This article is taken from chapter 1 of Thomas Armstrong's book, The Myth of the A.D.D. Child: 50 Ways To Improve Your Child’s Behavior and Attention Span Without Drugs, Labels or Coercion. "Specific, encouraging help every parent needs and every child wants." - Dorothy Rich, Ed.D., author of MegaSkills: The Best Gift You Can Give Your ChildThe Myth of the A.D.D. Child is the first book of its kind to challenge the misdiagnosing of millions of children with attention-deficit disorder and to question the overuse of psychoactive drugs in treating hyperactivity. Thomas Armstrong is a psychologist, teacher, and consultant who has had years of experience working with children with attention and behavioral problems. He believes that many behaviors labeled as A.D.D. are in fact a child's active response to complex social, emotional, and educational influences. By tackling the root causes of these problems- rather than masking the symptoms with potentially harmful medication and behavior-modification programs-parents can help their children experience positive changes in their lives. Dr. Armstrong offers fifty non-drug strategies for helping a child overcome attention and behavioral problems. These include activities for increasing self-esteem and making the most of vitality and creativity. He also provides a checklist to find the interventions that are best for a particular child, and hundreds of resources- books and organizations that support these fifty strategies. Provocative and persuasive, The Myth of the A.D.D. Child is a practical, essential guide for both parents and professionals. Chapter Index: America's New Learning Disease
America's New Learning DiseaseI'll never forget Manny. This remarkable twelve-year-old son of a Portuguese immigrant worker was a student of mine in the mid-1970s in a special education class I taught at a junior high school in Montreal, Canada. Manny actually looked like a miniature Robin Williams, and the resemblance didn't end there. Frequently cracking jokes and hamming it up in the middle of class, Manny was the class clown. Yet Manny could also be deadly serious and even philosophical. I remember some of our best times together were spent outside of the classroom, in the walks we took in a nearby park discussing life, the world, and our futures. He always functioned better when he was on the move. Seeming so mature at times, Manny was also like a toddler in the way that he was attracted to new things. He could really irritate me when he would burst out of his seat with no warning during class and walk toward an object of interest - a book, a poster on the wall, a new game - completely oblivious to the rules of the class, my astonishment, or the titters of his classmates. Manny was truly an enigma, a delight, a burden, a perpetual motion machine, and a test of my patience, all wrapped up in one fascinating package.Today, Manny would probably be labeled attention deficit disordered (A.D.D.) and medicated to help control his impulsive, distractible, and hyperactive behaviors. No doubt this might have helped him immeasurably. Possibly, too, it could even have allowed him to return to a regular classroom from my special education program. But I wonder what such labeling and medication might have done to Manny's uniqueness, to his "Manny-ness." Somehow I would almost prefer my uneven memories of Manny to a more sanitized version such as "that hyperactive kid we successfully treated back in '76." It seems as if the past fifteen or twenty years has witnessed a kind of takeover by the medical establishment of certain domains that were once the province of the educator and the parent. Children who were once seen as "bundles of energy", "daydreamers," or "fireballs," are now considered "hyperactive," "distractible," and "impulsive": the three classic warning signs of attention deficit disorder. Kids who in times past might have needed to "blow off a little steam" or "kick up a little dust" now have their medication dosages carefully measured out and monitored to control dysfunctional behavior. I'm not necessarily arguing that medication is a bad thing for some kids. I feel certain that thousands of children have been helped by the use of psychoactive medication used in conjunction with non-drug interventions. However, I wonder whether there aren't hundreds of thousands of kids out there who may be done a disservice by having their uniqueness reduced to a disorder and by having their creative spirit controlled by a drug. This, then, is the essential motivation behind my writing The Myth of the A.D.D. Child: to question America’s new learning disease (A.D.D.) and the primary treatment for this "disorder" (Ritalin), and to provide parents and professionals with some alternative ways of thinking about and helping kids with behavior and attention problems. If you should pick up any of the many recent popular books on attention deficit disorder written by