Linda Graham's concerns regarding the alarming increase in the use of medications in children diagnosed with ADHD are understandable and commendable and echo concerns psychologists have been raising for some time. It is therefore curious that she takes a swipe at psychologists who offer parents an alternative to drug treatments for improving their ability to manage children's behaviour, which can be challenging for a range of reasons. Her choice of phrase, 'the dubious PR practices of psychologists', is simply insulting. If she believes psychologists announcing the availability of parenting programs with well established efficacy, such as Triple P, is 'dubious' in any way, I suggest she makes a formal and presumably supported complaint to the Psychologists Registration Board, Health Department, Australian Psychological Society, Office of Fair Trading or other relevant body. Or she could apologise and withdraw the offending remark so we can all concentrate on the important issues.
Dr Bob Montgomery

Thank you for your article and genuine concern Linda. This is a very important issue and it definitely needs a lot more exposure and dialogue.

I'm disappointed by the lack of responses here, but I think they're all caught up in the "all men are filthy rapists" article also running today. I hope more will join this thread after they've finished fighting over that one.

I for one am deeply concerned over, what appears to me to be, the wanton drugging of kids. Any way one looks at it, it certainly can't be doing any of them any good. I feel deeply worried for all involved. There must be a better way. I believe there should be a lot of very serious research into the matter, because people like myself with no direct connection with the problem find it very difficult to get any reliable information at all and subsequently form conclusions that may not be correct.

And don't worry about the good doctor's comments above. If they're the ones dishing out these drugs, they're the very ones, that need to be doing the research to find better remedies than drugging kids stupid and to identify exactly what is causing this peculiar condition, which seems to have sprung up out of nowhere.

In my thinking, I think the good doctor doest protest too much.

Thanks again for bringing the subject to our attention.

I agree that this is a very important and disturbing trend in the attempt to control our children. Unfortunately, I think the government's reaction to the problem is a reflection of their ideology. That is there is no structural problem, it is the individual that is the problem and therefore it is his or her responsibility.
On a personal note, my son was investigated at school for ADHD and the conclusion was that he was "just a very naughty boy". That was about 16 years ago. Would that be acceptable now I wonder or would he be dosed up so that he would conform? By the way, he is a delightful 22 year old now. I am concerned however, about what sort of adults are going to result from these "drugged" children.

Thanks for a very interesting article which rang true.

There has been an enormous amount of social change in a very short time and the children are the meat in the sandwich.

As usual, we go about treating symptoms with bandaids.

One thing many could do right now is to choose a simpler, more meaningful life. Increased work hours to buy McMansions and electronic gadgets come off the time one has for living. We have lost the time spent doing mundane things with our children, such as chatting while preparing food or digging in the vegetable patch.

Also, in many cities children have lost their free space and the interaction with others and nature that they once had. Parents are convinced that if children are free to roam then they could be run over or molested. Some of that could be overcome by redesigning our suburbs around people rather than around cars or for profit alone. We have put the cart before the horse and we are paying for it.

As for education, well yes I believe we lost the plot when the economists and social engineers took over. If parents had more time to help their local school and attend functions all would gain enormously. But for many that is not as important as climbing the greasy pole for more income to pay off an overworked credit card.

I suspect the author is right and putting it in my words, many children are being treated for psychological and behavioural problems that are in fact just normal reactions to the crazy abnormal stuff that is going on around them. After all, how many other animals would think they are taking good care of their offspring by staying well away from them and replacing parental contact with gifts of meaningless objects?

Another aspect along with lifestyle and less stress, is nutrition.

There has been a decrease in how much fresh food is eaten, and the very food that is eaten is usually not vine ripened. Some of it is gased and left in cold storage for up to a couple of years before being brought out.

It would not be surprising to find some kids with an annoying, irritating feeling inside due to being hungry for missing vitamins, minerals, and glyconutrients.

I am of the belief that the so called attention deficiet syndrome only occurs in Australia, a bit like kangaroo paw which had it's beginning with office workers, it was labrllrd RSI.
In the good old days of the sixties, all the doctors pescribed dexedrine for the housewives together with phenobarb or pentobarb for goung to sleep.
I have witnessed 1000 ritalin and dexedrine scripts, and have observed that it is the mother/father who is unbalanced not the child.
My assumption is that they harras the doctor to prescribe the stimulant in the dream that it is the kids fault, not theirs.
Ritalin increases concentration and coordination, good for golf, wheras dexedrine increases heart rate and keeps you awake longer, it is rougher and cheaper.

maximus, psychologist's can't prescribe medication. They work with thinking patterns, and education not pills. Sometimes their work is supplimented with medication (precribed by a different profession) as a means to get a behaviour under control while other issues are worked through but long term solutions via medication are not their approach.

Parenting programs and similar services are a great idea for parents confused by the massively conflicting information coming at them from so many "experts", current affairs shows, book writers and the like.

I do have somewhat less confidence than the doctor in the value of trying to make a complaint about shoddy practices though. I tried it regarding a medical doctor some time ago and could not find anybody willing to listen.

R0bert

Good day RObert, how are you going?

If I was in error about psychiatrists (doctors, if I'm not mistaken) aren't in the business of prescribing drugs then I apologize to all and sundry. However - "Ultimately pediatricians and PSYCHIATRISTS are responsible for writing prescriptions for stimulant medication. That doctors play a large part in the problem is not in dispute," writes Linda Graham, right here in this article.

Well, it seems now that that it IS in dispute, and by none other than your good self, RObert.

Linda Graham thinks they can, and psychiatrists, as doctors, I would have thought they could, but if you know better, then I stand corrected.

But just quietly RObert, I think you might be wrong about this.

If you aren't, then it makes one think, why did the good Dr Bob Montgomery write what he did in the first post above and why did Linda Graham write what she wrote in the article about psychiatrists?

Have a think about it.

Are you sure you mightn't be confusing psychologists with psychiatrists?

