A Disease Called Childhood: Why ADHD Became an American Epidemic - Softcover

Wedge, Marilyn

Softcover

ISBN 10: 1101982888 ISBN 13: 9781101982884

Publisher: Penguin Publishing Group, 2016

Synopsis

A family therapist offers a surprising new look at the rise of ADHD in America, arguing for a better paradigm for diagnosing and treating our children.
 
Since 1987, the number of American children diagnosed with ADHD has jumped from 3 to 11 percent. Meanwhile, ADHD rates remain relatively low in other countries such as France, Finland, the UK, and Japan, where the number of children diagnosed with and medicated for ADHD is 1 percent or less. Alarmed by this trend, family therapist Marilyn Wedge set out to understand how ADHD became an American epidemic—and to find out whether there are alternative treatments to powerful prescription drugs.
 
In A Disease Called Childhood, Wedge examines the factors that have created a generation addicted to stimulant drugs. Instead of focusing only on treating symptoms, she looks at the various potential causes of hyperactivity and inattention in children, and behavioral and environmental—as opposed to strictly biological—treatments that have been proven to help. In the process, Wedge offers a new paradigm for child mental health—and a better, happier, and less medicated future for American children.

About this title

About the Author

Marilyn Wedge is a practicing family therapist with a Ph.D. in social psychology from the University of Chicago, where she received a grant from the prestigious Danforth Foundation. She was a postdoctoral fellow in ethics at the Hastings Center, a nonprofit institution dedicated to bioethics. Wedge is the author of Suffer the Children: The Case Against Labeling and Medicating and an Effective Alternative, which was published in paperback with the title Pills Are Not for Preschoolers: A Drug-Free Approach for Troubled Kids.

Excerpt. © Reprinted by permission. All rights reserved.

AUTHOR’S NOTE

In order to uphold therapist-client confidentiality, I have changed the names and identifying features of the clients mentioned in this book. The processes and outcomes of the therapy sessions are real. Family therapy relies for its integrity on the accuracy of case studies. The people and conversations I relate are composites that I have adapted conceptually from a number of individual cases from my twenty-five years of practice. Any resemblance of the composite characters or therapies to any actual person is entirely coincidental.

INTRODUCTION

A Season in Childhood

In 1988, when I started my practice as a child therapist, I had barely heard of attention-deficit/hyperactivity disorder, or what is typically called ADHD. The diagnosis had arrived on the scene a year earlier, in the third revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), the book doctors use to diagnose mental disorders in children and adults. Previous iterations of the manual had identified various types of hyperactivity and attention problems in children, including attention deficit disorder (ADD), the precursor to ADHD, in 1980. But this was the first time the term ADHD as we know it today appeared. According to the DSM, to warrant a diagnosis of ADHD, a child had to exhibit eight symptoms of hyperactivity, inattentiveness, or impulsivity (from a checklist of fourteen) for at least six months. The checklist included things such as “is easily distracted” or “often interrupts” or “intrudes on others.”

Despite its codification in the DSM, at the time ADHD was not widely discussed among child therapists, let alone parents, teachers, and pediatricians, as it is today. Psychoanalytically minded child therapists (those inspired by the work of Sigmund Freud) saw children’s problems as the expression of inner conflicts, while family systems therapists like me considered kids’ problems responses to stressful situations in their social context: at home, at school, or with their friends. We saw no reason to formalize a diagnosis for behavior that child therapists had been successfully treating for years. So we ignored it.

For a while, that was fine. From the time I started my practice until the middle of the 1990s, not one mother or father ever asked me if I thought their child had ADD or ADHD. If their child’s behavior changed, parents assumed something was worrying or stressing their child. They came to me to discover the source of stress.

From my point of view, behavioral problems such as aggression, disobedience, or other behaviors commonly associated with ADHD, such as inattention and hyperactivity, are signs that something is wrong in a child’s life—either extreme trauma, like abuse or poverty, or something more typical, like a lack of discipline or a difficult family transition. Children are not fully developed mentally or behaviorally. Negative emotions that arise from lack of structure or difficult circumstances in their environments usually manifest themselves in their behavior, since children are not equipped to express themselves directly. I was used to treating children’s symptoms as responses to rough patches in their family life or troubled relationships with friends or at school. I helped children cope with sadness or anxiety, compulsive behaviors or aggressiveness, inattentiveness at school or moodiness at home by discovering the cause of the child’s distress.

