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What Do We Know About ADD/ADHD?

L. Alan Sroufe’s opinion piece in the New York Times, “Ritalin Gone Wrong,” certainly will raise controversy.

Sroufe is a psychologist who has worked with children for 40 years.  He notes that in the the use of drugs to address attention deficit disorder is now 20 times what it was 30 years ago.  He believes that drugs like Ritalin and Adderall are effective over the short term, but over longer periods improve neither behavior nor academic problems.  ADD, he says, citing various studies over the years, is not an anomaly present from birth, but likely caused by childhood experiences and environment.  He concludes that there isn’t one simple solution for children with learning and behavior problems, and that medicating millions of children feeds into the idea that everything can be solved with a pill.  Children diagnosed with ADD or ADHD, he says, also may have anxiety or depression or other related issues.  “We need to treat them as individuals, “ he writes. Boys-study-globe-I167-07-304

Over 3 million children take drugs to help them with problems of focusing in class, and Sroufe’s piece will probably provoke ripples of support and blowback.  Parents, teachers, and others will provide reams of anecdotal evidence and contradictory studies showing how a child profited from being on ADD drugs.

The Attention Deficit Disorder Association insists that ADD or ADHD is not caused by “poor parenting, poor teachers or schools, too much TV, food allergies, or excess sugar.” Instead, ADDA says that the condition “is very likely caused by biological factors which influence neurotransmitter activity in certain parts of the brain, and which have a strong genetic basis.”  Treatment, according to the association, can be a combination of therapy, counseling, and medication.  Ritalin and Adderall are listed among the drugs the association says have been “found to be effective.”

It is not uncommon for teachers of children who are impulsive, disruptive, and inattentive to encourage parents to try Ritalin or other drugs for the child.  As an administrator I routinely pointed out to teachers that they were not physicians and were not licensed to prescribe.  Instead, teachers should refer a child having difficulty to the appropriate child study team and should work with parents to find strategies to help the child learn.  This is not to say that the child would not end up taking one of the hyperactivity drugs, but if the child did, it was for the child’s benefit, not the teacher’s.  The standing joke among administrators after listening to a teacher complain about a child’s behavior was that someone needed to be on Ritalin, but maybe it wasn’t the child.

ADHD is, of course, recognized as a disability under federal law.  It is the most commonly diagnosed behavioral disorder of childhood, affecting about 3-5% of school aged children.  It is diagnosed much more often in boys than girls.  Still, it appears we don’t have a clear picture of what the best treatment is for kids or even what causes it. Just one more useful thing we could have been spending our money on. 




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