Maximus, good evening to you too. Have I misunderstood your original post? Dr Bob commented on what was said about psychologists in the article "It is therefore curious that she takes a swipe at psychologists who offer parents an alternative to drug treatments for improving their ability to manage children's behaviour".

Your post seemed to suggest that you thought they were the ones dishing out the medicine (in conjunction with pediatricians).

"And don't worry about the good doctor's comments above. If they're the ones dishing out these drugs, they're the very ones, that need to be doing the research to find better remedies than drugging kids stupid and to identify exactly what is causing this peculiar condition, which seems to have sprung up out of nowhere."

Psychiatrists can prescribe medication, psychologists can not. Dr Bob's comments seem to be in support of the work done by psycholgists.

No confusion here about psychiatrists and psychologists (I hope).

R0bert

Thank you for your kind comments Maximus, however I must acknowledge that Dr Montgomery has a point. I neglected to say “some” psychologists and for this I do apologise. While my swipe may offend, I still think it important that practitioners in any field examine what effect the things said and done in the name of that field may have upon parents and teachers and, in the long run, children.

For example, a couple of weeks ago, the Sunday program ran a special called “Is your child normal?” Psychologists featured heavily in that special but, as professionals, should ask themselves hard questions about how their actions come to influence parent perception and where that might lead. Then we have the trashy reality style programs like “Honey, we’re killing the kids”. I understand that a public service argument could be made here but would respond that psychological practitioners must take responsibility for how these ways of seeing and speaking come together to constitute a pervasive deficit view of child behaviour, which then comes to be taken up in the home and the classroom.

Dr Montgomery is right to say that psychologists have long been querying whether the attribution of a medical diagnosis and prescription of medication for problematic behaviour is the right course of action. However, the caveat “some” would again be appropriate here. During my review of the literature surrounding ADHD, I found that there was an interesting relationship between medicine and psychology. On one hand, and as Dr Montgomery points out, there are psychologists who challenge the medical response to behaviours said to indicate Attention Deficit Hyperactivity Disorder by calling for practitioners to avoid the use of terms such as “diagnosis” which may privilege the medical model. Then, on the other hand, there are some who argue for the validity of the behavioural descriptors and the veracity of the medical construct – in order to advance a psychosocial perspective and multimodal treatment

With respect to the field of education, whether behaviour is thought to be influenced by neurological, biological or environmental factors, medicine and psychology offer means of making adjustments to the child - leaving the pedagogical and structural arrangements of schooling relatively unaltered. This is a huge oversight and one that needs to be addressed, considering that most of the behaviours listed as characteristic of ADHD are connected with (and one could even argue contingent upon) the demands of schooling. Not blurting out answers in class, remaining in one’s seat and being still and quiet are cultural expectations brought about by the advent of mass schooling.

For example, if children were still working in the mines at nine years of age their energy levels would be considered a bonus. However, the modern and increasingly competitive demands of schooling have resulted in the rearticulation of normal childhood exuberance, curiosity and energy as “unnatural”. Problematically the contribution of changes in schooling demands - such as lowering of school entry ages, increased emphasis on academic learning and seat work, pressure for children to learn to read earlier and better, crowding of the curriculum, and the shortening of children’s recess and lunch times – barely rate a mention in the myriad of contributing and causal factors being considered in the literature around ADHD.
But… picking on psychologists (or teachers, parents, doctors etc) is a diversion.

Ultimately, everyone is responsible for the problem. Public policy in Australia currently privileges the medical model – paediatric appointments attract a sizeable Medicare rebate, stimulant medication can now be obtained for as little as $4.70/month and, in Queensland, only a medical diagnosis counts in claims for educational support funding. And, as I have said earlier, public education has been subjected to market-based reform and governments are retreating from quality public service provision. Voters are letting them. This has to change if we are ever to seriously combat the growing problem we call “ADHD”.

PS: Psychologists cannot prescribe medication, only doctors with a medical degree can

Linda

What you say makes good sense and from discussions with teachers at the sharp end there would be a lot of agreement with what you say.

Just to make one point, the insistence on unnatural behaviours to make mass education in the classroom 'efficient'(examples being sitting for in one place for lengthy periods and keeping quiet) is unkind to girls but it is tragic for boys. It is in the nature of boys that they are fidgety and need to do things to learn.

No wonder then that boys are so often (wrongly) seen as 'problems' in the classroom and in need of discipline, punishment, re-education and medication.

Good points Linda - My daughter is dyslexic teenager, not ADHD, but a lot of what you say applies to her situation as well.

Narrow definition of disability limits the assistance available to teachers.

Large class sizes can result in undemocratic and punitive discipline systems.

Some teachers and administrations aren't fully aware of the Disabilites Discrimination Act 2005.

Educators are not fully telling parents about all the avenues of help available to them.

Ms. Graham,

I am to assume that it is not parents who are responsible for their children being on stimulate drugs, but rather teachers who refer the parents to Pediatricians and Psychiatrists. I gather I am to understand that teachers do this as they “are forced into a funding play-off”.

I so we plow more money into the education system and all is solved. Medication. Wonderful. Children now know their school work, have no social problems, who’s peers love to play with them, are organized, have a good sense of time, are no longer impulsive, with wonderful working memories, short term and long term memories are up to scratch, who can inhibit; their speech, their actions, their impatience. Good on these teachers, they have now cured ADHD. If only it was that simple.

See Dr. Russell Barkley’s lecture, San Francisco on 17 June 2000. In this lecture Dr. Barkley mentions that the US plowed millions into special education for those with ADHD with very little effect.

All children went to school in 1945!

Doctors in Australia have been well behind the times,finally some of them are getting educated in ADHD. Parents are better informed

Oh, I hope that you will publish your findings. Your interviews, with teachers, parents, children,pediatricians. How many did you interview? What were your methods? What materials did you refer too? Etc.

