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Recently, I was discussing the astounding rise in ADHD diagnoses—and medication use—in young children with a prominent family physician who has been in practice for more than 30 years. He mentioned that more and more parents were now coming into his office and demanding their child be put on ADHD medication. Prior to the recent ADHD “craze,” families openly asked his advice about whether their child actually had ADHD—and whether he recommended medication. A decade ago, virtually no family requested medication for their child, and ADHD was very uncommon in young children. He also indicated that many of the patients demanding ADHD medication reported being told by a teacher that their child had ADHD and needed medication to be successful in school. These comments parallel my own experience in working with families of late talking children: Schools are increasingly pushing ADHD diagnoses—and medication—on first graders, kindergartners, and even preschoolers.
My wife and I experienced this firsthand when our youngest son was in second grade. During a school meeting, his teacher pointedly suggested that he would benefit from ADHD medication. She also indicated that he could not sit still during reading time and that unless he received medication, he would likely fail second grade—and fail in future grades as well. I pointed out that he sat still just fine during math, science and art—he was good in these subjects and was (and still is) a gifted artist, and that the ADHD “symptoms” may have been the result of reading lessons that were above his skill level. I note here that this son is now a college graduate and an air traffic controller in the Air Force: all without the “benefit” of ADHD medication. Ironically, his college major was political science and he is an avid reader. However, in second grade, his reading skills were slow to develop relative to many of his peers.
The point here is that US schools are pushing students beyond their skill levels while forcing them to complete endless—and mindless—worksheets. This “perfect storm” of rigid instruction at ever-younger ages and an inflexible “one size fits all” common core curriculum may actually be contributing to the ADHD “epidemic.”
To be sure, ADHD is a real condition and some students with ADHD can benefit from medication. On the other hand, current diagnosis and medication rates are absurd and simply not credible: Recent data indicating that more than 14% of all school age boys are diagnosed with ADHD and that most are being treated with Ritalin, Adderall, Concerta or other schedule II prescription medications[1]. And this increased medication rate comes despite an explicit Academy of Pediatrics recommendation that behavioral treatment, not medication, should be the focus of treatment for most young children with ADHD.[2]
How do the US ADHD numbers compare with other countries? Is the staggering increase in ADHD in America an inevitable byproduct of the competitive demands of education worldwide?
A look at Finland, a country which recently had the highest achievement scores in the world[3], is instructive. In the most recent data, the rate of ADHD medication in school age children in Finland was 1.23 per 1,000.[4] That translates to .123 percent! This means that ADHD is “diagnosed” nearly 100 times more often in US school children (rate of 110 per 1.000 children) than in children in Finland.
In that case, surely medicating US children at a much higher rate than Finland and other countries must result in higher achievement for American students. After all, US schools are probably pushing ADHD with the goal of improving student learning. Sadly, dramatically increasing ADHD--and ADHD medication does not appear to be helping American students learn better than students in other countries. While Finland is at or near the top of the world list for achievement in reading, math, and science, the US is not even in the top 10. Indeed, the US is barely in the top 30—and getting worse relative to the rest of the world. It is obvious that the ever increasing US diagnosis and medication rates for ADHD is not improving America's world standing in education.
Isn’t it time to revisit basic assumptions about education is US schools? By now it should be abundantly clear that insisting on pushing highly structured reading, writing and math instruction to young children before their developing minds are ready for the information is not working. And, it is entirely possible that the ongoing ADHD medication debacle is likely due, at least in part, to how—and when—lessons in reading, math and science are being taught. ADHD rates are increasing at the same time that curricula are become ever more rigid and intolerant of individual learning styles while also expecting younger and younger students to learn ever more complex instructions.
For example, a US Department of Education “common core” writing standard for Kindergarten is: “Participate in shared research and writing projects (e.g., explore a number of books by a favorite author and express opinions about them).”[5] Is the person writing this standard aware that although this is a reasonable goal for high school students, it is completely unreasonable in Kindergarteners whose oral language is still developing?[6]
Is it a "symptom" of ADHD—requiring medication—when some Kindergarteners cannot yet “participate in shared research and writing?” As Dr. Jerome Groopman, a Professor of Medicine at Harvard Medical School observed “There’s a tremendous push [in schools] where if a kid’s behavior is thought to be quote-unquote abnormal—if they’re not sitting quietly in their desk—that’s pathological instead of just childhood.[7]”
Who among us could pay attention when the material being taught is either too complex to comprehend or is simply a boring repetition of what we have already learned? A look into medical diagnostic guidelines for ADHD is instructive: Parents should be aware that an ADHD diagnosis should NEVER be based on behavior in only one setting (e.g., a classroom) and that teachers should not be diagnosing ADHD. If the only time your child displays ADHD “symptoms” is in school (or when doing homework), this is not sufficient to justify an ADHD diagnosis and NO child should ever be medicated simply so they can be in school.
If ADHD is pushed on you and your child by a school, be sure to have an independent evaluation and have an open discussion with your pediatrician or family physician. And, if your child does indeed have ADHD, be sure to discuss the American Academy of Pediatrics guidelines for ADHD treatment with your physician, which emphasizes behavioral intervention as an important treatment option.
Footnotes:
[1] http://www.demarleinc.com/ADHD%20NY%20TIMES%20more-diagnoses-of-ADHD%20… accessed on May 31, 2016.
[2] ATTENTION-DEFICIT, S. O. (2011). ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, peds-2011.
[3] Heitin, Liana. "US achievement stalls as other nations make gains." Education Week (2013). http://www.edweek.org/ew/articles/2013/12/03/14pisa.h33.html?tkn=TVOFK6…
[4] Zoega, H., K. Furu, M. Halldorsson, Per Hove Thomsen, A. Sourander, and J. E. Martikainen. "Use of ADHD drugs in the Nordic countries: a population‐based comparison study." Acta Psychiatrica Scandinavica 123, no. 5 (2011): 360-367.
[5] http://www.corestandards.org/ELA-Literacy/W/K/ accessed on May 31, 2016
[6] Hoff, Erika. Language development. Cengage Learning, 2013.
[7] http://www.demarleinc.com/ADHD%20NY%20TIMES%20more-diagnoses-of-ADHD%20… quote on p. 2, accessed on May 31, 2016.