physicians, psychologists, or concerned parents, you will probably be indoctrinated into the "A.D.D. myth," a certain set of beliefs offered up as basic truths about why some children won't behave or pay attention. I'd like to present this myth to you before going on to explore some of the problems that are inherent in such a perspective. Here, then, is the A.D.D. myth: A.D.D. is a neurologically based disorder, most probably of genetic origin, that afflicts from 3 to 5 percent of America's children (roughly two million children in all). Significantly more boys appear to have this disorder than girls, although girls who have evaded detection for years are increasingly being identified. A.D.D. is characterized by three main features: hyperactivity (e.g., fidgeting, excessive running and climbing, leaving one's classroom seat), impulsivity (e.g., blurting out answers in class, interrupting others, having problems waiting turns), and inattention (e.g., forgetfulness, disorganization, losing things, careless mistakes). Current thinking has identified three major groups of A.D.D. children, one group that appears more hyperactive-impulsive, another that seems more inattentive, and a third that combines all three traits. There is no lab test available to diagnose this condition. Assessment methods include parent, child, and teacher interviews, a thorough medical examination, and the use of specially designed behavior rating scales and performance tests.This represents a quick overview of the A.D.D. myth. While it may neglect certain fine points in the overall picture, there is little in the above summary that most A.D.D. experts would seriously disagree with. And for the most part, it represents a coherently organized system of beliefs - an orthodoxy, so to speak-that helps contextualize the concerns parents, teachers, and other professionals have about children who won't behave or pay attention despite appearing normal in other ways. The problem with the above canon is not so much that it is wrong - for within its little universe it makes perfect sense, as most myths do. The problem, rather, lies in the fact that it omits, or gives scant attention to, the broader social, political, economic, psychological, and educational issues that have surrounded this term - and others like it - from its inception. To begin to shed light on this wider context, let's look at the history of A.D.D. The Birth of a Learning Disease Restless children who don't mind their parents and who ignore their teachers have probably been around since the dawn of humanity-and even earlier, if evidence of impudent tykes from the animal kingdom give us any indication. However, the roots of modern-day attention and behavior problems - and their control-might very well be found in a nineteenth - century children's tale written by German doctor Heinrich Hoffmann for the benefit of his son. Among the characters represented, there is one Fidgety Phil: This tale stresses a Teutonic ideal of discipline and control, virtues that appear to quietly but firmly underline the modern-day A.D.D. myth.Fidgety Phil, The medicalization of attention and behavior problems seems to have taken place around the turn of the century, with the 1902 lectures of George Frederic Still to the Royal College of Physicians in England that were published in the British journal Lancet. Still described twenty children in his clinical practice who were often aggressive, defiant, resistant to discipline, excessively emotional or "passionate," showed little "inhibitory volition," and displayed lawlessness, spitefulness, cruelty, and dishonesty. Still believed that these children shared a basic "defect in moral control," which was probably hereditary in some children, and due to pre- or postbirth injury in others. This linking of children's troublesome behaviors to biological causes received a big boost during a major epidemic of encephalitis that affected large numbers of children during and after World War I. Doctors noticed that children with this disease often developed a postencephalitic syndrome with symptoms that included impaired memory and attention, poor motor control, irritability, personal untidiness, and general hyperactivity. Other researchers during the 1920s and 1930s investigated the relationship between behavior problems and birth trauma or post-birth head injuries in children. The 1930s also saw the first use of psychoactive drugs to control hyperactivity. A Portland, Oregon, physician, Charles Bradley, reported that the use of Benzedrine - a stimulant drug - helped to calm the behavior of hyperactive children. A further milestone in the development of A.D.D. occurred in the 1940s, when several researchers at the Wayne County Training School in Northville, Michigan, studied the psychological effects of brain injury in a group of mentally retarded children. Among the symptoms observed were distractibility and hyperactivity. Their work culminated in the 1947 publication of Psychopathology and Education of the Brain Injured Child, and led the way in the 1950s and 1960s to the use of such terms as "minimal brain damage," "minimal brain dysfunction," or simply "MBD," to describe children who displayed these characteristics. The term MDB, however, fell out of favor during the 1960s, when little evidence was produced to show that brain damage actually existed in these kids. The 1960s also saw the first use of Ritalin (in 1961) in the treatment of hyperactivity and the first official "consecration," in 1968, of A.D.D.