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Does ADHD Even Exist? Alice, the mother of a seven-year-old son, Nathan, recently visited my office for a counseling session. Nathan had reportedly been different and difficult from the beginning: exhibiting early seizure-like activity, a most challenging temperament, great sensitivity to various types of stimulation, intense frustration, aggressive tantrums, and other apparent developmental difficulties. Alice had taken him to doctors from a young age, obtaining a variety of mostly nonspecific diagnoses of developmental problems. Alice felt unappreciated as a parent, hurt and angry that the Montessori school her son had attended at ages four and five had ultimately rejected him. She felt judged by other parents, whom she felt blamed her for her sonís challenging behavior. And she felt unsupported by both camps of opinion regarding ìmedicationî: the pro-Ritalin forces challenged her reluctance to use the drug for her son, and the antidrug group vehemently urged her to resist drug use. Aliceís personal stance on the Ritalin issue was clear. While she basically agreed that these ìmedicationsî are not good for children, she also felt that, in her familyís case, it had been helpful. Nathan had been diagnosed at age five with attention deficit hyperactivity disorder (ADHD), and had taken Ritalin for a year. Alice thought the drug greatly helped her son, slowing him down enough so that he could listen and process information. She and her boyfriend both felt drugs made the boy much easier to be with; further, their own reduced stress eased them so much that they were now able to consider other alternatives for Nathan, such as nutritional supplementation. Proponents of psychiatric drugs attest that they ìwork,î meaning they alter mood, thought, and action. They also ìwork,î of course, in that they assuage the medical communityís expectation that drugs be used to ìtreatî these children. I believe that fully informed adults should have every right to voluntarily use any drugs they wish, as long as they donít endanger others in doing so. Children, however, are not able to give fully informed consent to drug use ó especially those under six years of age, a group in whom we are witnessing a dramatic increase in psychiatric drug prescription.1 It is, therefore, our responsibility as adults to ensure every possible opportunity for optimal development for our children, to protect and defend our children from powerful toxic drugs, particularly those prescribed for psychiatric purposes. Like Alice, a large percentage of adults who take psychiatric drugs or give them to their children would prefer to avoid them ó and yet they capitulate and use them because the drugs provide relief: from tension, fear, and desperation, as well as from the external strains of judgment and coercion. Lawrence Diller, author of the best-selling book Running on Ritalin, argues that: ìThe 700% rise in Ritalin use is our canary in the mineshaft for the middle class, warning us that we arenít meeting the needs of all our children, not just those with ADD. Itís time we rethought our priorities and expectations unless we want a nation of kids running on Ritalin.î2 Dr. Diller decries the trend (as I do in my book The Wildest Colts Make the Best Horses), contending that this increased reliance on drugs reflects a society in distress. Rather than try to force our children to shrink into situations that do not meet their needs, he states, we need to take responsibility for our society. Diller himself is, however, torn by the same conflict many parents have concerning Ritalin. On the one hand, he says: ìAs a citizen I must speak out about the social conditions that create the living imbalance. Otherwise I am complicitous with forces and values that I believe are bad for children.î On the other hand, though, he concludes: ìAs a physician, after assessing the child, his family and school situation, I keep prescribing Ritalin. My job is to ease suffering and Ritalin will help round- and octagonal-peg kids fit into rather rigid square educational holes.î3 This seemingly contradictory stance is the same one Alice and millions of other parents face. Itís not as if all parents readily accept the prescription of Ritalin. Alice, in fact, incurred the wrath of her sonís neurologist because she refused to give her son Adderall, a combination of three different amphetamine-like stimulants often used as an alternative to Ritalin. Increasingly over the past ten years or so, millions of parents are nagged by their childrenís physicians: ìIf your child had diabetes,î the doctors taunt, for example, ìyouíd give him insulin wouldnít you?î ìWhat could I say to that?