Take charge of a class of 3, three should be enough, 10 year old boys with ADHD (combined) who are not on medication. Let me know your opinion after a month of teaching them.

You have insulted teachers, parents and doctors. You say teachers want their pupils drugged, parents and doctors DO AS TEACHERS tell them! I don’t believe that? Your research is from the US. Not Australia. And not properly reported.

Now if YOU want to find a better way than medication then get into genetic research, there you will find the answer.

Do you believe in depression? Do you believe in any mental illness? Where does that $10,000 come from which you have received as a grant? Who put the money up?

jennywren

Ms. Graham,

I have just posted within the constriction of 350 words. A very difficult feat for an ADHD combined person. If as you state education is the answer to ADHD. What is your answer for a 66 year old female and a 38 year old male, still with the DSM symptoms of ADHD? I would really like, as would the 38 year old male, a solution to our life long disability.

Your assitance would be most appreciated indeed. Please help us. What do we do? You have the answers so please tell us. I am sure there are other readers who would be interested as well.

Can't wait for you kind assistance,

Jennywren

You're absolutely right Cornflower - boys are overrepresented in ADHD diagnosis: ie. between 1988 and 1998 the number of boys diagnosed with a mental and behavioural condition increased from 2,200 to 20,800. Then, research into disability and severe restrictions rates from the ABS also shows that the sheer number of young boys diagnosed with ADHD contributes to a peak in that rate at age 5, levelling off at age 15. This, as the authors of the report confirm, correlates with compulsory schooling ages.

Do we really have an gender specific epidemic on our hands? I think not. Do we have a generation of young people growing up with the belief that there is something "wrong" with them? Unfortunately, yes. Research shows that children internalise an ADHD diagnosis with a belief that they are somehow defective and need drugs to be "normal". My argument is simple: So, there are children who are fidgety, distractible, impulsive and so on... the problem is not that such difference exists - but instead what we do about it and, ultimately, whose interests this serves.

Good teachers can reach these children through innovative pedagogies and stimulating curricula. I am suggesting we give them the support and space to get on with it.

Well done, Linda.

I badger teachers a great deal about opening up their hearts and minds to kids who won't sit still and keep quiet.
The great majority (not all) are indeed boys.

Boys are overwhelmingly represented in exclusions, suspensions and similar bad results.
US educators are just waking up to the over-medicalisation of the problem?? of kids who have too much energy for those poor weary teachers. And to the hard fact that many boys are being pushed aside by the education system in the race to get ahead. Most at risk are working-class boys and dark-skinned boys who scare teachers, who then too quickly blame, shame label and punish them.

Unfortunately so-called problem kids get lost in the complexity of Departmental memos, Sydney-Hobart-Canberra squabbles and so on.

This is a great discussion and highly important to parents.

Bravo

Thanks for the article Linda.

I agree with you and a number of other posters who point to the changing nature of society, changes to the education system, less time spent with kids by the parents, even poor nutrition.

My brother had ADHD and was prescribed meds (can't remember which sort, they're the ones which are basically a milder form of speed) to help him out. My brother said that the meds helped him concentrate at school, but he just didn't feel himself when on them. When he was about 16, he took about a dozen of them. He wrote a kick-ass song that night, but he wasted much of his teenage years and early twenties smoking far too much weed. (He's been clean for a year and a half now, which is fantastic. I finally have my brother back.)

Sorry for the little testimonial there Linda. But there are some interesting points I don't know the answer to. Is there a correlation between taking of ADHD meds and use of illicit drugs? The risk factors for ADHD seem to be fairly similar to those for drug use.

There was one hell of a lot of tension in our family as we grew up. What do you think of Rommel's comment, suggesting that bad parenting is a problem? I've noticed among some of my friends’ kids, that the less attention given, the worse the brat.

General question- My mum reckons I show symptoms of ADHD too, and occasionally point to various people as exhibiting ADHD symptoms. Do people get the impression there is a tendency to try and share the problem around- a bit of transference going on? (grobble toodylooo poo wee... oops, that was my ADHD talking.) I've never really paid much attention to it- it was a conscious decision not to fall for the effect Linda talks about- internalizing the idea that there is something wrong with you.

One last thing, I'm glad Cornflower noted the high proportion of boys diagnosed with ADHD. I agree with Linda that it's important not to 'gender' the issue, and it would be downright hypocritical of me to do so given my mini-essays on other threads. But I would argue that education policies designed to socially engineer changes to certain aspects of masculinity do more harm than good.

The interesting thing is that even though methylphenidate (Ritalin) has been in use for over 50 years, there are no reliable studies of the effects of long term use or long-term effects of using stimulant medication. Worringly, a US study described as the 'most comprehensive scientific analysis of the drugs to date has found little evidence that they are safe, that one drug is more effective than another or that they help school performance’. There is concern that kids who are given stimulants are more inclined to take street drugs but serious research has not been conducted in the area yet. Certainly there are reports on the ground that there is a lot of black market activity going on, kids (and apparently some parents) on-selling stimulant meds. Also many research studies in the area of medication have been sponsored by drug companies - the results of those have to be treated with caution.

I have never met a parent yet who did not agonise over the decision to give their child medication - sometimes on a daily basis! One of the reasons for that was the side effects that their children were experiencing. The important thing for the public to know is that stimulant medication has to be allowed to wear off with enough time for children to eat a decent dinner and sleep at night. Also parents have to deal with the rebound effects of that medication, which can often produce behaviour far more extreme than that which the child was originally medicated for. The claim that parents medicate children for their own benefit is way off-base. What we do need to know more about is why parents make that decision and what alternative to drugs and labels we can come up with.

