Thursday, July 8, 2010

Peter Gray: School and ADHD

Peter Gray, in his Psychology Today blog Freedom to Learn, has tackled the topic of the prevalence of ADHD diagnoses based on children's behaviour in a school environment.

ADHD and School: The Problem of Assessing Normalcy in an Abnormal Environment

The numbers he quotes are shocking, but not necessarily surprising. ADHD medications that contain stimulants like methylphenidate (such as Ritalin) restore order and calm to classrooms that do not accommodate normal levels of get-up-and-go in male children.
What does it mean to have ADHD? Basically, it means failure to adapt to the conditions of standard schooling. Most diagnoses of ADHD originate with teachers' observations.[3] In the typical case, a child has been a persistent pain in the neck in school--not paying attention, not completing assignments, disrupting class with excessive movements and verbal outbursts--and the teacher, consequently, urges the parents to consult with a clinician about the possibility that the child has ADHD. Using the standard diagnostic checklists, the clinician then takes into account the ratings of teachers and of parents concerning the child's behavior. If the ratings meet the criterion level, then a diagnosis of ADHD is made. The child may then be put on a drug such as Adderall or Concerta, with the result, usually, that the child's behavior in school improves. The student begins to do what the teacher asks him to do; the classroom is less disrupted; and the parents are relieved. The drug works.

Peter says some wonderful things about normal human diversity that I must quote here:
Why do some kids adapt to school better than do others? The answer to that does lie in biology--normal biology, not abnormal biology. For good evolutionary reasons, members of our species vary genetically in ways that create diversity in personality.[6] People have always lived in communities, and communities--as well as the individuals within them--benefit from diversity. It is good that some people are relatively restrained while others are more impulsive, that some are relatively passive while others are more active, that some are cautious while others are bolder, and so on. These are among the dimensions that make up normal personality. In situations where people are free, they find ways of behaving and learning that fit best with their biological nature, and through those means they make unique contributions to the communities in which they live. Normal human environments always have a variety of niches that people can occupy, and people who are free naturally choose niches where they are most comfortable and happy, the niches that match best with their biological nature.

How fortunate for our homeschooled children that they can simply find their own niche that fits naturally for their unique and individual personality and biology.

I did respond to Peter in the comments as I've been troubled by this for many, many years - ever since my first year teaching when I saw a drastic change in a little boy, 8- or 9-years-old, who came to my classroom for math. He was a bright light who may have been more impulsive than most kids, but didn't miss a beat and could keep up with his work. I never had a problem with him (although I did have to help him navigate conflicts a bit more frequently than I helped other children). One day he came to my classroom and spent the whole class with his head on his desk. When he spoke, it seemed like he was under water - he was slow and out of it. I asked his homeroom teacher what was going on and she informed me he had been put on ritalin. I told her that the dosage had to be wrong and told her what I'd seen. She agreed and spoke to the parents. There was a slight improvement after a couple of weeks, but he still seemed abnormally distant, compared to other children, for the rest of the year.

Prior to teaching, I had worked with teenagers with fairly profound behavioural issues or psychiatric diagnoses (sometimes street drug induced). Some of these kids were medicated while in care, especially those who were seriously unsafe to be around when they were not. Watching a little boy who was a bit squirmy and slightly impulsive being sedated in this way was difficult as it seemed like such an over-the-top reaction to a relatively small issue.
When I worked in schools as both a teacher and a counsellor, I saw so many little boys diagnosed with ADHD because their teachers did not create environments that allowed movement or choice. I often said that I thought boys should not have to attend school until they are 10 or 11... and then, after that, most of them would probably benefit from an outdoor education setting rather than the confines of a middle school.

I sat in on school district arranged psychiatric consultations as part of my job, representing the results from the BASC and the Connors, as well as my own observations and the teacher's. Fortunately, the particular psychiatrist we worked with was a very sensible person who only handed out prescriptions to children who clearly were suffering because of how their behaviour was being handled at school (and, more rarely, at home) and tried to keep dosage as low as possible. However, I've seen other children receive medication from medical professionals who did not monitor dosage and the changes in the child's personality (and overall health) were dramatic and disturbing.

This is a fantastic PBS presentation about medicating children with any kind of psychotropic drug.

The Medicated Child

It's interesting that most of these drugs have not been through clinical trials on children... and the trials that have been done are all sponsored through the pharmaceutical companies. There is a great debate about whether or not these medications cause lasting changes (damage?) to young brains that are anything but helpful or if they offer some sort of long-term protective effect.

One thing I learned working in schools is that no one likes to deal with conflict. No one. It's inconvenient and it's uncomfortable. The typical child who is eventually diagnosed with ADHD tends to be one who gets into trouble frequently, either through not completing school work or through impulsive behaviour (including physical altercations). All school personnel know that methylphenidate slows kids down and reduces conflict, and that can include the conflict that frequently arises between the school and the child's home. No parent likes to receive frequent phone calls complaining about their child's behaviour and no teacher or school principal likes to have to make those calls. I've watched (and been party to, unfortunately) the strong-arming of parents so that they will take their child to see a psychiatrist and then medicate their child. This has included such tactics as the school sending the child home for an extended period of time because there aren't resources available (aide time) to help the child without medication.

Yes, there are children who cannot cope with school (and vice versa). Although some children who may be diagnosed as "hyper" out-grow it by adolescence, some do not. And I wish the families of all children whose behaviour is not tolerated in a classroom setting could bring their kids home to learn in the way that best suits each individual child.

More information about ADHD and whether or not it exists: PBS Frontline: Does ADHD Exist?

A wonderful book about different kinds of minds: A Mind at a Time by Mel Levine

Another wonderful book about helping children be optimistic (as so many kids eventually diagnosed with ADHD are discouraged and lack self-confidence): The Optimistic Child by Martin Seligman

A book about stimulants and ADHD: Talking Back to Ritalin by Peter Breggin

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