Julia Steiny: ADHD Overdiagnosis, Prescriptions a Mental Health Crisis


By Julia Steiny

In the early part of the 20th century, a pediatrician identified what he called “an abnormal defect of moral control in children.” This described kids who had challenging behaviors, but were otherwise intelligent and normal.  Later in the 1950s, the same behaviors were labeled in the US as “hyperkinetic impulse disorder.”  As you’ve guessed, the label morphed eventually to the more familiar ADHD, or just ADD, depending on how physically hyperactive the kid is.

The disorder was obscure until the late 1990s when the rate of diagnoses started to increase by 3% every year.  Remember that the late 1990s was also the era of “zero tolerance” and the massive spike in school suspensions and expulsions.  The crack cocaine epidemic spawned widespread, and now unfounded fears, of “super-predator kids” who would grow up to be aggressive and violent.

Perhaps most importantly, the traditional family, which had started to dissolve in the late 1960s, began to fray the culture as a whole.  Fewer children were being raised in two-parent families, attached to extended families, consistent neighborhoods, faith-based communities and common norms.  Increasing numbers of kids were coming to school with behavior that was less please-and-thank-you and more rude and defiant of authority.

Then, according to a report by the Centers for Disease Control (CDC), in the mid-2000s new ADHD diagnoses increased by 5% a year.  Most recently the rate mushroomed by 7%, and now fully 11% of the U.S. population between ages 5 to 17 have been diagnosed with just over 6% taking medication to control their behavior.  Some psychiatrists question the healthiness of these rates and ADHD’s biological origins.  Skeptics consider the meds “chemical restraint.”

Personally, I think that we’re caring for a garden by spraying it with weed killer rather than doing the work of pulling the behavioral weeds.

Pills are so easy.

I fully understand the public concern over the horror of the current drug overdose epidemic, but it affects fewer people than we think.  The public seems to take little notice of the spread of ADHD to double-digit proportions of our school-age children, who might be suffering from totally normal attributes of exuberant, play-loving, wriggly childhood.  Yes, a few young people do seem biologically ill-programmed.  But most of the “bad” kids I see desperately need more time to run, scream, play, roam, even wrestle and rough-house.  They need lives that are far more hands-on than eons of time parked in front of electronics.  They can’t sit in classroom seats for literally hours at a stretch.  If “sitting is the new cancer,” why is it okay for kids?

This is personal for me.  From kindergarten to senior year, the schools that one of my three sons attended insisted I medicate him for ADHD.  The diagnostic checklists of symptoms for the disorder included being fidgety, disorganized, and distracted.  That could be you or me on a hectic day.  He wasn’t bad so much as annoying — super fidgety and off in space.  So every year when administrators, psychologists, teachers made the pitch, I asked:  What’s the message?  (Say no to drugs?)  What’s the end game?  (Does he ever wean off?)  What are the side effects?  And since I stipulate that he’s profoundly ADHD, how will he ever learn to deal with it if we mask it with drugs?  (It wasn’t easy, but he’s now a married, successful working professional who still gets scattered.)

Children and youth are not machines who need a tweak, a tune-up or new part.

No one likes irritating or disruptive behavior.  But taxpayers, and many parents and teachers, would like irritating behavior changed in a manner that’s fast, easy and cheap.  That’s not going to happen.  In fact, while ADHD drugs can give support to a few kids, mostly drugs are a short-term fix to deeper problems that will re-surface later on.  Problems like:  Are there routines at home?  Structure to the day?  Caring, but firm adults, who are themselves reasonably functional?  If not, the kid’s likely to broadcast his chaos or distress with misbehavior.  (Most are boys.)

Even so, the CDC reports that fewer than “1 in 3 children with ADHD received both medication treatment and behavioral [talk] therapy, the preferred treatment approach for children ages 6 and older.”  Talk therapy costs time and money.  Many adults resist letting their kids go to therapy asserting they don’t believe in it — which conveniently avoids having a therapist turn the tables and hold anyone besides the kid accountable.

About the babies, the report says, “Only half of preschoolers (4-5 years of age) with ADHD received behavioral therapy… and 1 in 4 were treated only with medication.”  Nuts.

We can’t fix kids’ behavior.  A fix implies a solution that will make whatever problem it is go away.  But conflict and problems do not go away.  They’re baked into life as deeply as death and love, both of which cause a great deal of problematic behavior that mostly need attention and empathetic care.  Drugs should be a last resort — especially for kids.

Julia Steiny
Julia Steiny is a freelance columnist writing about kids and schools through the lens of Restorative Practices and Restorative Justice. Currently she is Project Manager for a National Institute of Justice grant to study the effectiveness of restorative conferencing programs now being implemented in six Rhode Island Schools. Steiny is the founding director of the Youth Restoration Project, the design partner in the grant. After serving a term on the Providence School Board, for 16 years she wrote the Providence Journal's weekly education column. Since 1998, she has consulted with The Providence Plan on data analysis and communications, helping to develop Information Works! for the RI Department of Education and the RIDataHUB. For more, see juliasteiny.com or contact her at juliasteiny@youthrestorationproject.org. The Youth Restoration Project has a Facebook page with news and resources on the Restoration movement in the US and internationally.
Julia Steiny
09 2, 2015