The first thing that should be done is that ADHD should be properly defined and parents, educators and governments should be familiar with the definition. Is the problem considered to be behavioural, medical, psychological, environmental or what?
In my experience, if a child exhibits any form of 'disruptive' behaviour, the suggestion is that they have ADHD. My own impression is that ADHD behaviour cannot be controlled by the child, parent or teacher for most of the day and night. Are there any statistics that identify the number of children exhibiting this kind of extreme behaviour?
I would hazard a guess that the figures would be relatively small in comparison to the number of medicated children.

Another aspect of this issue is the crossover with other "conditions" all of which come in differing degrees and which people can often have trait's of a number of.

(ignore spelling please)
Things like ODD (Oppositional Defiance Disorder), Aspergers, CD (Conduct Disorder), Autisim and a variety of others seem to have some overlaps.

I'm left wondering how often kids are diagnosed with one or more of these because someone has suggested to a parent that their child may have one of them. The parent has done some research on the web and convinced themself that their kid has the condition then either deliberately or otherwise provided information to the treating doctor which supports the diagnosis.

If you are a parent with concerns about your parenting skills which you don't wish to face then there is a strong emotional motivator to find your childs behaviour is the result of a medical condition rather than a predisposition to one or more conditions combined with a lack of boundaries for the child.

All of which has to make things harder for those people who actually have the conditions, the ones who need medication to help them manage day to day issues. These things come in various strengths, we need to keep that in mind when looking at the issue so that we don't ignore the needs of those who do need the medications.

R0bert

I'm 72, so I went to school a long time ago. My mother taught me to read and write simple sentences, times tables up to 12X and how to do simple outline drawings, before I started school. I jumped classes and got a scholarship when I was ten to an expensive school , which my family could not have otherwise afforded. And I was very small for my age. Plenty of stress, with bullying, blatant snobbery from staff and other pupils and the old fashioned English religious private school system with its entrenched distorted values.

I was generally unhappy with the school system and, with the exception of a few subjects, I was often bored stiff. I was not overtly disruptive [I didn't want to get a flogging], but constantly fidgetted and dreamed. I dreamed up academic ways of disrupting lessons, like when I worked out how to trisect an angle with compasses [something which has never been done] and challenged the gullible maths master to prove me wrong. Yes, there were SOME happy times!

I think that today I would probably be diagnosed with some emotional/mental disfunction. But back then, I was just a kid with some difficult personality characteristics. I had bags of energy and worked it off by long distance and cross-country running and rugby union, all of which I enjoyed.

So what has happened since then? Is ADHD overdiagnosed and/or wrongly diagnosed now and/or was it just not understood then?

Like so many prevalent current health problems, I believe it has a lot to do with poor nutrition and inactivity. We see the obvious results of this with the obesity epidemic, but mind altering effects are more subtle. Even much of the supposedly "good" food today is grown/raised on impoverished soils, often over-processed, lacking in adequate levels of essential minerals and vitamins, picked unripe and gassed or cold-stored, sprayed and treated with goodness-knows-what. So if that's the good stuff, what does that say for the known junk?

I'm with you Rex. I'm not 72, not even close, but I did go to school, public schools, when kids didn't have excuses to fall back on, didn't eat so poorly and in general terms behaved themselves. Seems there was no need for someone to come up with the term ADHD, and the drugs to treat it, until not all that long ago.

I often wonder how many children, boys especially, are diagnosed with ADHD who really just need more physical exercise. My seven year old does a total of 30 minutes PE at school each week and it is noticeable now that soccer season has finished that he is more easily distracted and annoying to his sisters. With parents ever busier and after school care providing little or no outdoor activities it is really no wonder our children are bubbling over with energy - and getting fatter too. I have heard teachers complain that the boys won't sit still but take no notice of my suggestion that they get them all to do some aerobics or a few laps of the oval before class. Any mother knows this is the best way to quiet them down and improve attention. Even the most difficult children will benefit to some extent.

Ms Graham,

LG>I have never met a parent yet who did not agonise over the decision to give their child medication

JW>Yes, that is correct, they do not do as teachers tell them.

LG> The important thing for the public to know is that stimulant medication has to be allowed to wear off with enough time for children to eat a decent dinner and sleep at night.

JW> Don't you think that doctors advise parents of this?

LG> Also parents have to deal with the rebound effects of that medication, which can often produce behaviour far more extreme than that which the child was originally medicated for.

JW> yes parents are aware of this.

LG> The claim that parents medicate children for their own benefit is way off-base.

JW> According to you they do it for the teachers benefit

LG>What we do need to know more about is why parents make that decision and what alternative to drugs and labels we can come up with.

JW> Yes, so why don't you talk to parents before you place yourself as an authority on the matter. If you HAD spoken to parents you would know the answer would you not? So obviously it is as I suspect, you don't know what you are talking about. You quote the situation in the US and pass it off as if it were in Australia. Why?

JW> Oh, I am still waiting for your drug free solution to my 66 year old ADHD. Oh, and of course just where is your claimed finance coming from? The source please.

Other readers take note. Ms. Graham is ignoring me, ask yourself why?

JennyWren

Although I teach at a University in China I do extra work in local schools where I teach students ranging from 5 to 15 years old. At University I teach classes at each level from Freshmen to Post Grads.

The classes are all enormous and the behaviour of the pupils would, by Western standards, be considered totally unacceptable. Students chat, yell, run around, fidget, sleep, giggle, shriek and bellow. Foreign teachers frequently are reduced to tears, not many renew their contracts, and breaking contracts to go home is very common. So is giving up and showing movies. In every one of my classes there are students who, in the West, would be in "special" schools.

All of my students come from at least middle class backgrounds. Although both parents work they are nurtured in the home by grandparents who give them constant attention, encouragement, help and advice which is backed up by parents when not at work. There are no obesity problems and none of the students eats junk food, pre-packaged food, or instant food, nor do they ingest artificial colourings or flavourings on a daily basis. The food they eat is organically grown, fresh daily and cooked lightly and quickly.

in summation: - none of my pupils are emotionally starved, lack attention, have bad diets, come from low soci-economic backgrounds or suffers neglect in any way. The majority of my pupils exhibit symptoms consistant with those attributed to ADHD. The older pupils consistantly struggle with issues of self-esteem. It appears that the only common denominator between these students and those in the West is overcrowding in classrooms.

