Saturday, December 8, 2018

Inducing ADHD

"Maybe you should consider testing him. You know. For ADD."

That was my son's kindergarten teacher. His mother and I were in for yet another conference because he was "a problem." The nature of the problem? Well, because of my schedule, he arrived 15-20 minutes before school officially started. His teacher's expectation was that he would sit at his desk, still and quiet, while she finished getting ready for the day. The rest of his problems were similar, violations of her desire for order in her classroom. He was an active and social five year old boy, a July birthday and so youngest in his class.

It was not a good year, and one of the top regrets of my life was that I did not make more of a fuss on his behalf. I should have demanded a switch to a different teacher, or gone over the head of the one we had, made a fuss, been That Parent. But I didn't want too be That Parent, didn't want to violate professional respect (particularly since this was the same district in which I taught). I only had about a decade in the field. I should have fought harder for my son.

But I did know enough-- and so did my wife at the time-- to know that he was not ADD, that he did not even need to be tested for ADD.

It was a bad year, and at the end of it, my son had learned to things-- that he was a bad student, and that he didn't like school. The better ending to that story was that my district in the following year instituted a Junior First grade, and with a supportive and nurturing teacher, he thrived.

That was twenty-five-ish years ago, and I have often thought back on it, and not just because of my own regrets. What would happen, I wondered, with parents who were younger, in their early twenties instead of mid-thirties? What would happen if someone with a little less education or education profession background heard a teacher say their child should be checked for ADD? And more recently, I wonder what happens in post-Core classrooms where the expectation is now that five year olds- even very young five year olds- will sit quietly at a desk and do academic work.

The short answer to all those questions is "about what you would think" or "nothing good."

Nowadays, of course, it's ADHD, and it is being diagnosed at an ever-increasing rate, with 5% of the children in the US on some kind of ADHD medication. And it's not like an ADHD diagnosis is backed up by a lot of hard science. As noted in the New York Times

Unlike other childhood diseases — such as asthma, obesity and diabetes — the diagnosis of A.D.H.D. is inherently subjective and depends on the assessment of parents, school personnel and health care providers. For a child who is easily distracted, an assessment of normal, inattentive behavior by one could be a formal diagnosis of A.D.H.D. by another.

And now here comes a study from Harvard Medical School, noting that a child born in August is more likely to be diagnosed with ADHD. Is August a wonky month? Is Leo actually the astrological sign of the ADHD lion? No, the most likely explanation is that August-born students are the youngest in their class, and that a child who has just turned five is very different from a child who is almost six, and that increased pressure to perform academic tasks in "the new first grade" highlights those differences.

This overdiagnosis, official or unofficial, is not a new phenomenon. Every time in education we decide that we've Got It, that a program or system that we've developed is pretty much perfect and correct, we create a problem. The perfect system will fail some students, but because we are invested in its perfectness, we conclude that the student must be defective. Public schools have done this for decades, all the way back to the old old days when left-handed children were subjected to all sorts of abuse to "fix" the defect of their left-handedness. Charter schools have institutionalized the problem by declaring that their system (no excuses, whatever) doesn't ever need to be changed and that students who don't have what it takes to thrive in that system should just go walk with their feet.

The rise in ADHD diagnoses is a clear sign that we are screwing up with the littles. If, as is the case in Florida, huge numbers of students are testing as "not ready for kindergarten, that's a sign that your kindergarten, or your readiness test, or both are wrong. If large numbers of tiny humans are having trouble coping with The New First Grade in kindergarten, that is a sign that your kindergarten is messed up. If large numbers of tiny humans are being diagnoses powerful drugs in order to make them more acceptable to school, then somebody has really lost the thread.

The folks who are not fans of public education will get plenty of mileage out of the Harvard study. I hope that school districts and charter schools read the study and rethink their choices for littles. And I hope that the next parent who hears a suggestion to drug up their five year old so that she can better cope with the demands of kindergarten-- I hope those parents push back way harder than we had the balls to.

Yes, ADHD is real, and somewhere in those many children diagnosed with it are children with a real problem. But mostly the truth is this: if a child needs to take strong drugs to deal with going to school, that school is messed up


  1. YES! My son...August birthday.....kindergarten was mostly seat time in 2009. All 3 MS English teachers suggested there may be a "medical problem" with my son. I informed them that the only problem he had was boredom in their classrooms (packets of common core drill & kill and informational reading about nonsense). Done with it ALL! Boy child now enrolled in an all boys HS and not a hint of problems. For the first time ever, he likes school, he likes his teachers (and they like him!) and he can't stop talking about how much he is learning. Being an all boys high school, they "get" how boys learn best and they do it well. Best money we have ever spent.