Of course, I saw plenty of children who were jumpy, disruptive, fidgety, oppositional, or uninterested in school. In these cases, parents generally came to me to ask if I could help them keep the behavior in check, sometimes after a teacher had complained that a child was interrupting class or refusing to do assignments. I typically came up with behavioral solutions for these kids. I advised parents to create a solid plan for discipline, to stay calm, not to yell, to give their child time to mature, to reward good behavior, to invoke consequences for mischief, and so forth. At times, I attended a meeting at the child’s school and worked with the child’s parents, teacher, and school counselor to find specific ways to help the child in the classroom. For particularly active kids—more often boys than girls—I recommended that parents enroll them in a sport or encourage them to ride their bikes as an outlet for their extra energy. Even in cases where something specific—such as divorce, a parent’s injury or illness, or another disruption in the child’s life—was causing the distress, I could usually work with parents and children to address the problem, talk to the child, and figure out a way for them to move past it. These techniques usually worked.

Not every misbehavior was rooted in a troubling situation at home. In those days, some degree of naughtiness and wildness was tolerated and even expected in children, especially in boys. If parents had a little Dennis the Menace at home, well, that was just boys being boys. Impulsive, distractible kids who occasionally rebelled against the authority of adults were considered naughty but normal. Nobody would have suggested that Dennis the Menace or Beaver Cleaver had a mental disorder that required medication. Nobody would have suggested that Huck Finn’s chronic truancy was the sign of a mental illness. A teaspoon of discipline, not a dose of psychiatric medication, was the cure for naughty children. Most people thought the only “disease” that afflicted kids like that was called childhood.

Toward the end of the 1990s, I began to see changes in my practice. More children were coming in to be evaluated for ADHD, often on the recommendation of their teachers. Around 2000, a worried father brought his six-year-old son, Liam, to see me after the boy’s teacher said he wasn’t keeping up with the rest of his class. The teacher worried that even though Liam was bright, he was falling behind. Liam’s father was an epidemiologist with a medical degree from UCLA. He told me in a grim voice that he thought his son had ADHD. I was struck by the fact that he seemed to think of ADHD as a disease that needed to be treated—something you have rather than a series of symptoms you exhibit. But I couldn’t blame him. The number of children who were being diagnosed with ADHD was skyrocketing. By 2000, approximately 7 percent of children in the United States had the diagnosis, up from 3 percent in 1987. By 2014, the number was 11 percent for children and 15 percent for high school kids. It did seem like an epidemic.

Liam wasn’t fidgety or squirmy, but he had trouble focusing and finishing his schoolwork. Sometimes he’d forget to bring home his backpack and would miss several homework assignments. I discovered that Liam was one of the youngest children in his first-grade class. Some of his classmates were already seven, whereas Liam had turned six just before he started first grade. Perhaps, I thought, he simply lacked the maturity to keep up with his classmates in the fast-paced, academically oriented elementary school he attended.

I recommended that Liam’s mother and father take turns sitting down with him in the evening while he did his homework and offer him help when he needed it. I suggested they keep the television turned off during homework time so that the noise wouldn’t distract him. The parents also made an arrangement with Liam’s teacher to contact her by e-mail if Liam forgot to bring home his backpack. The teacher would then e-mail them the homework assignment for that day so Liam wouldn’t fall behind. With the extra support and attention, Liam soon caught up with the other students.

Fortunately, we were able to resolve Liam’s school problems without referring him to a doctor for medication. However, the epidemic continued to grow for many children. By 2010, Centers for Disease Control and Prevention data indicated that more than ten million American children and teens had been diagnosed with ADHD in doctors’ offices. Medication became the go-to solution for kids who were hard to control or struggled at school. Doctors typically prescribed psychostimulant medications such as Ritalin and Adderall to help kids sit still and focus. These medications were not new in the medical arsenal—stimulants had been used to treat nasal congestion, obesity, and mild depression since the 1930s, but they had been newly positioned for children. By 2012, almost twenty-one million prescriptions for Ritalin and Adderall were being dispensed for children each year, up from fewer than three million prescriptions in 1990.

The drugs also became the catalyst for a radical change in the culture of American parenting. Parents came to believe that in an increasingly competitive world, children could no longer afford to dawdle or daydream and learn at their own pace. Kids who didn’t apply themselves to their academics were jeopardizing their futures. The media barraged parents, teachers, and doctors with the message that the gap between young people with college degrees and those without degrees was getting wider. From the moment a child entered school at four or five years old, each day mattered.

Kids needed to prepare earlier and earlier for higher education and the workforce. If medication could help them finish high school and get into a good college, parents believed it was their responsibility to medicate their children. The Great Recession of the early twenty-first century exacerbated these trends and accelerated the acceptance of ADHD medications. Childhood itself was getting a makeover, becoming a race to the top instead of a romp on the playground.

