The Easy Way Out

Having spent my entire professional career working with children–and more than half of it to date in a residential setting–the fact that medication is the quick and easy solution pursued by many parents and physicians for misbehaving children is not news to me. When I started teaching in 1998 the letters ADD (attention deficit disorder) were just starting to be widely used (at least in a context other than math class!) Since then, we have added a letter, and now there is also a diagnosis of ADHD…attention deficit hyperactivity disorder. There are a variety of drugs that have been developed for the treatment of ADD/ADHD, and sadly I think I have probably encountered children on all of them (and some children on more than one!) What really shocked me, though, was a report I recently read stating that the American Academy of Pediatrics is now recommending that doctors should begin treating ADHD in children at age 4 if behavior therapy fails to be effective.

According to the U.S. National Library of Medicine, ADHD “is a problem with inattentiveness, over-activity, impulsivity, or a combination.” As the father of a 4 year old and as someone with fifteen years of experience working with children (I worked in summer day camps before I started teaching) I would submit to you that inattentiveness, over-activity and/or impulsivity are normal traits of childhood development! Are there times that I wish my son did not have quite so much energy or was a wee bit more attentive to my instructions? Ummm, yeah. Most days, in fact. Do I think he needs to be medicated? Nope. It has never even crossed my mind. And if it crossed someone else’s mind and they suggested it to me I would (politely, I hope) invite them to mind their own business.

The National Library of Medicine, by the way, states that in order for a diagnosis of ADD/ADHD to be made the symptoms described above must fall outside the “normal range for a child’s age and development.” NLM goes on to state that ADHD affects 3-5% of school aged children. Now, there is considerable debate among the medical and mental health communities as to what really qualifies as ADHD behavior, or even, in some cases, whether or not ADHD is a legitimate disorder since the precise causes of it are not known. That is a discussion for another day and time. For the sake of this argument, let’s assume that ADHD is real and that it is caused by a variety of things including genetics, diet and environment. (Incidentally, that is the position to which I hold. Since this is my blog, it works nicely that way). Even assuming that, though, it is startling to see that, according to the Center for Disease Control and Prevention’s 2007 National Survey of Children’s Health, many more children have been diagnosed with ADHD than should have it.

The NLM, remember, indicates that ADHD affects 3-5% of school aged children. The CDC survey, which reported by state the percentage of youth 4-17 who have ever been diagnosed with ADHD, had 5.6-7.9% as it’s lowest reporting threshold, and even then only eleven states fell within that range. Put another way, only 22% of U.S. states have a reported percentage of children diagnosed with ADHD that falls within a range that begins higher than the stated highest percentage of children who should be affected. Another twelve states reported 8.0-9.5% of children 4-17 having been diagnosed, and twelve more reported 9.6-10.9%. That leaves fifteen states reporting between 11.0 and 15.9% of their 4-17 year old children having been diagnosed with ADHD. Yes, thirty percent of U.S. states have had two to three times more children diagnosed with ADHD than likely have it (even assuming the high-end “normal” percentage of 5%)!

I want to stress two points. First, I am not suggesting that ADHD is bogus or that children should never be medicated. I have worked with enough children, and seen the benefits of medication in enough cases, to know that medication is sometimes a necessary part of helping individuals to behave and focus. God has blessed humans with the ability to think and to develop scientific solutions to problems that years ago had no known treatment, and for that I am thankful. Furthermore, medication can sometimes bring a person to the point where other interventions can enable additional progress that could never be made without medication. Just a few days ago I spent forty-five minutes on the phone with a young mother with a six year old son who has been diagnosed with ADHD, adjustment disorder and pervasive development disorder (NOS). Her son had also sustained a serious head trauma at age two, resulting in a subgaleal hematoma. I do not doubt that that young man requires not only some medication but some intensive treatment to help him be able to function in a normal and healthy manner. What I appreciate about his mother is that she wants to get him the help that he needs but also wants to make sure that he is not just arbitrarily prescribed the latest ADHD drug or sent to the most convenient treatment facility. She called me, despite the fact that I am 1500 miles away, because she knows me and knows I would do anything I could to help her make the best possible decision for her and for her son. Other times the diagnosis is not nearly as serious as that but there is a legitimate need for medication in order to overcome a chemical imbalance. There is no shame in utilizing or even seeking medication when it is genuinely necessary.

The second point I want to make, though, is that medication is not the answer most of the time. As a society we have allowed ourselves to digress to the point where we are too often unwilling to put concerted time and effort into solving problems, preferring instead to have a quick and painless solution. After all, we can watch hundreds of channels with the movement of our index finger, we can heat our food with the push of a couple of buttons, we can communicate around the world via text, voice and/or image with a few key strokes…so why not get our children to behave by giving them a pill?

The sad truth is that most of the medications prescribed for ADHD, and especially in the earlier years of such treatment, were never tested on children. Translation: we have no idea what the long-term ramifications of years of taking this medication will be on today’s children. An equally sad truth is that we are allowing parents to abandon their God-given responsibility to raise their children. Raising children, by the way, requires time, effort, patience, perseverance and discipline. Some years ago I had the opportunity to listen to Dr. Malcolm Smith talk about working with youth, and I also had the opportunity to sit beside him at a dinner and talk about this issue. Dr. Smith has spent the majority of his career working with the most violent children in the United States–those you have heard about on the news for killing their parents, teachers and classmates. He has also maintained a private counseling practice. He is squarely in the realm of those academics and practicioners who might be expected to tout the benefits of prescription medication to help children behave. But he is not. In fact, what Dr. Smith said, more than once, is that the most effective method of working with children who are inattentive, overactive and impulsive, is “consistent, loving discipline over time.”

It’s no coincidence that is also what the Bible says….

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