Teaching is extremely challenging and exhausting and calls for continual fresh strategies, constant re-working of daily teaching plans and inventiveness. Controlling a classroom is possible but only because of the latitude given to teachers in order to excercise these constantly changing attitudes.

While not advancing any conclusions from the foregoing I do throw it into the debate for those who might like to do so.

Thank you Romany, that is fascinating to hear. ADHD is a western phenomenon - that much is obvious in the diagnostic statistics which are highest in the US, Canada and Australia (countries using the DSM-IV). Diagnostic rates in the UK have been rising more moderately partly because they use the ICD-10 classification.

Incidentally, a review of international research recently stated that the optimum class size was between 13-17 students. Reducing class sizes from 28 to 25 students had no effect. Real impact was achieved when the class size went below 20.

For the last 15 or so years in Australia, we have embraced inclusive education but our teachers are still being rubbished by the Federal government for "falling standards". Fact is - our teachers have managed to hold the line even when the student population has dramatically (ie. see benchmark performance and OECD results). Our public education classrooms increasingly house students with disabilities, increasing population of English language learners, disadvantaged students and so on. The market "choice" policies being pursued by the Federal government (privatisation of education) has caused a drift in the most advantaged (and easy to teach) students to private schools.

However, the stress on teachers and schools is very high. Teachers are buying resources (whiteboard pens, paper etc) out of their own salaries. Contrary to popular opinion, many teachers work long hours. Those parents who can afford it, donate to schools so schools can top up their learning support funding! It goes without saying that some schools will do better in this than others. In a country that is aiming for excellence and equity in education - the underfunding of public education is unsustainable.

Jenny, I asked the question and wondered if it might be becuase of the very aggressive manner you use in your comments and questions.

Maybe instead of treating Linda as an enemy look and see if some of what she is saying has value. Look and see if she is using the forum to broaden her understanding of the issue (mabe not by much but a bit).

I got the impression that the article was not an attack on all medication for ADHD but rather a discussion regarding factors which might be contributing to a perceived overdiagnosis of the condition.

My own understanding is that ADHD is a real condition which has some similar symptoms to behaviours contributed to by environmental items more than genetics. Poor diet, lack of boundaries and a whole bunch of other things can in some kids lead to behaviours that look like ADHD. Linda is discussing particular aspects of the latter involving schooling.

If you disagree with that then tell us why, ask Linda if she is opposed to all medication for ADHD. If you are willing tell us some of what it is like as an adult ADHD sufferer.

I have a very good friend who is ADHD but at a low enough level that it is managed without drugs so I know some of it but have no understanding of the more severe levels and the impacts for an adult.

R0bert

From our experience, students need diversions to expend energy, to help with personality and physical development and to develop additional groups of friends. Just commenting briefly on the last mentioned (friends), when things are not going so well at school as they inevitably do, it is useful to have outside interests through membership of a sporting or special interest club (eg photography, science, art) not connected with the school.

Our boys benefitted greatly from joining the Scouting movement. Helped their confidence and egos no end and channelled their energy into something useful. Scouting developed a sense of community in them too which made them much more pleasant to deal with than some of their irritable, egocentric peers. Most children sit in front of the TV or computer when not at school and this cannot help.

Robert,

Your response is much appreciated indeed.

It seems to me, that Ms. Graham said, that it was teachers who were sending parents to doctors, who were then prescribing medication because the teachers sent the parents there in the first instance. Because the teachers had to met what could be performace targets.

This point seems to have been missed by most who have responded to Ms. Graham.

I am a 66 year old ADHD combined, who managed to acheive a B.Sc at the age of 43,with dyslexia. I have made a very thorough study of ADHD. I will say it has taken several years to do so. While I most certainly do NOT claim to know all, I most certainly know a great deal. As a parent, as grand aunt. Meeting a great many of ADHD adults. I would think I was qualified to say what I have said.

The references that Ms. Gramham made apply to the US. Those laws were put in place in several states because teachers were reporting parents to the relevent child welfare agencies. These agencies were impowered to declare any child who a teacher said should be on stimulate medcation as a neglected child, then take that child away from the parents. Ms. Gramham did not report the full story. Nor did she state which country this occured in.

Yes ADHD is a very serious disorder, a very debilitating disorder. And yes, medication is on most occasions required. It can make the difference between a child going to jail in later life, or becoming a speed addict.

As Ms. Gramham has decided to ignore direct questions. I will not be posting in this area again.

I have no wish to be part of Ms. Grahma's thesis for a PH.D if this is the reason why she left her message in the first instance.

I will leave those of you who do not know enough about ADHD to continue on. I am very sorry that no one else stuck up for teachers or the parents.

So be it, enjoy,

JennyWren

jenny, thanks and good luck in looking for better solutions.

I'm saddened that you are moving on. I would have liked to hear more of what you have learned and your views on what can be done better.

R0bert

RObert, You are very perceptive. I am not opposed to medication per se. I am very concerned about the rising prescription of medications to children - particularly because prescription is concentrated by socioeconomic status. We do not know enough at this stage about what these medications do to developing brains. That is what the medical research literature says. Undoubtedly these medications offer respite for some children - but certainly not all. 30% of all children diagnosed with ADHD do not respond to medication. Many others experience side effects severe enough to counteract therapeutic use. Given this, I do not see the harm in questioning what alternative there is to drugs and labels. And you're right, as a scholar in education, an area where so many of these children struggle, I have looked at the problem from the scene of the school. Many of the children who come to be described in these ways have learning styles that simply do not fit with the dominant ways of doing things in schools. Didactic (chalk & talk) instruction and rigid expectations for seat work fail. On the other hand, many of these kids are visual learners, have difficulties with receptive language and abstract concepts - they need teachers who can explain things in different ways. They need instructions to be broken down into smaller parts. They need reminding. Teachers need time to be able to do this - as well as teach all the other children in their class.