î Alice asked me. Her question was not so much a call for information as it was a need to express her hopelessness. It was encouraging to me that she was angry, for anger is a great antidote to hopelessness. She was mad about the treatment she had received from prior medical and mental health professionals, as well as the lack of support from two opposing drug camps. Before I would hazard a possible response for that neurologist, Alice and I talked about the feelings of relief, guilt, and anger the Ritalin issue had caused for her family. Finally, I gave her what would have been my response: the diagnosis of ADHD is, itself, fraudulent. ADHD: Nothing but a Sham Prescribing Ritalin for something that is not a ìdiseaseî does not, in my estimation, constitute a legitimate practice of medicine. If ADHD is not a disease, treating it medically constitutes a fraud. Yet many physicians are true believers in medically treating ìmental illness,î despite the consistent lack of scientific evidence of ìmental illnessî as a ìdisease.î5 Herein lies the conflict for parents like Alice. The Significance of Oppression Theory There are two specific forms of oppression that are pertinent to the discussion of psychiatric drug use for children. The first is adultism ó the systematic mistreatment of young people by adults simply because they are young. Like other forms of oppression, adultism is self-perpetuating: when we are treated poorly as children, we internalize the idea and feelings that life is unfair; that rank and power should be used for personal advantage; and that we are somehow unworthy of respect, incapable of clear thinking, and unable to become our own authority. The second form of oppression is what I call psychiatric oppression: the systematic mistreatment of people labeled as ìmentally illî ó including children diagnosed with fictitious illnesses such as ADHD. Institutionalized in our society, psychiatry is also guided by a worldview that embraces biopsychiatry.7 Juxtaposed with adultism, psychiatric diagnosis and treatment enforce the message that an ìADHD childî is inadequate, defective, unworthy of complete respect, and in need of drugs to control and cope with the effects of his or her ìillness.î Lies My Doctor Told Me ìSocial adjustment is good.î While the ability to adjust socially may be important, it is not always a ìgoodî thing. In its most extreme form, social adjustment leads to conformity and compliance, which has resulted in dire social phenomena, including slavery and genocide. This seems a particularly aberrant notion in a society like ours, which is so deeply grounded in the quest for individualism, free speech and association, and the ìpursuit of happiness.î ìChildren must learn to conform.î When a child fails to adjust to school, we should at the very least think about our abilities to consider the childís needs. It is certainly important for children to learn how to get along in various situations, and how to avoid drawing sanction upon themselves. Nevertheless, young children must be enabled to express their unique gifts within their communities. It is a mistake to force our children to fit molds imposed upon them according to the needs and conventions of the adult order. ìFailed social adjustment causes suffering.î In our competitive culture, we tend to view mistakes as negatives to be avoided. It is hard to accept the notion that mistakes can be good, and actually, in fact, are the way we learn. We are obsessed with the notions of success and failure. We judge a childís actions as success or failure according to our expectations and demands, not through the eyes of a developing child. Eventually, the child internalizes both the standard and the evaluation: ìI failed to live up to the expectations, therefore I am a failure.î I would argue that it is not failure that causes suffering, but rather it is oppression ó in the form of adultism ó which imposes arbitrary standards, and an adult shame-based worldview. This is what causes children to feel and think of themselves as failure, and therein lies their suffering. ìA physicianís job is to ease suffering.î Certainly it is ó through the practice of medicine that incorporates compassion ó not labeling, coercion, or guilt. ìRitalin helps children conform.î Not always. Sometimes it makes them ìpsychotic,î sometimes it makes them aggressive. Other times Ritalin makes children anxious or nauseous. It can make some children feel suicidal. And for some children, Ritalin has been a deadly prescription.8 When it ìworksî well, the child is observed to produce better in the classroom. This, the research shows us, is the only positive short-term outcome. There are no positive long-term effects in any aspect of child functioning ó social, behavioral, or academic ó associated with the use of Ritalin.9 ìTherefore, giving your child Ritalin lets me ease her suffering.î In an 1854 speech on the Kansas-Nebraska Act, Abraham Lincoln said, ìI would consent to any great evil, to avoid an even greater one.î10 Many parents feel the compulsion to punish or discipline their child in hopes that even greater misfortune might not befall them. Given the reality of todayís oppressive society, and its lack of resolve to truly meet the needs of our children, the argument goes, Ritalin may seem a better choice than continued pressure, disapproval, and sanction. This ìease the sufferingî argument reveals one of the most consistent justifications for the use of Psychiatric drugs for children: on one level or another, Ritalin absolves each person of his or her responsibility. The child is not responsible, heís ìsick.