Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on where you live. Read More
I read your article eagerly, since I have a teenager with ADHD. We are indeed American. And, while I would agree that limits, rules, and consistency are important for all children, kids with ADHD often truly can't comply, as much as we or even they would like.
Any parent with a child with ADHD will tell you that applying rules and sage advice offered by therapists is not always possible. It may seem that it is to someone who doesn't live 24/7 with a child who can't stop talking, walking, drumming on the table, throwing things--but it's simply not effective all of the time. Parents I know with these special kids do agree that some tactics work better than others, depending on the child and the age. Water, for instance, seems to work wonders in calming down even young kids. (My son has always been very clean!)
Now that my son is 16, bright, engaged, and kind, he will tell you that days without medication are torture for him. He can't concentrate on anything at school, his quick thoughts and inattention actually bother him. He doesn't like the way he acts, and will avoid social situations. On days when he misses his medication he will tell you he just wants the day to be over. With medication,he is involved in music, Scouting, friends, academics, and helping others.
I will never regret finding my son the medical help he needed, and treating the biological aspects of ADHD while I focused on the "real boy" beneath the behavior.
After having my son by forceps delivery via caesarian (truly) at 42 weeks gestation, my obstetrician told me at the 6-week post-natal check-up that I would never have gone into labour. The induction didn't elicit a brankston hicks, not a murmur, nothing.
I knew the exact date I had conceived and wanted "nature to take its course". My clever Dr had an idea and tested the remainder of a blood sample of mine. He discovered the problem was: placental sulfatase deficiency.
My son's skin sheeted off after birth; he'd been "cooked". But his apgar scores were 9/10 and then 10/10 so there seemed to be no need to worry.
What's this got to do with ADHD?
The obstetrician told me that this deficiency was genetic. I So what did this mean? What were other related problems? He brushed my question off flippantly. But I wrote every detail down from his massive medical journal. Logic told me that problems of biology don't occur in isolation. I was right. (I wish I wasn't.)
My son was a delight, such an easy, good-natured baby. But what child wouldn't be when they are so cherished and nurtured and loved? He was outgoing and confident at a very young age.
But then this changed for no good reason.
My son developed anxiety. This anxiety got worse and worse and worse. By Year 1, it became crippling. The family doctor was baffled and suggested he see a psychologist. But she agreed that he didn't seem to have catastrophic or faulty thinking. It was more like frustration and an overwhelming feeling. He changed from a bright, happy kid into a timid, depressed recluse and without any good reason.
I taught him meditation and tried diet changes. We eliminated wheat and changed to dairy products of natural probiotic sheeps milk yoghurt and A2 milk (like in France!) This improved our health a little but we'd always eaten veggies and salad which my son enjoyed.
But he started to get upset because we were visiting quite a few doctors to investigate hearing, sight, allergies, etc. But no one could explain the source of the anxiety.
The teacher said that he sometimes didn't hear her. I knew he had what he had a narrower focus of attention than normal. If he was talking to someone, his attention was on them, so he may not hear someone calling his name some distance away like others usually could. But this was a problem I also had. I was fine one on one or two on one but in groups I would get anxious because I didn't seem to be able to catch the conversation when it was coming at me from all directions. My brain just didn't catch it all. It's sort of like having a loose connection, like a light globe not quite screwed in properly and it sort of flickers. But there's nothing you can do to fix this debilitating problem. Or so I thought...
To cut a long story short, I met a group of parents whose kids were having similar difficulties. I had my suspicions but doctors and psychologists all thought me crazy to consider inattentive ADHD (the one without hyperactivity and impulsivity or externalising behaviour) or a mild variant of Fragile X.
I consulted a developmental paediatrician whose clinic sees more children like my son than any other in the world. Why? Because this doctor is also a highly cited researcher and he employs the most comprehensive collection of assessment tools to delineate specific problems in children like my son.
As it turned out, my son had a much less common variant of ADHD, one that I found out later was directly related to the STS gene that was related to the problems he had trying to come into this world...
Do please - Look it up.
Ritalin (methylphenidate) increases DHEA in the brain. My son has a lack of this given the sulfatase deficiency. For this reason, his brain needs the Ritalin to be able to have adequate neural connectivity to function normally. No change in diet or any other change could ameliorate this problem. It was like a miracle when the anxiety completely disappeared within weeks of commencing medication.
Need I say more?
Congratulations, Elisabeth. You were doggedly intelligent in tracking down treatments to help your child. Lucky boy.
It was a struggle but one well worth the effort.
Our children are so precious...
When your only option is drugs then so be it but there are natural solutions without side effects. Most parents are not aware of the options or the side effects of drugs. ADHD drugs do produce short term benefits for 80% of children but they are not long term and they have side effects like stunted growth and heart disease to mention a few. I have seen miracles with simple remedies like vit C, grape seed extract and low dose non toxic lithium orotate and with no side effects.