I also speak as a parent who has been at the ADHD (gifted, ODD, comorbid anxiety disorder, Asperger Syndrome etc etc) coalface for the past 8 years. My research question was whether an ADHD diagnosis is educationally helpful and whether it is the best we can do. Comprehensive analysis of education policy in Australia, three years of doctoral research, time spent with mothers and fathers in support groups, parenting classes, and interviews tells me it is not.

Linda, I suppose my son must be part of the 30% (I would have thought it was greater than that) of ADHD kids who respond well to the right type and dose of medication.

He was diagnosed with ADHD and dyslexia early on by an educational psychologist, who also said his IQ was then in the top 3%. My wife had to teach him how to read, because the school would not. The primary school principal actually said to us: "We'll just have to accept the fact that we'll never be able to teach some kids how to read." He can read quite well now as a third-year apprentice carpenter, but it is not a leisure-time activity for him.

We tried him on medication in Year 2, but the child psychiatrist must have prescribed too high a dose or the wrong type of medication and he turned into a "zombie" temporarily. So that was it for drugs and we tried behavior management for the next 10 years. However, his behavior got worse and worse (self-medicating on marijuana, brushes with the police) until he saw a youth counsellor who recommended trying medication again.

The ADD clinic at Toowong diagnosed him in Year 11 and started him on one-quarter of one tablet of dexamphetamines. He built this up gradually to find the right dose (which is now 5 tablets a day to enable him to concentrate and focus). So after 11 years of failing at school, he actually got A's in Grade 12 and finished high school with success and went on to get an apprenticeship.

The right medication saved my boy from a life of failure and crime. I believe the real problem in this area may be that too many ADHD kids are undiagnosed and not getting the help they need, including the right medication as required.

I would say that if I was at school now I believe I would be diagnosed as ADHD. Why, because my 'normal' level and pace of functioning is so fast that when having to deal with teachers that need to talk slow so that the whole class understands the obvious and when they need to present the work at such a low level and pace so that the whole class can be included it causes boredom, frustration and stress - alot of stress and frustration and it can drive you mad. The days are long and draining.

I spent half my school life outside the classroom for talking waiting for recess, lunchtime and sport.

The problem with the education system is that they function at one pace only and that doesn't suit some children. Some children need to move faster as their bodies are wired faster. The only way to slow them down is with drugs.

Add to that the issue with the lack of discipline and lack of time spent engaging with parents in the home then, when kids get to school, there are going to be issues and problems.

There needs to be an acceptance and understanding that every child is different and that trying to treat them and teach them the same is not going to work.

Romany's experience in China seems to fit in nicely with the so-called Little Emperor Syndrome.

http://en.wikipedia.org/wiki/Little_Emperor_Syndrome

I'm not trying to suggest a "fit-all" answer, but I'm sure that many [certainly not all, so don't jump on me over this] of our problem kids are inadequately/inappropriately spoiled, undisciplined, un-nutritioned, unsupervised [or over-supervised], unparented, unexercised etc etc.

And I'm equally sure that many kids with genuine problems are undiagnosed and/or wrongly diagnosed and/or wrongly treated [just the same as many other physical or psychological health problems are mishandled for all of us at any age].

Congratulations to all of those who persevere until they get the right answers, treatments [if necessary] and results. Just as in all other aspects of health, we can't know too much, so congratulations also to those researchers who keep plugging on to reach the answers.

And I too am sorry to see JennyWren leave this topic and I hope she will reconsider her decision. Most of us are probably speaking, at least mainly, from the point of view of conjecture. But personal experiences add intrinsic value to any subject.

When we live as frogs in a well, it is more difficult to see the whole problem. I have a advantage in caring for african children as a doctor for a number of years. Firstly, these little ones always have the mother or father around them, and physical contact...carried on the backs even at work like working in the field. They have a great sense of connection to their parents, and vise versa, and I have never seen a attentional problem..just big smiles that originates from real feeling of happiness deep in their being.

Our children, on comparison dont, miss out on this and I think it is our fault for not recognizing this fundamental need of our children and able or be able to give them this within the crucial first 6 years of life. Its all about the quantity and quality of time in a day with the parentchild. Blame parents forced to work long hours to keep income to maintain our good life style and big mortgage... cant...but it needs to change.

Blame a parent whom uses oppressive power and authority to control the child's behaviour to their liking...I think so, a child's nature is to be free to explore and learn within safety of the parents care and connection...does this form a significant aetiology of ADHD pathogenesis, I dont know of a single research where it has been looked at, and wonder why...all I know is another catastrophe on our society is looming when all these drugged out unhappy kids become adults...

Sam

Parents are taught to ignore their babies when they cry as they need to learn routine. As their children grow older they are told that children should be seen and not heard. Then when the kids become teenagers they are told that all teenagers are liars. How can our children feel wanted, respected, cared for and supported in this environment?

Many children that show characteristics of ADHD are actually gifted to different degrees.

The senate report on gifted children spoke about the attitudes to those that are gifted from page 21. It certainly isn’t easy being an individual in this world.

http://www.aph.gov.au/senate/committee/eet_ctte/completed_inquiries/1999-02/gifted/report/c02.pdf

Sam, I agree with you. In a paper, The Politics of ADHD, which I am presenting at a conference in Adelaide later this month, I argue that:

* the change to social structures in individualised Western societies, culminating in the demise of the extended family, kinship and shared responsibility for child rearing, is seldom recognised for the disabling impact it has upon parents.

* Neither is it readily acknowledged that fast capitalism, whilst producing healthy GDP and current account figures, has been extraordinarily unconducive towards social health and wellbeing.