î Parents, doctors, the community, the medical and educational institutions ó the society at large ó are relieved of their duty to meet the real needs of that child. We prescribe drugs; the child conforms, the educational and medical institutions donít have to change; and our standards of ìnormalcyî are passed on to the next generation of drug-assisted children learning to fit into the mandated square hole. We have endless justifications that allow us to conform to oppression with a seemingly clear conscience, while an estimated 5,000,000 children are on methylphenidate, and another 3,000,000 on other toxic drugs ó given to them by adults who care for them. Some may call this ìmedicine,î but a growing group of parents and others are beginning to see it as institutionalized child abuse. This article is adapted from a report by John Breeding, which can be found at www.wildcolts.com. Insert #1 Suffer the Children? On a psychological level, Ritalin produces two especially harmful effects. It deprives a child of the right to develop a character and a way of living with self and world, in a drug-free state. Ritalin also creates a burden of shame, a conviction that a child who is on this drug is somehow defective, unworthy, and neither lovable nor even acceptable in his or her ìnaturalî state. These stimulant drugs for children truly are about enforcement of our cultureís preeminent value: productivity.3 Amphetamines, as we have learned over the course of the past century, increase output. But of course, with amphetamines, the trajectory is usually crash and burn. In the US, millions of adults, and an alarmingly increasing number of children, take psychiatric stimulants like Prozac to ìkeep going and going.î Similarly, we give children as young as two years of age stimulant drugs to help their ìimpairedî productivity. But wherein lies the suffering, in the ìfailureî to produce or achieve, or in the so-called remedy we prescribe? Insert #2 Ritalin Use: Simply Out of Control Based on the available data, a realistic estimate of the number of school-age children on Ritalin today in the US is 5 million. Considering that Ritalin ó like other amphetamines, a Schedule II controlled substance that carries a significant risk of abuse ó represents 70 percent of the total prescriptions for amphetamine-like drugs, it is reasonable to estimate that over 7 million US schoolchildren are on some sort of stimulant drug. We can add close to 2 million children now on so-called antidepressants, so it appears that over 8 million children in this country are on psychiatric drugs today. According to census data from 1999, the US population for ages six to 18 is just under 51.5 million, meaning approximately 15 percent of our schoolchildren are on psychiatric drugs. In many schools and districts, the estimations are quite higher, as much as 20 or 40 percent. A study reported this year in the Journal of the American Medical Association revealed that Ritalin prescriptions for two to four year olds increased 200 to 300 percent between 1991 and 1995.1 In an era when we are constantly told to protect our children from drug abuse, it seems there are some very disturbing exceptions to the rule. Insert #3 Supporting a Childís Emotional Expression Know that children are not ìreasonableî when upset. They generally donít talk it out. Your attention is essential. Counsel your child when you feel awake and aware. Do not try to counsel your child when you are emotionally upset, overtired, or distracted by other concerns. Emotional expression (crying, shaking from fear, angry talk) is not the hurt; it is the release of hurt. For example, when a child cries, unless she is in acute response to pain, she is releasing a hurt that was already there before she cried. The emotional discharge, the expression of the feeling, is what allows the child to heal from the hurt. Do not interfere with your childís necessary, balancing emotional discharge by trying to get the child to laugh or be distracted, by shaming the child for showing feelings, or in any other way. Instead, relax, stay close, encourage discharge. Know that your child wants to be completely close to you. It is only the distress that makes the child push you away (or makes you want to get away!). Remember when a child shows anger that he really does not want to hurt anyone or anything. Protect your child from doing harm, and be confident that he or she is doing what is necessary to express some really difficult feelings. Few in our parentsí generation had this information, so many of us were not supported in our emotional expression as children. Therefore, doing this for your child may not be easy. Counsel your child, but get help when you feel that the job is more than you can handle by yourself. Excerpted from The Wildest Colts Make the Best Horses (Bright Books, Austin, Texas, 1996.) Available from the author ($19.95 includes shipping and handling), 2503 Douglas Street, Austin, Texas 78741. Much of this thinking on counseling children comes from the teachings of:
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