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Why the Increase in ADHD?

New research reveals causes for ADHD type behaviors.

In the last six years the rate of diagnosis of ADHD has jumped 15% according to data from the Centers for Disease Control and Prevention. What are some of the possible factors behind this increase in ADHD symptoms?

Over diagnosis is certainly a possibility, although the criteria for diagnosing the behavior associated with ADHD have not changed.

The second possibility is pressure from parents and teachers to have the child take the “magic pill,” and hopefully do better in school. Remember, Ivy League college scholarships are worth over $200,000 for four years.

Another factor is that children with ADHD do better when they play outside on grass. They do better than indoors, but also better than outdoors on concrete. Times have indeed changed. Children are spending half as much time outdoors as they were before 1992 and 8-18 year old kids spend 7 hours and 38 minutes using entertainment media in a typical day, not Including computer time for schoolwork. Only 6% of kids even play outside on their own. Most of them are in daycare or school and come home only for a snack and bedtime. School and city playgrounds are deemed unsafe, mainly because of the fear of lawsuits.

No one is sure why this is true, but the data appear reliable. So maybe outdoors is a good place for our kids, especially if they are overly active. Any solutions? How about playing video games outdoors? Sounds kinds of dangerous, doesn't it? Whatever prompted such a scary thought? I can see kids walking into trees or getting lost while playing Donkey Kong.

New research from the Journal of Biological Psychiatry supports this need for exposure to the outdoors. It suggests that living in States with greater sunshine (solar intensity or SI) may protect against the development of ADHD. There is a wide variation of reported attention deficit disorder from a low of 5.6% in Nevada to a high of 15.6% in North Carolina. Some of this can result from differences in diagnostic practices, but something else may be going on as well.

Why would this be the case? The authors believe that use of modern media, including IPads and mobile phones shortly before bedtime, results in delayed sleep onset, shorter sleep duration, and melatonin suppression. Natural light may counteract the affects of modern media in the evening.

But yet another factor may be lack of structure in children's lives, along with poor sleeping habits. Pediatricians are worried because some parents are using melatonin to help their kids get to sleep at night. (A magic sleeping pill for children? Jennifer Breheny Wallace, The Wall Street Journal, Sunday, June 30, 2013). That's all we need! Kids given meds at night by their parents and then turned over to electronic games during the day. Talk about going around in unhealthy circles!

In most cases, good sleep habits come from good family habits. Children love structure and that means regular bedtimes and regular meal times. Regular study times also need to be included because otherwise the child may be anxious or stressed about success in school. I am amazed at the number of children I see out late at night at baseball games, restaurants and community recreation events. They are over-tired and over-stimulated because it's way past a reasonable bedtime. And, of course, they are excited to be included in adult activities.

Most parents realize that their children need structure but are so unstructured themselves that they can't follow through. Parents mean well and love their children, but they are often encouraged to be "flexible" and not inhibit their child's freedom and potential greatness.

While true ADHD is probably genetic, all of the above factors could results in increases in behavior that mimic ADHD. Another obvious explanation for a rise in ADHD type behaviors is the increase in digital devices and their use by children. It's no wonder children dive into electronic games. The games provide some degree of structure, meaning, and control. Kids are able to impose the kind of control their parents should be imposing and the kids relish it.

Observations at our Center Academy Schools for ADHD lead us to believe that kids focus on video games in a different way than they focus in the classroom. In my book, The Digital Pandemic, Reestablishing Face-to-Face Contact in the Electronic Age, I discuss the dilemma of the Pug in the Park:

I observed a crowd of people laughing as a cute little Pug chased bits of reflected light on the sidewalk that came from the metal dog tags around his neck. Our little dog was what we psychologists call stimulus bound. The stimulus, or flashing lights in this case, bind him tightly as rope or chains and he can’t escape its hold over him.

This frustrated little guy was both over-focused on the reflected light and under -focused on the world around him. Replace the cute little dog with a child and the picture isn't pretty. This explains the popularity of the term electronic cocaine in describing children's stimulus bound and addictive responses to electronic games. (South Korea reports 1 in 5 students are addicted to Smartphone use –over 7 hours per day, with insomnia and depression when cut off from use!)

So this increase in ADHD symptoms could result from a combination of things including over diagnosis, poor sleep habits, lack of structure, too much indoor living, the pressure to push the “magic pill” for academic excellence, and the addictive use of electronic games.

What to do? Provide as much structure as possible, including regular meal times, bedtimes, chores, and study times. Limit electronic game use during the week and at night prior to bedtime, but allow their use in short increments as a reward for completed chores and cooperative behavior.

Go with the flow, but keep the flow under control. Don't be a Scrooge: Play some electronic games with your children while keeping the big picture in mind at all times. Your children will probably adapt and make it through all of this just as they have in the past, but we need to give them a fair shot at accomplishing this. If things get out of control, be sure to follow your pediatrician’s advice and ask for a referral to a child psychologist.

Good luck. Isn’t the family a great and challenging institution? Dare I say ––Enjoy!

More from Mack R. Hicks Ph.D.
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