-precursor "hyperkinetic reaction of childhood" as a disorder by the American Psychiatric Association (APA). In the 1970s, psychologists and psychiatrists turned the focus of their research regarding behavior problems in children to the study of attention problems. Canadian researcher Virginia Douglas may have helped to initiate this new focus in 1970, when she delivered her presidential address to the Canadian Psychological Association, arguing that deficits in attention were more likely to be the real culprit in many children's behavioral difficulties rather than hyperactivity. By the end of the 1970s, there were over two thousand published studies on attention deficits. The APA sanctioned this new disease in 1980 by listing "attention deficit disorder" in the third edition of its influential Diagnostic and Statistical Manual (DSM-III). The 1980s witnessed an even greater surge in research on A.D.D., and the founding in 1987 of the parent advocacy group Children with Attention Deficit Disorder (CH.A.D.D.), which mushroomed in size from twenty-nine chapters in 1988 to over six hundred chapters in forty-nine states by 1994. In 1994, the best-selling book Driven to Distraction and a cover story in Time magazine on attention deficit disorder put A.D.D. on the lips and in the minds of millions of Americans. One commentator in the Time article even suggested that President Bill Clinton had A.D.D. and was "only a pill away from greatness." By the mid-1990s, A.D.D. had come into its own as the learning disease du jour of American culture. It should be apparent from reading the brief history above that A.D.D. has had a rather bumpy ride on its way to its current popularity. The syndrome itself has gone through at least twenty-five different name changes in the past century, including: The history of this disorder, then, is not like the stories of how other diseases, like polio, diabetes, or AIDS, were discovered. This is not the tale of a hidden disorder carefully unmasked by scientists through years of patient research. It appears more closely to resemble the errant wanderings of a pinball through the mazes of an arcade machine. And the discovery of "attention deficit disorder" represents not so much the unveiling of a malady that has been waiting for decades to be discovered, as it does the confluence of complex social, political, economic, medical, and psychological factors coming together at just the right time. It seems improbable, for example, that A.D.D. would have received such widespread support as a learning disease had not the powerful American Psychiatric Association officially named it as a disorder in 1980. Yet it should be remembered that psychiatric illnesses tend to go in and out of fashion with the social and political climate of the times. Before 1974, for example, homosexuality was considered by the APA to be a disease. During the 1930s, individuals scoring low enough on standardized intelligence tests could be diagnosed by psychiatrists as "idiots," "imbeciles," or "morons." Similarly, over the past forty years, the APA has shifted dramatically in its classification of restless and inattentive children. In the early 1950s, the APA had no category for restless and inattentive children. Children who showed these problems would be listed in the Diagnostic and Statistical Manual (DSM) under "organic brain syndromes," and comparatively few children qualified. With each new edition of the DSM, however, psychiatrists created categories for hyperactivity and inattention that included more and more children. As University of Houston psychologists Gay Goodman and Mary Jo Poillion put it: "The field [of A.D.D.] has shifted from a very narrow, medically based category to a much broader, more inclusive and more subjective category ... In part, this could be because the characteristics for A.D.D. have been subjectively defined by a committee rather than having been developed on the basis of empirical evidence." A.D.D.'s growth and development also benefited greatly from governmental support. The parent advocacy group CH.A.D.D. lobbied Congress in 1990 to have A.D.D. officially declared a handicapping condition eligible for special services under federal law. It encountered massive opposition, however, from several national educational and civil lights groups which argued, among other things, that