"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.
Why A.D.D. Is a Simplistic Answer to the Problems of a
During talks I've given around the country, I've similarly noticed among some parents a strong negative reaction to my statement that "A.D.D. doesn't exist." I think these parents believe I'm saying that their children's difficulties with behavior and attention don't exist. This isn't what I'm saying at all. In fact, I empathize deeply with the struggles of parents who for years have tried to get others to understand and accept their puzzling children. I recognize that many of these kids have had tremendous difficulties at home and in school. Most of these children do have the kinds of behaviors described in the diagnostic and statistical manuals: fldgeting, not following through on work, disorganization, daydreaming, blurting out, restlessness, and so forth. The issue is whether or not the A.D.D. myth described in Chapter 1 is the best way of understanding and helping these youngsters.
Clearly, I'm saying in this book that it isn't the best way. A.D.D. proponents would have you believe that A.D.D. is a medical disorder. In fact, the causes of A.D.D.-type behaviors are complex and many-faceted. Some of these causes are cultural or social in nature. Other causes are more specific to the individual. Ultimately, there may be as many explanations for A.D.D. behavior as there are children with the label. However, in this chapter, I'd like to present a few of what I consider are some plausible non-biological explanations for A.D.D.-type behaviors such as hyperactivity, distractibility, and impulsivity.
The first explanation I'd like to give suggests that society has actually invented A.D.D. to help preserve its social order. To close one's eyes to the important role society has in defining deviance risks falling into the same kind of trap as Samuel A. Cartwright, a well-respected Louisiana physician and American Medical Association member who felt he had discovered a new "disease" during the 1850s in pre-Civil War America. After conducting a study on runaway slaves who had been caught and returned to their Southern owners, Cartwright concluded that the slaves suffered from drapetomania (drapeto, to flee; mania, craze), a disease that caused them to flee. In a written report to the Louisiana Medical Society, Cartwright wrote: "With the advantages of proper medical advice, strictly followed, this troublesome practice that many negroes have of running away can be almost entirely prevented." As social theorist Ivan Illich pointed out in his devastating critique of the medical model, "Each civilization defines its own diseases. What is sickness in one might be chromosomal abnormality, crime, holiness or sin in another. For the same symptom of compulsive stealing one might be executed, tortured to death, exiled, hospitalized, or given alms or tax money."
A.D.D. may exist, then, because the values of our society demand that it exist. What are those values? A look at the roots of American culture from colonial days on suggests that the Protestant work ethic, for one example, has played an important role in defining standards for appropriate conduct. As former American Psychological Association president Nicholas Hobbs pointed out, "According to this doctrine ... God's chosen ones are inspired to attain to positions of wealth and power through the rational and efficient use of their time and energy, through their willingness to control distracting impulses, and to delay gratification in the service of productivity, and through their thriftiness and ambition." Such a society might well be expected to define deviance in terms of distractibility, impulsiveness, and lack of motivation - the same traits frequently used to describe children suffering from A.D.D. Labeling children A.D.D., then, may represent a means through which our society attempts to preserve its underlying value system. For as Nicholas Hobbs noted, "A good case can be made for the position that protection of the community is a primary function of classifying and labeling children who are different or deviant."
Other cultures appear to have very different expectations toward children's behavior and attention levels. Children with A.D.D. behaviors in cultures with more relaxed behavioral standards may be considered entirely healthy. Educator Terry Orlick, for example, compares parental attitudes in North America with those held half a world away in Papua New Guinea: "If I take my daughter out to eat in North America, she is expected to sit quietly and wait (like an adult) even if there are all kinds of interesting objects and areas and people to explore.... Now if I take her out to a village feast in Papua New Guinea, none of these restrictions are placed on her. The villagers don't expect children to sit quietly for an hour while orders are taken and adults chat. Children are free to do what is natural for them, thus eliminating potential hassle for everyone." On the other hand, for societies with stricter behavioral norms than those of the United States - including China and Indonesia - research suggests that mental health clinicians are more likely to identify "normal" children (by U.S. standards) as hyperactive.
Our culture may also be creating A.D.D. in quite a different way. Children's A.D.D. behaviors may actually be reflections of the very deterioration of those values described above. Harvard professor Lester Grinspoon and Susan B. Singer observed twenty years ago that "our society has been undergoing a critical upheaval in values. Children growing up in the past decade have seen claims to authority and existing institutions questioned as an everyday occurrence.... Teachers no longer have the unquestioned authority they once had in the classroom.... The child, on the other side, is no longer so intimidated by whatever authority the teacher has." Grinspoon and Singer go on to say: "'Hyperkinesis' [a term used to describe A.D.D. symptoms in the 1960s], whatever organic condition it may legitimately refer to, has become a convenient label with which to dismiss this phenomenon as a physical 'disease' rather than treating it as the social problem it is."