There’s no question that this attitude was well intentioned. Parents want their kids to have good lives as adults. In a shrinking job market and an increasingly competitive society, parents saw education as the key to their children’s long-term success and happiness. They came to believe that stimulants were the answer if their child was struggling because they could help him focus better in school. And as the number of kids taking these medications continued to increase, it became more normal. Like doping in professional sports, you needed a performance enhancer if you wanted to compete.

Unlike many of my therapist colleagues during the first decade of the twenty-first century, as the number of stimulant prescriptions for children rose, I did not refer children to physicians for ADHD medications. I don’t think any child without actual neurological damage from disease or injury needs to take a psychiatric medication, whether Ritalin or Adderall for ADHD, antidepressants such as Zoloft or Lexapro, or the dozens of others on the market. Medications can of course manage symptoms and even sculpt a child’s personality into a form that is more pleasing and acceptable to adults. But I believe psychiatric medications only conceal, rather than treat, the real cause of a child’s troubles. I am not opposed to psychiatric medication for adults. Many anxious and depressed adults believe it has helped them, and it can offer the most seriously disturbed among us the chance to lead normal lives. However, when psychiatric medications are prescribed to most adults, it is best that it be for the short term and accompanied by psychotherapy. When it comes to children, however, I have seen no indication, either in my research or in my own clinical experience, that the diagnoses or medicinal treatments that work for adults apply to kids.

By 2011, many of the children who came to my office were already taking psychiatric medications, prescribed by child psychiatrists or pediatricians. Some of them were so heavily dosed with two or three psychotropic drugs that they seemed more like sedated zombies than active children. I decided it was time to put a stop to the disturbing “quick fix” response to children’s problems by the psychiatric community. These children were suffering and the causes of their suffering were not being addressed—indeed, they were being concealed.

In response, I wrote a book called Pills Are Not for Preschoolers: A Drug-Free Approach for Troubled Kids to offer parents ways of helping children’s emotional problems without medication. I applied family therapy techniques to a wide variety of childhood troubles: anxiety, depression, suicidal thoughts, and compulsive behaviors, as well as behavior and school problems. The book was well received. Soon I was getting e-mails from parents all over the world asking me to help them find a family therapist. One especially moving e-mail came from a father who had returned from deployment in Iraq to find his ten-year-old son taking ADHD medication. He knew his feisty son was a handful and his wife was doing the best she could to help him do well at school. With a little research and a lot of e-mailing back and forth, I helped this father find a family therapist near his town. Six months later, he wrote to tell me that his son was doing well at school and no longer needed medication. Parents from as far away as India and Chile wrote to me asking why their children were prescribed medication for misbehaving at school. What was ADHD, these parents wanted to know, and were there alternatives to medication?

As I watched the ADHD epidemic grow I began to wonder if children in other parts of the world had ADHD in the same numbers as in the United States. In 2012 I happened to read Bringing Up Bébé, a charming book about child rearing in France. I couldn’t help but notice that the author, Pamela Druckerman, did not mention ADHD. Were French kids somehow escaping the epidemic? What about children in Finland or England? I decided to find out.

My research on ADHD in Europe led me to write an article on my Psychology Today blog called “Why French Kids Don’t Have ADHD.” In writing this, I was inspired by the work of medical sociologist Manuel Vallée, who wrote a cross-cultural study of ADHD in the United States and France. In my article, I argued that French child psychiatrists and neurologists view ADHD differently from their American counterparts. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes, and the preferred treatment, psychostimulant medication, is also biological. French child psychiatrists, on the other hand, believe that ADHD is psychosocial and situational. Instead of treating children’s focusing and behavioral problems with drugs, French doctors prefer to search out the underlying issue causing a child distress—not in the child’s brain but in the child’s social context. They then treat the social context problem with psychotherapy or family counseling.

The response to “Why French Kids Don’t Have ADHD” was overwhelming. The article attracted national and international attention. It received more than seven million hits, making it the most widely read and shared article in the history of Psychology Today. Readers translated the article into French, Norwegian, Portuguese, Greek, Spanish, and a host of other languages. Parents, doctors, therapists, and educators who read the article felt moved to contact me. Many people, especially Europeans, expressed support for my point of view. They were shocked at the idea that so many American children were diagnosed and medicated. T...

Edition details

• Publisher: Penguin Publishing Group
• Publication date: 2016
• ISBN 10: 1101982888
• ISBN 13: 9781101982884
• Binding: Paperback
• Language: English
• Number of pages: 272