ADHD: The Epidemic Scapegoating of Our Children
An Overdue Rational Conceptualization
Children are diagnosed with mental health disorders at a rate that far exceeds any theorized or previously observed prevalence rates, with American children experiencing a 35 fold increase in mental health diagnoses in the last two decades (Angell, 2011). Diagnoses such as Aspergers Syndrome, Bipolar Disorder, and Depression are levied daily across our society, perhaps none more so than Attention Deficit Disorder (ADD) and Attention Deficit-Hyperactivity Disorder (ADHD).
As ethical human service professionals and caring people we must be impelled to harbour some concern for the long term effects to these diagnosed and medicated children, and for how we as a society think about human behaviour and emotions. Psychiatryís tendency to not acknowledge primary etiological factors such as family dysfunction and inadvertent parenting deficits often lead to normal children being misdiagnosed and effectively turned into psychiatric patients, often for the rest of their lives. I believe this is related to psychiatry and pharmaceutical companiesí systematic campaign of misinformation and myths suggesting that childrenís chemical imbalances and biology are to blame for their condition. Since the 1990ís I have paid a great deal of attention to child psychiatric assessments and have noticed a consistent lack of relevant thorough analysis of family interactional patterns, parental emotionality, and acutely relevant discipline issues.
As a mental health clinician I have come across 6 or 7 cases of legitimate attention and hyperactivity disordered children which might have been related to biological/neurological issues in the last two decades. Given what was known about those particular children; it is probable that a few were alcohol or drug affected, however, due to adoptions or gaps in assessment information none of that cohort was able to be conclusively diagnosed as such. The remaining children in that group likely struggled with impaired attention or focus related to: sleep deprivation, anxiety, trauma symptoms, abuse and psychogenic interpersonal communication patterns within the family system but were unable to follow through with services to enable further assessment. Over the years of conducting functional behavioural assessments in a minimum of three distinct settings, including parent-child interactional assessments; evidence has demonstrated the need for increased clinical attention towards a pre-existing and overlooked normative interactional pattern between children and parents.
Noncompliance and coercion has been referred to as a king pin behaviour problem (Jenson, Reavis and Rhode, 1987) and clinical experience suggests that it might be of paramount significance regarding the etiology of childhood behaviour and emotional disorders. This behavioural pattern can be considered normal since we as humans are pre-programmed to survive and have our needs met and will engage in functional behaviour to meet these goals until we are taught differently. This notion is consistent with previously proposed psycho-social stages of development which suggest that children from 1 to 3 years old strive to develop autonomy (Berk and Levin, 2003). We have learned that autonomy at too early an age and without internalized self management skills can be detrimental for children who become egocentric, oppositional and adept at getting their own needs met. Children learn how to not be selfish, irrational, reactive and manipulative by being provided with consistent, fair, firm discipline and rules of conduct which provides a balanced sense of autonomy and teaches appropriate social norms of their society, such as respect for authority and subordination of their own needs. Noncompliance and coercive behaviour become problematic when children learn to avoid doing what adults want, avoid direction and rules, and learn to get what they want when they want it by; ignoring, delaying, using excuses or emotional manipulation which then might escalate to tantrums and aggression. The behaviour is usually reinforced when parents give in, get angry and frustrated or act inconsistently when they are stressed and emotional. In many homes the disparate perspectives about parenting held by fathers and mothers exacerbate problems by creating inconsistency between the primary disciplinarians, increasing the ability for children to use splitting/manipulation to get their own way.
Given some negative reactions in western society to the concept of "discipline", we must be clear on what it means: Merriam-Webster online dictionary defines discipline as "training that corrects, molds, or perfects the mental faculties or moral character" (retrieved August 21, 2013). The more inconsistent discipline is for children, the greater the chances of behavioural problems and the greater the deficits in self management become. When children do not experience consistent external behavioural management, they develop deficits in internalized self-management and struggle to subordinate their own needs and do what is asked of them.
It stands to reason that such children will struggle to sit patiently and pay attention when their immediate self-centred wants are not prioritized, and will then become oppositional towards, and devalue authority figures as well as their learning environment and tasks. They might learn to avoid and make excuses about why they canít learn, complete schoolwork, or remember things. They may become adept at using excuses, tantrums, saying they are sick, saying people are not fair to them, saying "you donít love me", using a victim stance and even aggression towards others or themselves (threats of suicide or self injuring) to get their own way. When children use higher order emotional manipulation, parents and caregivers who are unable to recognize the behaviour for what it is will give in or make exceptions because they are made to worry or feel badly which then reinforces the childís behaviour. The child is then debilitated further because they do not develop empathy (concern or understanding for othersí feelings, wants or needs) and struggle to interact collaboratively with peers and super-ordinates.
A "social mirror" is created which reflects back to the yet developing sense of self that they are not successful, not liked, not accepted, and not like others. This leads to further possible complications: persistent emotional issues, anger, self-reproach, shame, fear and high levels of anxiety and self doubt and predictable sleep problems. When such a child is placed in a setting which evokes stress; their deficits in self management and fragile sense of self result in easily triggered psychological reactions (ie: fight or flight) with physiological responses that might be perceived as "inattentive" and "hyperactive" behaviours. When social and collaborative skills do not develop, children then have conflictual relationships with parents, teachers, siblings, and peers. When these children are left to become sources of conflict and tension they are at increased risk of being viewed as "the problem" and medicalized and pathologizing explanations are often sought: a "biochemical imbalance" or a genetic problem ie: ADHD or bipolar disorder. These professionally assigned labels then reinforce and legitimize what the social mirror was telling them. The real victims of this tragedy then develop a sense of self that is even more deficit based and pathologized without any understanding or rational explanation of the probable etiological factors that have lead to their dilemma. The children are left feeling helpless and hopeless with no sense of their self-efficacy to remediate the identified problem: their biology.