Grinspoon and Singer might also have referred to the breakdown of the American family in their assessment of the deterioration of authority. There are twice as many single-parent households - 8 million - as there were in 1970. The number of working mothers has risen 65 percent from 10.2 million in 1970 to 16.8 million in 1990. Some parents simply aren't around as much these days to provide the kind of guidance and support that is essential to a child's emotional development. As a result, children are experiencing an epidemic of stress-related and mental health difficulties. Nearly 1 million reports of child abuse or neglect are recorded each year. An estimated 15 to 19 percent of the nation's 63 million children and youth suffer from emotional or other problems warranting mental health treatment. Having less support to deal with an increasing number of societal pressures, many children simply buckle under the stress. As Antoinette Saunders and Bonnie Remsberg point out in their book The Stress-Proof Child, "Our children experience the stress of illness, divorce, financial problems, living with single parents, death, school, remarriage, jealousy, achievement, vacations, step brothers and sisters, sex, drugs, sensory bombardment, violence, the threat of nuclear war-a long, long list. The effect can be overwhelming."
Among the most frequent symptoms of child stress that Saunders and Remsberg include in their book are restlessness, difficulty concentrating, and irritating behavior. In other words, the same behaviors that make up attention deficit disorder. At the same time, researchers are increasingly recognizing the presence of even more serious problems in many children who've been identified as A.D.D. Recent studies have suggested, for example, that as many as 25 percent of children labeled A.D.D. suffer from severe anxiety, and that up to 75 percent of "A.D.D. children" have some form of depression. As one pair of researchers noted, "Our results suggest that ... treatable childhood depression may be the major underlying disorder with hyperactive school problems." It could be, then, that many children who are hyperactive or inattentive are not A.D.D. but rather are anxious or depressed due to any number of family, school, or other problems.
Not all children labeled A.D.D., however, are hyperactive or distractible because of stress-related anxiety or depression. For the past couple of years, the Comedy Central Network on cable television has broadcast a show entitled Short Attention Span Theater consisting of short comedy sketches and clips. I have to chuckle when I hear this title because it serves as a kind of reminder of the times in which we live. A hundred years ago, it was common for a group of farmers to stand in a wheat field for two or three hours listening to a traveling politician. These days, the attention span of the average American has been shortened considerably by mass media. In one instance, a CBS experiment to use 30-second sound bites in its news shows during the 1992 presidential election was stopped because of the slow pace (the industry average was 7.3 seconds).
This suggests to me that our culture may be producing a whole new generation of "short-attention-span kids." In fact, over thirty years ago, media prophet Marshall McLuhan suggested this when he referred to a new generation of kids whose worldview was no longer based on plodding one-step-at-a-time thinking but rather on instantaneous flashes of immediate sensory data. Film critic Arthur Knight addressed this phenomenon when he wrote: "One has only to view an old movie with a young audience to realize that the kids have gotten the message of a shot almost at the first flash; when it remains on the screen, they giggle because the protraction seems to underline what is, for them, the obvious. As a result, editing tempos have had to be stepped up."
Today's fast-paced media - MTV, video software, multimedia computer programs, Nintendo games, and other electronic marvels-shower children with an ever more rapid succession of images and bits of information. As a result, many kids seem to have evolved attentional strategies based on grasping information in quick and rapid chunks. As media expert Tony Schwartz points out in his book The Responsive Chord, "Today's child is a scanner. His experience with electronic media has taught him to scan life the way his eye scans a television set or his ears scan auditory signals from a radio or stereo speaker." Many of these fast-paced, media-fed kids may be labeled A.D.D. by adults who live life in the slow lane. What is considered a disease or disorder by parents or professionals may in fact be, for some kids at least, an entirely normal and healthy response to a faster cultural tempo.
The collision between short-attention-span kids and life-in-the-slow-lane adults is particularly evident in our schools. Here, students must often sit at desks for hours at a time, listening to monotone lectures, and going over textbook and worksheet material that is presented - not like MTV - but like MTB (Material That's Boring). Kids who are labeled A.D.D. have a particularly rough time in such environments. Studies suggest that "A.D.D. students" do most poorly in environments that are boring and repetitive, externally controlled, lack immediate feedback, or are presided over by a familiar, maternal-like authority. This sounds like a typical American classroom. As A.D.D. researcher Russell Barkley puts it: "The classroom is their Waterloo." Yet Barkley is talking here about the traditional classroom model; one that has as its chief features an emphasis upon rote drill, externally controlled tasks ("Do the work on pages 143 to 145"), and lots of sitting in one place.