  2. I get tired of hearing that teachers recommend ("diagnose")that a child be tested ADHD. We were trained to NEVER, EVER pretend to know the source of a child's difficulties. Teachers can only report on a child's behavior. Diagnosis of a disorder is the responsibility of the doctor, in cooperation with the parent.

  3. I am 79 years old. I found I had adhd at about 55 after being fired from two jobs which I thought I was doing just fine. I was the little girl that day dreamed out the window. Not necessarily active, but ADD just the same. I wish that someone had prescribed something for me in the primary grades so that I could stay on focus enough to excel rather than just get by.

  4. My view is quite unpopular in many circles, but I don't even believe in ADHD. In fact, I don't believe in most mental health diagnoses. Mental health diagnosis is mostly quackery. Not to say I don't believe in mental health problems, just not mental health diagnoses.

    With physical health, there are objective ways to diagnose - presence of certain bacteria, for instance, or biopsy to determine a tumor. For mental health diagnoses, it's just a list of symptoms to tick off, most of which are what you presented for in the first place. It's like if you went to your doctor and said that you had a cough you couldn't shake. The doctor would ask you about your symptoms, not physically examine you or run any objective tests, then tell you you have a "coughing disorder".

    That's exactly what ADHD is. You bring your kid to a shrink, tell the shrink that your kid can't pay attention and sit still, the shrink then tells you your kid can't pay attention and sit still (which is what ADHD is). There's nothing about any specific underlying mechanism, which in turn would lead to a specific treatment. If you're coughing because you have bronchitis, the treatment is different than if you're coughing because you have COPD or lung cancer or just the common cold. But "can't pay attention and sit still" invariably leads to "ADHD" which leads to medication to make the kid sit still and pay attention. It's like if the only treatment option your doctor had for colds was a cough drop.

    I used to work with traumatized kids, many of whom came to us with ADHD diagnoses. Gee, you think maybe their trauma has anything to do with it? Maybe treatment might involve dealing with the trauma? That is, in fact, exactly what we did, and, miracle of miracles, the kids' attention span and ability to control themselves improved.

    Granted, for most allegedly ADHD kids in school, I don't think trauma per se is the issue, at least not the sense of extreme abuse/violence that we usually think of in connection with trauma. But on the other hand, expecting young children to sit at desks for hours and hours focusing on tedious and developmentally inappropriate tasks is a form of trauma.

    1. Ugh, correction: "It's like if the only treatment option your doctor had for *coughing* was a cough drop."

  5. You have expressed your regret about that kindergarten situation before so I know it is a painful spot. A whole year with a teacher who has a student "pegged" is pretty serious business. Is that just another opportunity for kids to learn grit or should parents be able to explore other options without shattering the notion that public education must be embraced by all? When your kid is suffering, maintaining loyalty to "public education" is not always a priority. And if so many kids are struggling with the process of education as we know it, do we keep asking them to suck it up until these problems finally get addressed by competent leadership with widespread buy-in? Or not?

    If other educational options were not so pernicious, or if they weren't in competition with public school resources, I guess the argument wouldn't be so emphatic. But for a little child being pegged, and possibly medicated, what is the answer?

    1. You make a valid point. Frankly, at the risk of being called paranoid, I think that is part of the agenda of the rephormers. Turn public school into something that doesn't work for the majority of kids such that pretty much all kids are suffering so most parents are motivated to find alternative options besides public education. Then, voila, no more demand for public education, which makes privatizing it so much easier.

      I don't know what the answer is. Our kids are in private schools for that very reason - our local public schools are all but intolerable. But then, we can afford private school (barely). What about those who can't?

  6. I'm glad you included the first sentence in your last paragraph, though, after reading some of the comments here, I think the fact that ADHD does exist will be missed.

    I agree that some doctors are too quick to prescribe drugs for ADHD for whatever reason: it's easier than fighting with parents, parents will just go to another doctor to get the drugs, kids are spending too much time in front of screens, etc.

    I agree that some teachers are too quick to blame ADHD for a child's behavior, though, legally, schools and teachers are not allowed to diagnose medical conditions like ADHD.

    Those overdiagnoses are the fault of poor medical practices, ignorant non-medical lay people, slipshod work by primary care physicians, or mistakes by fallible human beings. The point is that "Yes, ADHD is real..." and can be a debilitating lifelong condition when left untreated.

    And, just for the record, a diagnosis of ADHD, according to the DSM, MUST include that the symptoms could not be explained by any other condition.

    We can't just deny that something exists because people screw up in their diagnosis. Medicine, like education, is not an exact science, and the medicine of the brain is no different. We do the best we can with the knowledge we have, and we ought to try to use that knowledge correctly.