the A.D.D. label could be used to stigmatize minority children. As a result, Congress refused to certify A.D.D. as a handicapping condition under the new law. Yet in 1991, a letter from the U.S. Department of Education to state school superintendents outlined three ways in which children labeled A.D.D. could qualify for special education services in public schools under existing laws. Having been stopped by Congress, A.D.D. essentially came into the schools quietly through the back door. There is an economic side to A.D.D., as well, that serves to drive its popularity. Many people have something to gain financially from the continued existence of this "disease." Pharmaceutical companies collect hundreds of millions of dollars annually from the drugs that are sold to treat the estimated one million children who are currently being medicated for A.D.D. Physicians, psychologists, and learning specialists have new markets opened up for them in treating the needs of children with A.D.D. It costs, for example, an estimated $1,200 for the medical diagnosis of a child suspected of having A.D.D. and $1,270 for a school system evaluation to determine eligibility for special education. One brochure for psychologists that I received in the mail advertised "How to Effectively Market the ADHD and Other Sub-Specialty Segments of Your Practice." Another brochure advertised a Caribbean cruise to learn more about A.D.D. Hundreds of tests, learning programs, and other educational materials have been created over the past five years, the makers of which in each case are seeking to get at least a piece of the A.D.D. market. It appears, then, that those individuals with a robust capitalistic instinct in America know when they see a good thing and have responded by turning A.D.D. into a veritable growth industry likely to remain in existence into the foreseeable future. Finally, it seems unlikely that A.D.D. would have become a popular and respectable idea in this country if our nation's psychological and psychiatric research institutions had not embraced cognitive and psychopharmaceutical perspectives from the 1960s until the present. Previous to that time, the psychology departments of our nation's universities were ruled largely by the behaviorists, and the psychiatric training institutes were fundamentally psychoanalytic in their theoretical orientation. Consequently, a child's hyperactive or inattentive behaviors were more likely to be chalked up to poor conditioning or the absence of a father figure in the house. During the 1950s and 1960s, however, a revolution occurred in psychiatry, as a whole host of psychoactive medications were discovered that could be used to treat a wide range of mental illnesses. Drug treatment began to replace psychoanalysis as the treatment of choice for many psychiatrists. Similarly, at about the same time, research psychologists began to focus their attention less on the external behaviors of human beings and more on the internal workings of the mind, including such factors as memory, perception, and, significantly, attention. The shifts that occurred in professional priorities over the past three decades were tailor-made for the creation of a cognitive problem (attention deficit disorder) that could be treated primarily through psychopharmaceutical intervention (medications). Essentially, then, A.D.D. appears to exist largely because of a unique coming together of the interests of frustrated activist parents, a highly developed psychopharmacological technology, a new cognitive research paradigm, a growth industry in new educational products, and a group of professionals (teachers, doctors, and psychologists) eager to introduce them to each other-all of this taking place under the beneficent influence of governmental approval. Of course, such a coordination of efforts would hardly be a problem if A.D.D. really existed as a discrete clinical entity. Then the governmental, psychiatric, social, and economic factors described above could be positively viewed as the logical outcome of a concerted attempt to meet the needs of children who have this disorder. However, as we'll see in the next chapter, no one really can be certain what A.D.D. is, how prevalent it is, or what causes it. While there are thousands of studies that have been done in the past three decades using some version of the A.D.D. myth as a governing paradigm, once we begin to peel away the artifice, layer by layer, we discover that - as with the disappearing Cheshire cat in Lewis Carroll's classic children's tale - all we're really left with in the end is the smile, if that. Get Thomas Armstrong's book The Myth of the A.D.D. Child: 50 Ways To Improve Your Child’s Behavior and Attention Span Without Drugs, Labels or Coercion. Suggested Reading List - Ritalin - ADHD Back to Main Ritalin/ADHD Page Back to Main SNTP Page Say NO To Psychiatry!
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