* Public policy informed by a neoliberal political rationality borrowed from the US and UK, has forged a ‘new Australia, with its culturally and linguistically diverse population, its volatile economy characterised by new and spatialised stratifications of wealth, and new pathways from school to work, community and civic life’.

* However, the effects of the new economies upon family life are generally ignored.

* Parents, particularly mothers, are criticised for working more and having less time for their children.

* In many cases though, mothers have been forced into working longer for less, with the traditional absence of working fathers translating to greater restrictions on their flex-ability to (co)parent, in a way many modern families would like.

As a result, I welcome Kim Beazley’s idea of family-impact statements. See: http://www.smh.com.au/news/opinion/richer-at-the-expense-of-the-priceless/2006/11/10/1162661895837.html.

As someone who began a PhD with a two children under five at foot and since has tried to juggle motherhood and an academic life, I say get rid of the double drop off, improve child care, and make employers recognise that men have parenting responsibilities too.

Then there's the wisdom of that African proverb: it takes a village to raise a child. Problem is: we no longer have a village...

Jolanda – I agree with both your posts. There does appear to be a sliding diagnostic scale - a continuum of shades of grey from classic autism on one side, moving towards Asperger’s and then some argue, ADHD on the other end. However, when you look at the characteristics said to indicate ‘gifted’ children, the continuum stretches even further and there is considerable overlap between the characteristics said to indicate any of these categories. The problem is that a child’s placement on that continuum depends to a very great extent upon the subjective interpretation of parents, teachers, psychologists, doctors and so on…
In the “Behaviour Rating Inventory of Executive Function” or the BRIEF questionnaire (similar to the Connor’s Teacher/Parent Rating Scale), there are questions that ask teachers to rate from a very scientific scale of “Never, Sometimes and Often”: whether the child, for example, blurts things out, talks at the wrong time, and/or talks or plays too loudly.
First of all, I have a low threshold for noise so what is bothersome to me, may not be a problem to another. So to whose measurements of these do we refer? What is the right and wrong time? How much is too loudly? In reality, we do not have a consistent point of reference to which we can refer. More problematically, however, a label of ADHD may mean that some put difficulties in learning to read down to problems with attentional control, rather than legitimate difficulties in phonological processing and receptive language - with the result that the child may not get the learning support they really need… The worrying thing is that we rely on signs, such as academic ability, verbal reasoning, long attention span, and good concentration as indicators of ‘giftedness’; and signs such as distractibility, high motor activity, impulsivity etc as indicators of disruptive behaviour disorder – and we treat and refer children accordingly. But you’re right – very intelligent kids can be high maintenance too... but we don't often hear calls to medicate them...

Linda. My children often tell me about children with ADHD in their class and how the teachers do not discipline them appropriately. It seems to them that the teachers cannot cope and the children delight in pushing the boundaries. The whole class suffers as a result.

I recall one particular child that my son said terrorised the whole class with his behaviour. My son complained that the teacher kept giving the student chances. From my sons perspective the teacher was giving the student permission to disrupt the class often up to 5 times before he actually did anything and by the time he did send him to the Principal or dealt with him in the classroom, the whole class had had their learning disrupted and the days seemed to involve just dealing with this student’s behaviour.

One particular day the student picked up a chair and threw it across the classroom. Highly dangerous behaviour and the teacher said NOTHING. It was like it was expected because he was ADHD and therefore they ignored it. A short while later the boy put his jumper over his head and the teacher went ballistic. For sure the teacher had just had enough but what message is that when you can throw a chair across the room and nothing is said yet put a jumper over your head and your head gets blown off.

There was also the case of the boy that delighted in using bad language. Nobody did anything about it because he was ADHD. My son said that it seemed that it was in a student’s best interest to be ADHD as then they could get away with anything and that other kids were noticing and copying.

There are some serious issues to be dealt with in particular with regards to consistent and fair discipline both in the home and the school.

My children believe that it is the parents fault as they haven’t taught their children well. Teachers have too many kids in the class at different levels and with different issues - they can’t possibly cope.

Linda,
I just read your 'spectrum of disorder' post just above. The spectrum youve listed is that of severe disorders, and its difficult to get a perspective unless its connected with how far from 'normal' the child's state is.

DSM-IV manual I found is good for this; http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm#Child

First phase when things start going wrong with a child is 'Separation Anxiety disorder' further on the scale 'Reactive Attachment disorder' before attentional and conduct disorder, then off the scale on 'autism'...

Sam

As a mother of a now 16 year old son, I feel the need to wade into the debate on ADHD. Whilst I have never had my son diagnosed, he has always been a free spirited, extremely trying but fun loving individual. Luckily enough his primary school years were spent in a relatively small (400 children) Catholic school and with much support and love, his teachers were able to help him overcome his difficulties with the long boring days of school. His attention span, his fidgiting, his apathy to homework and his carefree nature were endeared & counteracted by his teachers. With smallish class sizes (20 - 25) and good learning support he was able to flourish in this system. Upon entering high school, a much larger (over 1500 children) but again Catholic school, his endearing 'qualities' began to desert him and he was labled disruptive. He became depressed, because although he tried to listen, stay focused and remain on task, he was unable to do so. After much deliberation, we decided to transfer him to a much smaller, but again private (Anglican) school. This made matters much worse, in the end 'tongue in cheek', I asked the school Principle if they would prefer I drugged the child to make him fit into their system! Instead of embracing individual children (and adults) society tends to put them in boxes. Boxes that do not allow for individualism. All nerds do not go on to become valuable members of our society, just like all 'troublemakers' do not end up in jail. We are all made up of different characteristics, but our teachers (schools) seem to desire easily controllable, trouble free children. This is not fair on the many talented children in this world who are not drugged to fit. From what I have leant since my son left school this year to begin an apprenticeship, this, amongst boys in particular, is not an isolated case. Education in Australia needs to be overhauled to encourage such children instead of making them try to live inside the square.