Unfortunately, this kind of classroom is deadly not only for the socalled A.D.D. child but for all kids. In a monumental study of one thousand U.S. classrooms funded by over a dozen foundations, John Goodlad, professor of education at the University of Washington and director of the study, concluded that America's students spent by far the greatest amount of time in school being lectured to and working on written assignments - especially workbooks and worksheets. The study criticized the lack of exciting learning activities in our nation's schools: "Students reported that they liked to do activities that involved them actively or in which they worked with others. These included going on field trips, making films, building or drawing things, making collections, interviewing people, acting things out, and carrying out projects. These are the things which students reported doing least and which we observed infrequently." Goodlad lamented this educational poverty by commenting: "Part of the brain, known as Magoun's brain, is stimulated by novelty. It appears to me that students spending twelve years in the schools we studied would be unlikely to experience much novelty. Does part of the brain just sleep, then?"
Some students do in fact sleep, but many others respond with hyperactivity, distractibility, and other symptoms of A.D.D. For it is this kind of classroom that students labeled A.D.D. are having trouble fitting into and this sort of school that many students are being medicated into accepting. I'm reminded here of the canaries that were kept by coal miners deep in the mines. If the level of oxygen fell below a certain level, the canaries would fall over on their perches and die, warning the miners to get out fast. It's possible that children who have been labeled A.D.D. are the canaries of modern-day education: they are signaling us to reform our worksheet wastelands and transform classrooms into more dynamic, novel, and exciting learning environments. A.D.D. may be more accurately termed A.D.D.D., or attention-to-ditto deficit disorder.
There have always been more boys than girls in programs for A.D.D. children, with ratios ranging from two to one (boys to girls) at the low end to ten to one at the high. Former Stanford researcher Diane McGuinness suggests that many of the features typically attributed to hyperactivity in children can in fact be accounted for by normal differences between boys and girls. In one study she conducted with a group of normal preschoolers where children were observed over a long period of time during free play sessions, boys spent less time on any given activity than did girls (eight minutes for boys, twelve minutes for girls), and interrupted their play three times more often than girls. She also cites research indicating that boys tend to be more interested in objects (e.g., blocks, manipulatives, toys), while girls show a greater preference for people, and that girls are more sensitive to verbal sounds, while boys' attention is grabbed more by non-verbal or environmental sounds (e.g., fire engines on the street, loud noises in the hall, the sound of a clock ticking).
This research suggests that girls may have an easier time (or appear at least to adapt well) to a traditional classroom environment that involves listening to teacher's instructions, sticking with an assignment, and relating well to peers and adults. Boys, on the other hand, are likely to be at a disadvantage. They may appear, by comparison, to be more distractible - picking up less of teacher's voice and more of other interesting noises in and outside of class - and more restless with their limited focus on any one activity. Essentially, then, some boys may be at risk to be identified as hyperactive or A.D.D. simply because their gender-appropriate activities clash with the expectations of a highly verbal, highly schedule-oriented, and usually female-dominated classroom environment.
Psychologists have known for decades that children are born with personality styles or temperaments that influence them throughout their lives. The most highly regarded theory of temperament, developed by Alexander Thomas, Stella Chess, and Herbert Birch at New York University, suggests that children can be divided into three major temperament groups: the easy child, the slow-to-warm-up child, and the difficult child. According to New York psychiatrist Stanley Turecki, difficult children have any combination of the following nine characteristics: high activity level, distractibility, and high intensity, irregularity, negative persistence, low sensory threshold, initial withdrawal, poor adaptability, and or negative mood. While Thomas and his colleagues suggest that 10 percent of all children are difficult, Turecki estimates that 20 percent of all kids fit into this category. Significantly, Turecki points out that difficult children are normal: "I strongly believe that you don't have to be average in order to be normal. Nor are you abnormal simply because you are difficult.... Human beings are all different, and a great variety of characteristics and behaviors falls well into the range of normality."
Whether a difficult child will develop serious behavioral problems (including symptoms of A.D.D.) depends at least in part upon how the environment responds to his temperamental nature. If there is what temperament theorists call a "goodness of fit" between child and environment, where the parent responds to a child's difficult nature with facilitating responses, then there often won't be a behavior problem. However, if there is a "poorness of fit" between the child's temperament and parental expectations and behaviors, this can result in behavioral disturbances. A child with a difficult temperament, for example, would be likely to have more behavioral problems in a family with a rigid or authoritarian parenting style than in a family that provides structure within an accepting and loving framework. Psychologist James Cameron concluded that "behavioral problems resembled metaphorically the origins of earthquakes, with children's temperament analogous to the fault lines, and environment events, particularly parenting styles, analogous to strain." In the context of temperament theory, then, A.D.D. may not be a "disease" that the child "has"; rather, it would be, at least for some children, a "poor fit" between the child's inborn temperament and the quality of the environment surrounding him. This does not mean that parents are to blame for a child's A.D.D. symptoms. The problem is neither in the child nor in the parent, but rather in the "chemistry" (or lack of chemistry) between the two.