You can also buy milk with DHEA, special baby supplements often contain it because many babies/children in the US are lacking it. Ritalin might be helping, but I would encourage you to go beyond the Dr/Pharmacist answers and investigate for yourself some of the long-term ill effects it can have. They often brush them off, but if it happens to you, it's not to be brushed off as such.
What both of your posts above don't consider is: Why don't French children, and in fact many European children, have ADHD? Given the diversity of cultures in the US, it is doubtful that a large-scale genetic difference exists between the US and Europe. What's left, then, are social factors.
America continues to pathologize behaviour that is inches away form the top of the normal curve.
I buy that American ADHD is caused by environmental and social factors but I do not blame myself for my son's struggles. I blame the school and education system. I can't change the school although I sure try.
When it's "not my fault," it's therefore no one's fault and consequently everyone's fault. Parents need to start blaming themselves a bit more AND blaming their children a bit more before offhandedly denying any responsibility and blaming exterior forces, as you seem to be doing.
Watch a few episodes of the Nanny 911 and Supernanny programs that were so popular a few years back, and you will find in over 75% of cases that the core issues turn out to be a lack of structure and behavioral framework in the home, a refusal for parents to follow through with consequences for bad behavior, and young parents who were allowed to run free by the previous generation that now have no idea how to behave as parents - they want to be Johnny and Susie's best friends rather than their Mom or Dad.
Own your role as a parent and you will be a better one and your kids won't terrorize your house or our schools, restaurants, grocery stores, etc.
Anyone observing my family would say that we need a lot more structure in our daily routine. I would agree to a certain extent except that my daughter and I do not lead a regimented life and I think society in general could use a lot less regimentation than it currently suffers. Now if my daughter wants to be a cog in a giant machine later on, obviously she will need to follow a stricter schedule and, with that in mind, it sometimes bothers me that we don't have that now.
And yet, whenever other adults talk with me about her, all I ever hear is what an awesome kid she is. I would say she has some attention issues but she is very, very good with children of any age and she is polite to grownups. She does not act like a terror in stores or movie theaters or libraries or anywhere like that.
So, NO, it's NOT always the parenting. Or, I should say, it's not *that particular* aspect of the parenting. But nice of you to armchair-quarterback when no one asked for your opinion.
Well, the problem is that life is structure. Unless you have a large family trust to bequest, your child will grow up and have to go to work. On time. Then have lunch. At a certain time. If they have children they have to go to school, on time, get picked up, on time.
I repeat, unless you have a large fortune (and I am suspecting that's exactly where you come from) these are good skills. Good luck, you;re going to need it.
Maybe she'll blaze her own trail. Who put you in charge of what one will have to do in adulthood? Maybe she'll run her own business and make her own rules. Why can't someone have a unique way of being in the world. I'm sure you're right, I'm sure realistic, and that's nice.
So this restaurant that she's going to run doesn't have to open and close on a certain time? Her employees can just come in whenever they feel like it to open up for the day? What about following the regulations of the health department? How will your daughter get around those?
Concern troll, much?
Having ADD does not render a person completely insensate to all structure, rules, and expectations. In your hypothetical example, the obvious solution is to hire a natural organizer as part of the staff. Growing an organization by adding people whose strengths complement one's weaknesses is pretty standard business strategy.
Furthermore, there are several career modalities in which people with learning disabilities, ADD/ADHD included, do well. It's no accident that many (successful) start-up founders are dyslexic or ADD. Same case with freelancers.
Maybe she'll blaze her own trail. Who put you in charge of what one will have to do in adulthood? Maybe she'll run her own business and make her own rules. Why can't someone have a unique way of being in the world? I'm sure you're right, I'm sure you're realistic, and that's nice.
Even if she does blaze her own trail and make her own rules, she will STILL be following rules and regimentation.
...and likely making others follow them, too.
Why are you dragging money into it?
This has nothing to do with ADHD and the type of structure that ALL kids with ADHD need to be successful.
Besides that, you're wrong. These kids can grow up and work for themselves or in a career where there's more flexibility or structure. It all depends on the individuals personality, learning style, values etc...
The other factor you don't seem to consider is the fact that one or both of the parents may have ADHD themselves and never got the education they needed to be able to function well. Please stop the blame game. It hurts, it doesn't help. Research clearly shows that kids and adults with ADHD learn differently.
Even if you take medication and money out of it, most public schools are not equipped to handle the type of education these kids need. They need a lot more in the way of executive function teaching. Perhaps if this was done, you'd see a better environment or social functioning on home front.
