The ongoing debate about whether attention-deficit hyperactivity disorder (ADHD) children require drugs or discipline can’t be resolved by examining prescribing practices cross-culturally. Dr. Marilyn Wedge asserts that in the US, at least 9% of school children have been diagnosed with ADHD, and are taking medications for it, whereas in France, it is less than 0.5%. She further goes on to suggest that irregular meals, lack of structure, and weak disciplinary practices are to blame.
As a mother of three ADHD children and a clinical psychologist, I think I can offer a different perspective on this matter. I knew my two eldest sons, born 12 months apart, had ADHD long before they ever got a formal diagnosis. At preschool, my oldest son was once found in the reception office making an escape map with another child. I once pulled into my other son’s childcare center to find he had slipped out of the playground and was actually wandering around in the parking lot.
At church, when other children were sitting quietly on the pews, drawing, reading their children’s Bibles, or holding a stuffed animal, my boys were crawling under the pews. I would grab onto their ankles to pull them back into my sphere of control, while they tried to wiggle free. Our pastor advocated regular spankings to bring them to heel, but spanking just wasn’t enough. I read all the baby books and took several parenting classes, but it wasn’t until I really understood ADHD that I realized I never had a fighting chance. My kids were already getting plenty of love, discipline, structure, and healthy foods. But they needed more than that – even more structure, shorter term rewards, and a little pharmacological assistance.
ADHD is not just another word for bad parenting. It’s an inherited, neurological disorder that includes a host of biological issues, including measureable delays in brain development. Children with ADHD have difficulty focusing on all but the most engaging tasks, are easily distracted, and need greater stimulation to maintain attention.
There are a number of social forces that have contributed to higher rates of diagnosed ADHD, even if there has been no change over time in base rates of the biological factors that contribute to the disorder. Increasing demands are made on our children that put kids with ADHD at a massive disadvantage. For example, when I was a kid, we had regular recess times, long lunch breaks, and daily physical education classes. Many schools have done away with these opportunities for antsy kids to release a bit of their energies in favor of more classroom time to prepare for standardized exams. Being expected to sit at a desk for six hours can be hard for any kid, and torture for one with ADHD.
My second son struggled in 6th grade, with grades ranging from A’s to F’s, but this was not for lack of intelligence nor discipline. Although testing showed exceptional ability, he was simply unable to sit in class all day and then come home and sit for another 2 hours doing homework. I put him a Waldorf School for 7th and 8th grade, and there was dramatic change. With small classes and many hands-on activities (like woodshop and needlework), he could keep his mind and body busy at the same time. The kids learned Shakespeare not by reading the book, but by making the costumes and performing it on stage. The Waldorf School wasn’t a cure for his ADHD, but it does illustrate how a disorder in one context (the public school) could be mitigated in another (hands-on learning).
The larger issue is that in our society more jobs require us to sit at a desk (or computer) for hours at a time. On a farm, a little ADHD might not be a problem when people have acres to roam free and hard labor to keep them busy, but in the office people with ADHD are going to have a much tougher time. That being said, I can’t fault the schools since they prepare children for this reality. The ADHD kid has nowhere to hide.
My son is now a junior at a competitive college. He majors in physics and likes to play chess – blindfolded and sometimes with multiple people at once. He’s on the rugby team and starts each day with exercise to help him focus. He wants to be a professor someday, yet his ADHD is not gone. He still struggles to study for classes that he considers boring and forgets to refill his medication for months at time. After doing a summer internship in biomedical physics, he decided to double major in physics and biology – against my better judgment. Let’s just say his grades haven’t changed much since 6th grade.
“So, how are you getting into grad school with those grades?” I ask. He looks down for a minute then smiles. “I made friends with a physics professor,” he says. “I met him in my salsa dancing class.”
My sons still enjoy chess.
Jensen et al. (2001). Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers. Developmental and Behavioral Pediatrics, 22(1).
Shaw et al. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. PNAS, 104 (49), 19649-19654.