Billy, an impulsive 11-year-old, is viewed by his teachers as somewhat lazy, easily distracted and lacking in motivation.
His parents, convinced their son’s poor performance was due to a ‘mental’ problem, insisted he be as tested by the school’s psychologist. When she reported Billy was a perfectly normal little boy they refused to accept her diagnosis. They went to three further psychologists all of whom confirmed their colleague's original findings. Still dissatisfied they sent him to a yet another specialist who finally provided the diagnosis they sought. Billy, he said, was suffering from Attention Deficit Hyperactive Disorder (ADHD). Given the appropriate medication their son could well turn into a straight A student.
“We always knew it,” they told his teachers triumphantly. “Our son is not lazy - he’s sick.”
They are far from unusual in this desire to explain away behaviour which, even a decade ago, might have been viewed as a normal part of growing up as a medical condition for which a cure must be found.
In the US, ADHD is now the second most frequent long-term diagnosis made in children, beaten only narrowly by asthma. Data from the Center for Disease Control and Prevention indicate it has been diagnosed in up to 15% of high school-age children and that the number of youngsters being medicated for the disorder has risen from 600,000 in 1990 to 3.5 million today. By contrast, world-wide, ADHD affects only around 5% of children, the majority boys. (1)
It is, of course, essential that children with a genuine illness are speedily diagnosed and effectively treated. Medication, in such cases, is often an essential first step on the road to recovery.
The trouble is that between obviously healthy and manifestly sick youngsters there is a grey area which is growing in size with every passing year. Since, in the absence of pathology, there are at present no tests or scans that can detect mental illness, diagnosis tends to be subjective. What one psychologist considers perfectly ‘normal’, another may view as highly abnormal.
In a recent interview with the New York Times Dr Keith Conners, a psychologist and professor emeritus at Duke University, who for more than 50 years has led the fight to legitimise the disorder, called this increase:
“A national disaster of dangerous proportions…a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” (3)
The most widely used form of treatment is to use drugs, such as methylphenidate atomoxetine, and dexamfetamine. Unfortunately, around one in five ADHD sufferers fail to respond to drugs (4) while in many other cases the response is only partial. Furthermore, all drugs have side effects, can also be habit forming and open to abuse. Long-term follow-ups have found that when children stopped taking the drug their clinical symptoms of ADHD reappeared.
Problems such as these have led some therapists, especially in the US, to start using a form of treatment known as EEG-Neurofeedback training.
This involves teaching sufferers how to control their ‘brain waves’ by playing computer games via sensors attached to their head. (5) The results appear promising, with improvements being found in around 40 percent of cases at six month follow-up.
In a recent study in my laboratory* two teenage boys played a computer game involving a race between a red and a blue caterpillar. Thin wires ran from electrodes pasted to their scalps to a control box. This detects electrical activity in their brains and uses these ‘brain waves’ to move the caterpillars across the screen.
Mark, aged 13 has been diagnosed with ADHD his friend, 14-year-old Ryan exhibits no such symptoms. During the game, Ryan’s red caterpillar speeds quickly along the track as he reduces his output of slow moving ‘theta waves’ while simultaneously increasing faster moving ‘beta waves’. Mark’s brains produces higher levels of theta and lower levels of beta waves his blue caterpillar barely moves off the start line.
Over a period of time, however, Mark trains himself to reduce his theta and boost his beta waves. In doing so he learns to control his impulsive behaviours.
While researching for my new book, Impulse, I came across several examples of behaviour which our forefathers would have shrugged off but which present-day parents see as requiring medical intervention. Given the lifestyle of many youngsters these days this may not be so surprising.
Many youngsters are discouraged from engaging in activities, such as exploring, getting into and out of scrapes, climbing trees and falling over, that earlier generations accepted as a normal part of childhood down. Even the amount of time they have for exercise is so constrained these days, especially for urban children, by parental concerns for their safety. Some children may be exhibiting the symptoms of hyperactivity simply because they’re not getting enough physically demanding exercise!
Taking risks and learning from the consequences of their mistakes is an essential part of growing up and developing independence.
The teenage years, especially, are the most intense and exciting of a child’s life. They’ll be unhappy, do silly things, take reckless decisions and make foolish misjudgements of people and situations.
But if they behave impulsively and fall flat on their faces from time to time, this doesn’t mean they need a diagnosis or a pill. It just means they’re being kids.
* Mindlab International is purely a research laboratory and does not offer any neurofeedback training. There are, however, many practitioners in both the USA and UK
(1) Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., Rohde L. A., (2007) The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis. American Journal of Psychiatry, 164(6), 942–948.
(2) Faraone, S. V., Biederman, J., Mick, E., (2006) The Age-Dependent Decline of Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Follow-Up Studies. Psychological Medicine, 36(2), 159–165.
(3) Schwarz, A. (2013) The Selling of Attention Deficit Disorder, New York Times, Dec 14
(4) Charach, A., Figueroa, M., Chen, S., Ickowicz, A., & Schachar, R. (2006) Stimulant treatment over 5 years: effects on growth. Journal of American Academic Child Adolescent Psychiatry, 45: 415–421.
(5) Lansbergen, M. M., van-Dongen-Boomsma, M., Buitelaar, J. K., Slaats-Willemse, D., (2010) ADHD and EEG-Neurofeedback: A Double-Blind Randomized Placebo-Controlled Feasibility Study. Journal of Neural Transmission, 118(2), 275-284.