"The whole people must take upon themselves the education of the whole people and be willing to bear the expenses of it. There should not be a district of one mile square, without a school in it, not founded by a charitable individual, but maintained at the public expense of the people themselves." -- John Adams

"No money shall be drawn from the treasury, for the benefit of any religious or theological institution." -- Indiana Constitution Article 1, Section 6.

"...no man shall be compelled to frequent or support any religious worship, place, or ministry whatsoever, nor shall be enforced, restrained, molested, or burthened in his body or goods, nor shall otherwise suffer on account of his religious opinions or belief; but that all men shall be free to profess, and by argument to maintain, their opinion in matters of religion, and that the same shall in no wise diminish enlarge, or affect their civil capacities." – Thomas Jefferson

Tuesday, January 8, 2013

ADHD: Not Bad Parenting

As a classroom teacher, Reading Recovery teacher, reading specialist and volunteer, I have spent time with a wide variety of students in 5 different suburban and rural public schools in northeast Indiana, and during my time in public education I studied various issues affecting students...one of which is Attention Deficit Hyperactivity Disorder (ADHD).

When I was growing up the umbrella term Minimal Brain Dysfunction referred to a group of behavioral and cognitive problems experienced by children...one of which was ADHD (the hyperactive child syndrome).

I always knew I had some learning problems while I was a child in school and learning about ADHD convinced me that I had what's currently called ADHD-Predominantly Inattentive Type. I came across the term Minimal Brain Dysfunction while I was studying about ADHD which triggered a memory. I asked my mother what the diagnosis of my problem was when I was in Elementary School and she replied with Minimal Brain Dysfunction. I have since been officially diagnosed with ADHD-Predominantly Inattentive Type...

In an article titled ADHD medication no substitute for effective parenting, Rama Cousik, an assistant professor of special education at IPFW, wrote
Having grown up in a world without ADHD, I struggle with the idea that many young children are increasingly being considered at risk for ADHD. I also struggle with the fact that medication is a part of the treatment package for many preschool children.

Like all drugs, methylphenidate has many side effects...nervousness, difficulty falling asleep or staying asleep, dizziness, nausea, vomiting, loss of appetite, stomach pain, diarrhea, heartburn, dry mouth, headache, muscle tightness, uncontrollable movement of a part of the body, restlessness, numbness, burning, or tingling in the hands or feet…”

While I am grateful that drug manufacturers are required by law to publish the side effects of all drugs in the market, one thing bothers me. How does one expect a preschooler to even begin to comprehend what symptoms she is experiencing, let alone communicate them to parents?

...Two statements at the end of the PubMed webpage were foreboding: “Methylphenidate may cause sudden death in children … (and) may slow children’s growth or weight gain.”

Naturally, the UNESCO study found that medication had adverse effects and hardly improved children’s behavior, whereas parent training programs improved children’s behavior and, most importantly, had no harmful effects.
"How does one expect a preschooler..."

The diagnosis of ADHD is contingent on it's deleterious effect on ones functioning in his or her life. If the symptoms of ADHD do not interfere with a person's academic, social or occupational functioning, then it's not considered ADHD. Further, every other explanation for the symptoms must be eliminated before a diagnosis of ADHD can be given.

The new version of the Diagnostic and Statistical Manual of Mental Disorders, which is in the development stage as this is being written, might include the suggestion that the "age of onset" for ADHD be increased.
On the table for discussion is to alter the age of onset from "on or before age 7" to "on or before age 12." The rationale? “Retrospective studies show that age of onset can occur or be first noticed or recalled between the ages of 7 and 12,” according to a proposal on DSM-V’s website. The complexity of the condition – and its concurrence with other disorders – makes it difficult to recognize in earlier years.
Dr. Cousik's statement about the medication of preschoolers, then, would be removed, pending good diagnosis by a doctor.

"Naturally, the UNESCO study found that medication had adverse effects and hardly improved children’s behavior,"

Dr. Cousik provides no link for the study she quotes. My guess is that the study states that use of medication provides no long-term improvement in behavior. Once a person goes off the medication the behaviors reappear. This has been found to be the case in more than one study. However, what Dr. Cousik doesn't say is that ADHD symptoms are improved while the child or adult is taking the medication. It is then that behavior modification can take place which does provide for long term, positive, behavioral change. If the behaviors aren't controlled by use of medication, then the chances for behavioral modification to have any lasting benefit are greatly reduced. "Good parenting" cannot always overcome the symptoms of ADHD.

The decision to place a child or one's self on medication for ADHD is not easy. It must be done after weighing the very real risks against the years of research showing the benefits.
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. ..Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. Research funded by the National Institute of Mental Health (NIMH) has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child's needs.
It's Not Bad Parenting

The decision is not often easy, either. A response Dr. Cousik's article stated
Parents of ADHD kids face misconceptions

It’s easy for Cousik to lecture parents on the potential side effects of medication, when clearly she has not been in the position most ADHD parents are in. We did not “force” medication on our son – we made a heartbreaking decision after years of trying behavioral interventions. We entered the decision with a clear understanding of the risks. I am secure enough in my parenting skills to know bad parenting did not cause his ADHD, but Cousik’s article, I am sure, made many parents feel they are to blame for their child’s ADHD. They are not.
ADHD has been blamed on "bad parenting" for years. This may not have been Dr. Cousik's purpose in her article, however the result is the same. ADHD is a real, debilitating, neurological condition which, if not treated can cause serious and sometimes life-threatening problems.

For more information see

Centers for Disease Control and Prevention: ADHD Research

National Institute of Mental Health: ADHD

Science Daily: ADD and ADHD News

ADHD: Current Research and Teaching Strategies for Reading and Writing

What Parents Need to Know About Medication for ADHD


Stop the Testing Insanity!


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