Some children may be labeled A.D.D. simply because they learn differently from the way most students learn. As we saw earlier in this chapter, the traditional classroom is set up for children who are good at sitting for long periods of time, listening to verbal instructions, and completing endless pages of worksheets. Most of this kind of instruction consists of what we might call "central-task" learning. In order to succeed in this type of setting, students have to be able to selectively attend to very specific features of the classroom environment: the teacher's voice, the words on the blackboard, the word problems on pages 142 and 156 of the textbook, items I through 15 on the worksheet, and so forth. Studies suggest, however, that certain students identified as A.D.D. may have a cognitive style that clashes with this particular teaching approach. Cornell University researchers, for example, discovered that so-called hyperactive students have a particular strength in "incidental" learning and may possess a wide or diffused attentional style. This suggests that they take in information from several different sources at the same time and may be expected to do better in learning environments that involve creating projects or going on field trips - settings where multiple sources of information are internalized and processed. Another study, at Purdue University, showed that hyperactive children were more spontaneously talkative than "normal" classmates and told stories that were more "novel" or creative.
What this means is that many A.D.D. students who attend schools that are based on "central-task," verbal, non-spontaneous learning will be at a distinct disadvantage compared to other students and may have learning difficulties and/or attentional or behavioral problems. That, in fact, is what the research reveals: that as many as 90 percent of students labeled A.D.D. have learning problems. The boundary line between learning difficulties and behavior problems is rather fuzzy for these kids. Because they have trouble learning in traditional ways, they become inattentive, restless, and disruptive. These behaviors make it even more difficult for them to learn material covered in class. If these students were provided with opportunities to learn in environments that embraced their personal learning style, they might well experience success. This is what the research shows. A.D.D. students are often indistinguishable from so-called normal students in classroom environments that use activity centers, hands-on learning, self-paced projects, films, games, and other highly stimulating curricula (in other words, the kinds of activities that all children enjoy).
After reading this far into the book, I hope that you have begun to seriously question the existence of A.D.D. as a distinct medical disorder. I also hope that you've started to sense the complexity of the issues involved and understand that, in fact, there is no "A.D.D. child," but many different kinds of children who are hyperactive and inattentive for many different reasons. For some kids who suffer from lead poisoning or distinct brain illness or injury (e.g., as was seen in postencephalitic children), the emphasis is undoubtedly on the biological side of the ledger. However, for kids with difficult temperaments or those suffering from depression or anxiety, psychological factors may be most important. For students with cognitive or learning style differences in traditional classrooms, educational issues may predominate. And in the case of certain Nintendo-crazed, television-addicted youngsters, broader cultural issues could become primary. Even where biological issues appear to predominate, I'd prefer to think of these as "biological predispositions" that need to interact with cultural, social, educational, and/or psychological factors in order to give birth to A.D.D. symptoms. In the same way, parents, teachers, and mental health professionals have the opportunity to create optimal educational, social, and psychological environments for these kids so that their "biological predispositions" don't erupt into A.D.D. symptoms.
Most A.D.D. proponents are acutely aware of these non-biological factors. However, they have found a place for them in their paradigm so that the basic tenants of the A.D.D. myth, particularly its existence as a discrete medical disorder, can be preserved. These other factors, especially the psychological and educational ones, are reduced to what they refer to, appropriately enough in this medical model, as "co-morbid" factors. In other words, a child can have A.D.D., and/or learning disabilities (LD), and/or mood disorders (depression, anxiety), and/or a range of other clinical disorders. What are in reality confounding factors (where does A.D.D. begin and depression or learning problems leave off?) are transformed into these co-morbid factors and the essential nature of the A.D.D. myth remains intact.
This artful process of piling on the categories reminds me of what the Alexandrian scientist Ptolemy did when confronted with data that contradicted his view that the sun and planets revolved around the earth. He created "epicycles" in the orbits of planets to account for the discrepancies in planetary motion. These epicycles were fictions, but they allowed Ptolemy and his followers to hold on to their illusions for a few more centuries. How many years of adding co-morbid "epicycles" will it take before social scientists recognize that there are too many complex influences in today's world creating hyperactivity and inattention in children to be able to speak credibly of A.D.D. as a unitary medical disorder?
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