child or adolescent (Breggin, 1998, pg. 318) Breggin feels it is necessary to train parents in relationship building with their children and in working through situations of conflict. He states, parent management training has consistently proven successful in improving parent self-esteem, in reducing parent stress, and in ameliorating ADHD-like symptoms, especially negative attitudes toward parental authority and aggression.?EDr. David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as ADHD who Stein prefers to call highly misbehaving?Echildren. In this program, known as the Caregiver's Skills program, Stein states it is necessary to treat your child as normal and not diseased.?EHe states that the children should not be taking any medications, as they are risky for the child's health and merely blunt behaviors. Stein argues, if the behaviors don't occur, we can't help (them) learn new habits.?EThe program encourages social reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The program encourages development of target behaviors and consistent encouragement and social reinforcement as well as consistent consequences for misbehavior. The program encourages the self-assessment and evaluation of the child of their own behaviors.
Barkley, Russell, Taking Charge of ADHD, Boys Town, NE, Boys Town Press, 1995)
Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, MA, 2000)
Breggin, Peter R., Talking Back to Ritalin,Common Courage Press, Monroe, ME, 1998)
Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)
DuPaul, Barkley, and Connor, Stimulants (article appearing in text Attention Deficit Hyperactivity Disorder, 1998).
Glasser, William, Psychiatry Can Be Hazardous to Your Mental Health, Harper Collins, New York, 2003)
Hedaya, Robert J., Understanding Biological Psychiatry, W.W. Norton, New York, 1996)
Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)
National Institutes of Mental Health Consensus Conference Statement, 1998
Stein, David, Unraveling the ADHD Fiasco, Andrews McMeel, Kansas City, 2001)
Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)
Weinberg, Warren et al., Attention Deficit Hyperactivity Disorder: A Disease or a Symptom Complex, Journal of Pediatrics, 130, 665-6
Dan L. Edmunds, M.A.,B.C.S.A.Mbr>
Doctorate of Education candidate in Pastoral Community Counseling
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BuzzFeed and Eko have been working together to create a wide range of interactive videos, which they began launching in the past week or so — starting with ...
Delicious And Nutritious Sunday Breakfast Recipes NDTV Food
Here, we help you with some interesting ideas of breakfast meals that are easy to cook and great to eat.
Recipes in 'Suqar: Desserts & Sweets From the Modern Middle East' sound amazing Press Herald
I was primed to love “Suqar” by Greg and Lucy Malouf, their eighth collaboration. I am as susceptible as other food lovers these days to the flavors of the Middle ...
Best Flan Recipe - How To Make Flan Delish.com Delish.com
The best part of this recipe? If you ask us, it's all about that caramel sauce. Make sure you're unmolding your flan onto plates with a small rim so you don't lose ...
Study Skills - How Can YOU Help Your Kids?
Some years ago when touring the Scottish Highlands, a man I met said something that's stuck with me ever since.He was elderly, yet was still working away on his small farm.
Teaching Reading: Part One
One of the biggest milestones in our children's education is when they learn how to read. You've probably asked yourself, "When is the best time to teach my child to read?" You can research this until you are blue in the face, but the answer is really very simple.
The Recipe For The Making Of A Self-Assured Child: One Part Communication, Two Parts Love
Each child carries a unique picture of the self, shaped in part by the influence of parents. Your child is not born with a self-image or self-assurance.
STOP Parental Alienation Syndrome before It Gets a Chance to START
Parental Alienation Syndrome was probably first identified and codified by Dr. Richard Gardner in his book of the same name.
Parenting Your Teenager: Self-Decorating or Self-Harm - How to Tell the Difference
Q. I need your help with a question about my teen-age daughter.
Protect your Kids Early with Safety Glasses
What exactly makes safety glasses different from regular glasses? There are several reasons glasses will be rated as safe. They must not only cover the front of the eyes but also the top and sides as well so small particles can't enter the eye.
Give Your Child Life Skills for a Lifetime
Many parents struggle with solutions to put their child on the fast track to success, and one such solution is not usually far from home. It is your local martial arts school.
MORAL ARMORS Irrational Parenting, Part III
Not Letting Them Think.We all implicitly know that anything questioning the process of cognition itself will be met with massive irritation, making us want to respond with "Don't question my capacity to think.
Parenting Your Teenager: Driving and Having a Car is a Privilege, Not a Right
Q. My teenage son is turning 16 early next year and he's already lobbying us for a new car.
Humans and Their Innate Need for Drug Stimulation
We know that ancient cultures and Indians and the like across the globe used such mind-altering drugs to alter their states. Still today in the world we have whole cultures enslaved to drugs of some type.
Is it ADHD or Bi-Polar Disorder?
Bi-Polar Disorder, or Manic Depression, is characterized by mood swings, sometimes extreme, ranging from depressed to normal moods, or from depressed to manic episodes. Manic behaviors are often very similar to "hyperactive" behaviors, including motor restlessness, irritability, temper outbursts, sleeping less, or having higher levels of energy.
Picky Eater - Fighting the Good Fight
Often, the struggle at dinnertime with your picky eater is not so much about food as it is about control. As children become more independent, conflicts can arise as they carefully scrutinize what goes into their mouths.
The Seven Keys to Child Obedience
Learning obedience is an important part of child development. This is the tool that allows you as parents to train your child.
Registering a Birth in Scotland
Who Can Register A Birth? The child's mother or father should register the birth within 21 days. However, a father who is not married to the child's mother can only register a birth and be named on the birth certificate as the father if: he jointly signs the register with the mother, or a court has declared that he is the father, or the mother and he jointly sign a declaration available from the Registrar.
Parenting Your Teenager: Kids and Money
Most teens go into the work world ill-prepared to manage the money they will be making. Even if their parents have attempted to teach them about money, they still haven't had the wonderfully frightening experience we have all had.
Dyslexia: Is the Shoe Perhaps on the Wrong Foot?
Reading is the most important skill that a child must acquire at school, because one must learn to read to be able to read to learn. The implication of this is that the child who is a poor reader will usually also be a poor learner.
Identifying Attention Deficit Hyperactivity Disorder in the Classroom: Eight Things Teachers Should
Attention Deficit Hyperactivity Disorder (ADHD) is the phrase that is used to describe children who have significant problems with high levels of distractibility or inattention, impulsiveness, and often with excessive motor activity levels. There may be deficits in attention and impulse control without hyperactivity being present.
Nail Biting Basics
Nail biting in all its various forms is problematic behavior beset by peculiarity and contradiction. Technically speaking, the correct word for nail biting is ANONYCHOPHAGIA.
Two Means Trouble
You have two kids who are 14 months apart. How cute, they look alot alike.
Potty Training ?To Train or Not to Train?
I have always found the notion of toilet training a toddler to be a bit much. I didn't feel right about pushing my girls to do something I felt would eventually come naturally.
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