Due to decades of strategic marketing by pharmaceutical companies and the proliferation of pseudo scientific theories about "brain disorders"; parents, teachers and school mental health professionals believe itís appropriate to turn to psychiatry for medications and a quick fix. The involved systems and professionals pressure disempowered parents, who are often treated quite oppressively if they donít comply, to seek medicinal treatment. If unknowing parents do comply and symptoms are medicated, the involved practitioners generally do not help parents remediate skill deficits ie: responding to behaviour firmly and consistently, teaching and role-modelling patience, subordination of oneís needs, and how to concentrate and focus oneís attention. The tragic secondary impact is that the childís skill deficits are then also left unaddressed: effective social skills, compliance with legitimate authority, requests, rules and directions, and how to cope with stress, focus and pay attention. This leads to negative feedback loops and increasing anxiety for children as they continue to struggle with normal expectations and social life while feeling a lack control due to the psychiatrist, parents, and school professionals telling them they have a medical problem, a disease or a biochemical imbalance. One legitimately worries that as adults, these children will likely be diagnosed with a boarder array of mental health problems such as: borderline personality, factitious disorders, bipolar disorder, depression and anxiety. There is also an increased likelihood that they have many secondary negative effects: sustaining social relationships, holding a job, problems with the legal system, drug abuse, alcoholism and the resulting self-reproach and self-doubt that perpetuates the negative cycle in peoplesí lives.
We must also consider other societal realities and rational correlates to this epidemic of ADHD: pressure for children to be involved in extra-curricular activities, "keeping up with the Jones" and resulting increased daily life stress, decreased consistency of care related to double income families and child care being provided by day cares and day homes where care is varied and potentially unhelpful to the development of internalized self management. Our society is plagued by sedentary lifestyles where social contact and recreation are provided by cell phones, TVís, and computer screens which drastically decrease levels of physical activity and healthy lifestyles which effectively work to manage stress hormones, physical tension and anxious thinking. Childrenís ability to learn necessary social skills might also be diminished by such societal shifts with very few adults feeling able to exert any control over such activities because "everyone is doing it". Also, noteworthy are the known and thoroughly researched effects of what our children might be eating and drinking. When examined at a fundamental level: what our children eat, drink, how they spend their time, how they think, and how they deal with life pressures and relationships - is related to what has been normalized, taught, or enabled by their primary caregivers.
My premise is therefore, in many cases, parenting is a key factor. However, many professionals and service providers in western society appear to acquiesce to politically correct positions perhaps because they are fearful of offending others or taking a position contrary to school systems or psychiatry where they might be judged and their credibility or jobs might be at stake. One wonders if such fear and lack of critical thought might be related to the feminist era backlash to "mother blaming", which could be the topic of extended study and review. For our purpose as helping professionals who strive to foster health over clientsí life course, who strive to engage in ethical and responsible behaviour that is focused on the best interests of our clients; it is not about blame but it is about a rational perspective, accountability for what needs to change, and responsibility for the long term social, emotional and psychological development of our children. That is something that necessitates a brave appraisal of the landscape of this societal and cultural problem.
It is my opinion that the ADHD diagnosis is rampant because of these aforementioned societal trends and fears, and because school systems, mental health practitioners, medical practitioners and parents allow themselves to be influenced by the so-called "experts" and "evidence" which inhibits critical and rational thought. What the average member of our society does not know is how special interest groups such as the very powerful and persuasive pharmaceutical conglomerates along with their direct beneficiaries (some psychiatrists and medical doctors) have engaged in a systematic and deliberate brainwashing of our society, and strategically used publication bias to withhold evidence that would undermine their profits and marketing plans for their products (Angell, 2011).
It is undoubtedly much easier for the active parties of this social tragedy to abstain from critical thought, perhaps out of a need to decrease their own cognitive dissonance, self-reproach and ethical dilemmas. The result has been myopathy and blindly accepting the myths about mental illness that the pharmaceutical industry and psychiatry have used to add credibility to their pseudo science (as they have yet to prove any biological causation or chemical imbalances), which effectively absolves them of their responsibility and the hard work it will take to remediate that which they have sown.
Yaddi Singh, Registered Social Worker
BA (Psychology), BSW (Honours), MSW (Specialization in Clinical Practice)
Angell, Marcia (2011). The Epidemic of Mental Illness: Why ?, New York Times, retrieved on line July 13, 2011.
Berk, Laura E. & Levin, Elizabeth A. (2003). Child Development: Canadian Edition. Old Tappan NJ: Pearson.
Jenson, W.R., Reavis, K., Rhode, G. (1987). A Conceptual Analysis of Childhood Behaviour Disorders: A Practical Educational Approach. Salt Lake City, Utah. The University to Utah Press, 1987.