Linda has raised an issue that many in the medical profession have preferred to avoid. We need to be very concerned about providing psychoactive substances to children. The hypocrisy of the medical profession is often seen in relation to the drugs they prescribe for behavioral and psychiatric disorders. For example, Ritalin is known to cause reductions in growth hormone and IGF 1, can increase agitation in some individuals, and there is some suggestion it might be implicated in liver cancer; but of course no-one will be in a hurry to investigate that ... . Perhaps the greatest concern though is that Ritalin and other ADHD drugs are associated with sudden death in a small number of cases. The simple truth is this: many prescribed psychoactive drugs are potentially and often far more dangerous than marijuana or esctasy or LSD.

What I find particularly distressing is the simplistic assumptions used to explain why ADHD occurs and why Ritalin works. No one really has an answer to these quandries, with the possible exception of P Goldman Rakic's "Optimal Dopamine Window" hypothesis.

The Medical model will never be sufficient to understand many behavioral conditions because:

We are more than molecules, our behavior is also mediated by the environment and our psychosocial circumstances. Hence trying to understand behavior solely be reference to biological substrates will often fail.

Despite all the research and the pretty pictures of brain function we still lack any significant understanding of brain function. Hence using a biological model to understand behavior is naive at best and often disingenuous.

Caveat: when ADHD drugs do work they work wonders. The drugs have their place, but that place is not as a cure all but as a starting point.

John.

Wow, I am overwhelmed with all the comments.

As the Mother of 3 ADD children, I feel I would like to make a few comments.

ADD has not sprung out of nowhere, it has been around since at least 1937

My son was diagnosed when he was 18 months old. I spent many hours looking at alternative therapies, elimination diets, sport etc, to no avail. When he started kindergarten and was climbing out windows it was time to look at the medication side. It helped, not 100%, but definitely made a difference to his ability to 'sit and learn' in class.

Education played a big part in where he ended up...their denial, their lack of empathy for the fact that he was 'different' to the others in their room, the curiculum which was set in concrete...they would not look at teaching him phonetics, for example, because that was not the way they taught reading. So his reading suffered.

Over the next 12 years we had a few teachers (I can count on one hand) who went out of their way to try and help him but for the most they put him in the too hard basket.

I am so proud that he got himself through year 12. He decided to not take medication at about the age of 15.

Along the way, even with medication, his behaviour alienated him from having friends. Never invited to parties, movies or over to play. He became isolated, withdrawn and lonely. His only comfort was to eat, which he did constantly, anything he could get his hands on. He became depressed which led to aggression, but never towards me. We have had to replace a number of walls though.

I was a stay at home Mum, lots of nurturing and care and consideration, we had stopped smacking long before this. I drove him wherever he needed to go, worked at the school. But I was just known as so&so's Mum...I didn't have my own name. Other parents had their own opinions and values, it didn't fit in with my son.

to be continued...

He is now working in a really good job. He has some friends, and he is obese. I have many people comment about how good he is at his job and how nice and polite he is.

My daughter was quiet, well liked, invited everywhere, quit school and home at 15 and spent 2 years on drugs, even though she was never on medication. We lived in fear of police showing up to say she had overdosed. She is now a beautiful 21 year old with a wonderful partner. And drug free!

Our surprise son,is the wild child from hell. 15, doesn't go to school, doesn't have a job, is verbally abusive and physically to me once. He drinks alcohol behind our backs, smokes and we suspect dope as well.

He was on meds for a while, then refused to take them again in primary school.

He went to school services for behaviourally challenged children, all boys, and the staff were fantastic but both services stopped because of funding from the government and he had to go back to mainstream high school. It was a disaster. Home on 'exclusion' more than he was at school. He is oppositional, has conduct disorder, is verbally abusive, destructive and, at times, has worse behaviour than a 3 year old, especially if I am on the phone.

I work 2 jobs and don't come home if I can do something else. I don't want to come home. I am tired of being abused and lack of services. I don't like my own son. I will always love him, but...enough is enough.

Unless you have to deal with this at least once in your life...sorry you don't know what it's like.

I live for the day when my husband and I can have our own life back again.

The positive in all this, there is a light at the end of the tunnel and all this encouraged me to go back to school to become a welfare worker, maybe I can help other parents get through what I had to go through...and still am.

Hi Everyone,
I can see we don't have too many responders who have dealt with ADHD.
1. Every child with ADHD is different. Some respond to meds, some respond to therapy, some respond to diet, and sadly some don't seem to respond to anything.
2. Meds is usually the last resort. We all try everything else first, we don't want to drug our kids, but each therapy or drug is designed to treat a different symptom.
3. Our children usually have a higher IQ than average. Under most Aussie Education systems this disqualifies them from any remedial help.
4. Adders are "hunters abd gatherers in a plodding farmers world". Our society is pretty myopic about how "normal" people behave and adders just can't fit into that square hole - they are like snowflakes - multifaceted.
5. Other support therapies. Ha! You try and find any!

I found her article very interesting and informative. I found this forum while doing research on ADD/ADHD. I am currently reading a book titled "Stop Medicating, Start Parenting," by Dr. David B. Stein. He has also written Ritalin is Not the answer, and several other books. For those who want to use a non medication approach with their children, Dr. Stein has a website at http://www.drdavestein.com He has a free newsletter to sign up for that is very informative.

I haven't had time to fully read all these posts but obviously the issues surrounding ADHD treatment and diagnosis is a growing problem. The important issue should be to support objective assessment. Most practitioners suggest this can not be done but our research shows it can. However, unfortunately the government does not support objective assessment. Go figure?? What I mean by objective is something like when you go to the pathologist and get a blood test, the results are entirely data driven and quantified. In a sense our group specialises in brain pathology and brain testing. Further more we can objectively ascertain whether or not someone is responding to the selected treatment. You can read more about our work on the objective testing of ADHD at http://www.brainprofiling.com