Our focus is in the wrong place.
Thanks to the challenge made by one professor of pediatrics, the ADHD argument received new momentum recently.
In his published opinion, “ADHD does a disservice to children as a diagnosis,” Dimitri Christakis, of Seattle Children's Hospital said he considers that the “attentional capacity” varies from individual to individual, situation to situation. Also, he found that the bell curve represents it better than a simple dichotomy of whether someone has ADHD or not.
He is not the first one to challenge the main stream medical model. In a 2012 article published by Psychology Today, Marilyn Wedge, PhD, argued that "French kids don’t have ADHD,” and published her own book stating that ADHD has become an American epidemic.
Though it makes complete sense to look at ADHD as a spectrum, in and of itself does not explain the difference in prevalence between Europe and America.
Naturally I don't want to hurt anybody's feelings — especially not the children who are suffering from the disorder, or the parents who have tried everything before they reached for medication. This article does not reference them.
I am talking about children whose dysfunctional behavior is a reflection of the non-biological, mostly emotional imbalances in their environment.
As a European therapist, I see four factors that contribute to the American ADHD excessive occurrence:
1. Children are forced to sit and listen in a school setting instead of getting up and experiencing things first-hand
The makeup of our behavior dates back to the time when our ancestors lived their hunter and gatherer lifestyle. Children learned from the parents and relatives while they lead their everyday life together in groups.
The activity was variable, moving from task to task, while they had a chance to change some words with each other while moving around. The group had to synchronize its activity, but the way how children participated was rather free and self directed.
In today’s schools, children's activity is not self directed, provides no chance to move around and requires long moments of focused attention with high levels of discipline. This was rarely necessary in ancient times.
Had I been chased through my five, six hours a day, class to class with four minutes breaks in between, like in U.S. middle schools, and had I been given sometimes two or more hours of homework on top of that, I surely would have a shortened attention span. I would fidget, and I bet I would burst out in heavy cursing, quite often without a crumb of ADHD.
Would you not?
In other words, the present day school expectations are unrealistic and not age appropriate in many cases.
2. There is less emphasis on structure and discipline
Growing up in Hungary and living in Germany for six years, I agree with Marilyn Wedge. In Europe, there is more emphasis on discipline, structure and compliance than in the U.S., although every culture differs from each other in certain aspects.
Limits, structure, routine, consequence — they are not equal with authoritative parenting style or rigidity, and far away from helicopter parenting.
In my case, it meant I had to be obedient with my parents and teachers. Had I not, there were consequences. There were rules I had to keep; there was a flexible, but steady, daily rhythm we were exposed to.
We had to wait while everybody sat down to the table and everybody finishes. There was very little TV time.
School had 45 minutes classes with 10 or 15 minutes in between. We had enough time to arrange everything in breaks, therefore we were not allowed to leave the classroom for the restroom, or eat or drink during class.
Being loud, bothering others was never allowed and we had to be polite. We even had to give our place to elderly people on the bus.
Naturally, the discipline what our parents provided translated into self-discipline as we grew up. That parental boundary setting doesn't exist in America.
3. Over-diagnosing is commonplace
In Hungary, I was trained to give mental health diagnosis very carefully because of the possible devastating effects. We observed patients for two weeks in different group settings and in individual therapies. We did multiple tests with them.
After two weeks, the whole staff (psychiatrists, psychologists and nurses) would sit together, discuss their experiences and come up with a cautious diagnosis.
We would never diagnose teenagers with psychosis, only “teen age disturbances” knowing that this age is rather turbulent and it might resolve as they grow older. Psychosis manifests itself mostly in young adulthood, not earlier. There was no way to diagnose children with bipolar disorder or other psychosis, with the exception of (very rare) hebephrenic schizophrenia.
In the US, it is common to diagnose children with the most severe mental illnesses in comparison to what we consider as nonsense in Europe. I live with the suspicion that in many cases ADHD diagnosis goes out with the same ease.
It is convenient to think in the medical model. If we can put struggling children in one medical category, we can assume that the problem is solved.
Instead of coming up with an alternative (less medicated) solution — exhausting activities, exercises, structure, routine, reward, consequences, sufficient time for sleep — the child is given medication to keep them from bothering anyone without the need for re-evaluating the effectiveness of the system.
Problem solved? No. Symptom solved.
4. Medication is thought to be the only solution
The pills that we use to influence the brain contain serious chemicals — many of them terribly addictive. Until we know exactly how the brain functions differently in ADHD (which hasn't happened yet), the treatment is mostly statistical trial and error. In some cases it makes the symptom disappear, but in many cases it does not.
I can accept it as the last resort when the behavior of the child is SO troublesome that it restricts his or her achievement or social life — but more often than not, this isn't the case.
Do we face biologically based ADHD or an "undisciplined" child, perhaps with partially delayed development?
Whether or not we medicate the child, this is the most important way we can help them; by giving structure, limits, appropriate exercises, enough sleep, interesting activities, appropriate diet, predictable daily rhythm, lots of attention and patience together with ever present consistence.
I know — it's an incredibly exhausting feat for parents.
But, sorry to deliver the bad news — no pill can replace it.
The unrealistic, age-inappropriate expectations in the public schools, the inconsistent socialization of small children, the dominance of the medical model in the culture and the pharmaceutical industry’s interest for profit are all contributors to the ADHD over-representation in America.
Zita Fekete is a counselor and therapist who wants to help you with emotional manipulation. Sign up hre for the free mini video series.