What if the parent and one, two or three children are all diagnosed with ADHD at the same time? This is quite a common scenario. Who's needs do you put first? Parents with ADHD may need some help and support for awhile, so that they can learn how to structure themselves in a way that works for their learning style before they can help their children. But often the support is not out there. Often adults with ADHD need specialized coaching and not therapy. But, insurance doesn't cover ADHD coaching. If ths is a performance or skills based deficit, wouldn't it make sense to provide that to these kids and adults?
This judgement that the parents are doing something wrong or should fall into a strict pattern and do things like everybody else, sets these families up for failure. Not everyone learns at the same pace anyway.
Life and this road is hard enough. Surrounding yourself with people and educators who make a concerted effort to truly learn about ADHD and LD and know how to implement POSITIVE strategies, interventions and behavioral modifications help and heal these families the most.
Negativity and making people feel bad when they have a legitimate learning challenge makes these kids and adults want to give up. Why? Because they never feel good enough. They're always made to feel like they're doing something wrong. In my experience, this type of teaching exacerbates the behaviors you're trying to improve. Some people may argue, that this type of teaching builds resilience and character. If this were true, why do so many ADHD adults end up in therapy? Trust me when I say, it's not just to receive drugs. And if medication is effective, so that the child or adult is able to learn and function better, I don't see what the issue is. It's better than self-medicating with illegal or inappropriate substances.
I'd like to know how many French kids self medicate with nicotine and other drugs to combat some of these behaviors and aren't being diagnosed as ADHD. I'd also be curious how many of the undiagnosed kids truly reach their potential in life.
What everyone has seemed to miss is that every child is different, whether they have adhd or not. The article did not say no one in france has adhd, its just not at the rate that we lable them here. Altho there are some cases that are goumded and you know what the cause was. Not all cases can be and if environmental or diet would even be considered more children might have the chance to reach there full potential! People need to be less defensive and let all possibilities be considered.
Having taught at French schools, I can testify to what this article says: French students are infinitely more attentive, disciplined, and generally functional than American students. I ran across only one student out of hundreds who had real symptoms of ADHD.
What this article leaves out, however, is that raising children is taken a lot more seriously by the culture in France. School starts at age 3 (free public preschools) to ensure that students all get the same basics. The school day runs from 8 or so until as late as 6 (so no latchkey kids or parents scrambling to rearrange their schedules to cover after-school hours). Mothers are given a pregnancy stipend. They get a stipend to help cover child care or to help replace wages should a parent choose to stay home as caregiver. Parents are given a combined childbirth leave of 18 weeks (heavily weighted in favor of the mother and up to a year of leave to care for a severely sick or injured child. And you can take two years of unpaid leave and return to your job afterwards.
So raising a child doesn't present the same kinds of challenges we see here. And fewer children are thus plopped down in front of the telly and more actively (but not indulgently) parented than in the US.
Astute comment regarding child care. What the author (and all of the other commenters) is not identifying in her article is the role infant daycare plays in ADHD formation. We have an epidemic of infant daycare in the USA and it's making the ADHD numbers go off the charts as unbonded kids develop behaviors to cope with their feelings of abandonment.
You should look into the French daycare system - it is actually quite impressive and structured, affordable as well - here is a little info: http://www.expatica.com/fr/education/pre_school/a-guide-to-daycare-in-fr...
To highlight, Laura, everything you mentioned is additive and commensurate with the article and speaks to the fact that broader systemic considerations are vital to dealing with this and any other mental health issues. e.g., It's not just about different cultural norms around parenting, it's about the fact that those norms are supported within the broader society by way of policies that support this kind of parenting.
As an aside, I've worked on psychiatric units for children and adolescents and I've seen some pretty transformative experiences on the part of these kids who come in with parents stating that their child is uncontrollable. In a relatively short amount of time, often before being seen by their doctor and prescribed a new or different medication, the demeanor of these kids shifts quickly as they come to understand that they are in a predictable and structured environment with clearly delineated limits. The same goes for kids who have already been medicated and continue on their meds after admission. What changed for these "uncontrollable" kids if their medication was the same before and after admission? What's difficult in understanding this is that it can leave parents feeling as though they are to blame. Families need support in this area, not chastisement. On the flip side, however, I've worked with parents of children diagnosed with bipolar disorder and they seem, in certain cases, to equate discipline as some sort of punishment for their child's disorder. e.g., "It's the disorder, not the child, so I don't want to punish my child for their behavior that is out of their control." Going back to my comments about working in child/adolescent psychiatric units, I can say without qualification that these kids absolutely benefit from a structured environment. It is quite literally, with medication on board, the only way they will have the opportunity to learn how to function effectively in their lives. With the guide rails completely off, even with medication, we're asking for a whole slew of additional problems.
For the article as a whole and with all the vitriol that seems to be flying back and forth over this topic, it's not an either/or situation. It's what we call a both/and situation in family therapy land. There are absolutely circumstances where genetics play a role in mental health issues, and, we know that in any number of circumstances, whether chronic mental health or even chronic medical conditions, the functioning of the system has a great deal to do with whether the issue is exacerbated or improved. Dealing with the system is not a cure for these chronic issues, but it does go a long way to ameliorating the issues a person is struggling with by not piling on with additional stressors.
As a final aside, I was recently surprised when reviewing an article a student had used in an assignment. It was an article published by the American Psychological Association in 2014, I believe (the journal title escapes me at the moment), but I was quite surprised to see some of the initial claims therein, that systems/family-based treatment outcomes have had little research. The statement should be qualified. The APA, per the institution’s broader paradigms about etiology and treatment that pervade the profession, has not examined systemically grounded models of therapy and their outcomes. Within the field of Marriage and Family Therapy, however, the efficacy of systemic interventions has long been established with meta-analyses reviewing research and practice before 1996 indicating as much. The larger point I’m getting at is that a major player in the mental health field in this country is quite literally just coming around to investigating the benefits of systemic approaches in dealing with human problems. We're talking about a 20 year lag in research behind the MFT profession! This speaks volumes to where this society is at in terms of understanding and dealing with mental health issues. Okay, I’m getting down off the soapbox. ;-)
These posts are exactly indicative of the issue. Lots of excuses and statements about "this child is a unique and beautiful snowflake that doesn't need structure because she is going to run a business", etc.
As long as your heads are buried in the "my child is special sands" you will continue to miss the point. 9 out of 10 of these diagnoses are incorrect and CAN be corrected with changes in parenting. Period. That other tiny percentage that needs medical intervention is not in jeopardy of missing out here in America since the overall culture railroads any kid that is hyperactive into some sort of medicated pidgeon hole.
As long as you can spout platitudes about how structure and discipline and are not meant for YOUR child, you will be part of the problem. Good luck with that.
Awesome, you hit the nail.
I have been to many workshops and read journals frequently. I am a special education teacher and also have ADHD in my family. Without medication, your life is not organized and incomplete. This leaves one feeling helpless and depressed. Executive function is the key. Medication can help. Visual structure definitely helps. Write it down, break it down, check it off, feel successful. Use routines and make yourself follow them, such as putting your keys in the same place every day. I also wonder how many French students self medicate or drop out of school and are no longer counted in the stats.
Or, you can be creative and figure out how to make the world work for you. Wake up when you want, go to work when you want, put in your 7.5 or 8, take lunch whenever, or not at all.. Eat whenever you like, while working. And then go home, when you want. Repeat x5x52x __.
Or you can subscribe to the idea that everything HAS to be on time. Always. You can have the box you build, I live outside it.
I lucked out though, and it works for me, 'cuz I'm pretty sure I've got ADD/ADHD. Being on time isn't in my vocabulary. I scored a great job at a huge megacorporation... I graduated from a world-class University with top marks in a science faculty. I rarely went to class and taught myself from home, at 2am in the morning... People like us sometimes have to jig the system to make it work for us. I did.
Right on, KK. I have ADD and have had a similar life experience/style and became a neurologist and sleep medicine specialist.
Let me add that most of this article is complete nonsense. Rather than going into all of the extensive facts that dispute Dr. Wedge's opinion, I encourage readers to research the science for themselves.
ADHD has been clearly shown to be a genetic neurobiologic "disorder". A child who has allergies that are causing problems with attention does not have ADHD. A child who is chronically sleep deprived with subsequent problems with attention does not have ADHD. There are too many to list issues that can cause persistent or intermittent problems with attention. Having a problem with attention does not equal ADHD. To imply that American doctors do not understand this and the French do is complete BS. Are some children and adults misdiagnosed? Of course. Is there a problem with underdiagnosis? Absolutely, and given the statistics from Dr. Wedge's article, the is a big problem in France.
Also, I happen to know french culture very well. I am married to a french woman and have stayed in France extensively. The french are in love with themselves. They do everything better and know better than everybody else. Their way is the best way even if the evidence is completely to the contrary. Trying to argue facts with a french person is like trying to argue with a religious cultist. The description in the article of french culture and child rearing is a french fantasy.
Readers, be careful about "expert" opinions, especially know it all PhDs. Research the issues yourself and look for at least some semblance of scientifically sound evidence/support.
Thanks for your post. I found parts of the article outright offensive.
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Marilyn Wedge, Ph.D., is a family therapist and the author of Suffer the Children: The Case Against Labeling and Medicating and an Effective Alternative.
Who says marriage is where desire goes to die?