Curbing the diagnosis of ADHD

In the Feb. 23 The New York Times, Stephen P. Hinshaw and Richard M. Scheffler point to “the writing is on the chalkboard” with their op-ed Expand Pre-K, Not ADHD: “Over the next few years, America can count on a major expansion of early childhood education. We embrace this trend, but as health policy researchers, we want to raise a major caveat: Unless we’re careful, today’s preschool bandwagon could lead straight to an epidemic of 4- and 5-year-olds wrongfully being told that they have attention deficit hyperactivity disorder.”

This comes very close to home for me, because my younger son, 24, who has been accepted in the U.S. Navy and goes to boot camp in less than a month, had been diagnosed with ADHD. (Attention Deficit Hyperactivity Disorder) in the fourth grade. He had also attended an excellent pre-K on the Upper Westside of New York City, the Columbia Greenhouse Pre-K. And, as the years went by, he outgrew the ADHD.

In retrospect, he was, as the article points out, one of millions of 3- to 5-year olds introduced to classrooms and preacademic demands. As a high energy boy that meant, as the authors also mention, that he was one of many more distracted kids who caught, undoubtedly, the attention of their teachers. Sure, many children this age are already in preschool, but making the movement to universal and embedded transitional-K programs in public schools is bound to increase the pressure. We’re all for high standards, but danger lurks.

As Hinshaw and Scheffler and the American Academy of Pediatrics now endorses the idea that the diagnosis of ADHD can and should begin at age 4, before problems accumulate. In fact, Adderall and other stimulants are approved for treatment of attentional issues in children as young as 3. In fact, my son was diagnosed at age 4 for ADHD. and had Adderall prescribed for him. Unfortunately, it caused heart palpitations for my son.

One generic brand of Adderall comes with this description from its provider: AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.

MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.

It wasn’t a very pleasant experience when this energetic boy of 10, walking up a not too steep hill in the Berkshires with me to the grocery store, stopped and asked me to feel his heart. I did. His heart was pounding and we slowly walked by to our summer place and disposed of the Adderall, prescribed by a neuro pediatric doctor and family friend. A closer looks at the name [adder all] is an obvious ploy to cast the drug as for all ADHD. kids.

Returning to Stephen P. Hinshaw and Richard M. Scheffler, they claim that early intervention for children with ADHD. could provide great relief. Children who go untreated have major difficulties in school and with their peers, and they have higher-than-normal rates of accidents and physical injuries.

Well, “the difficulties in school” often occur in overcrowded pre-Ks and later in classrooms, As to higher-than-normal rates of accidents and physical injury, my son had his share, not necessarily higher than normal. But what you would except a healthy, active boy to have.

The problem, according to Hinshaw and Scheffler, is that millions of American children have been labeled with ADHD. when they don’t truly have it. “Our research has revealed a worrisome parallel between our nation’s increasing push for academic achievement and increased school accountability—and skyrocketing ADHD. diagnoses, particularly for the nation’s poorest children.”

As a parent of three grown children, two of them men now and from two different moms, my older son by ten years exhibited and still exhibits high energy symptoms as a Juilliard graduate jazz musician. He is married to a Julliard classical pianist.

Returning to the authors, they found “that in public schools, ADHD. diagnoses of kids within 200 percent of the federal poverty level jumped 59 percent after accountability legislation passed, compared with under 10 percent for middle- and high-income children. There was no such trend in private schools, which are not subject to legislation like this.”

A reader commented “A teacher who worked with elementary age ADHD kids said most calmed down and focused if he took them outside to sit on the grass.” I have a similar observation that the outdoors of the Berkshires in the summers was calming, especially for my youngest.

Another reader said, “When my son was in pre-school, he drew abstract art when told to practice copying the ABCs. Well, actually, he was scribbling in various patterns that were quite attractive.”

Both were read to and surrounded by books early on and made the transition to reading at age about 6, not 5 or less. Start kids schooling later, particularly boys and ex-premies.

Said the authors, “By age 17, nearly one in five American boys and one in 10 girls has been told that they have ADHD. That comes to 6.4 million children and adolescents—a 40 percent increase from a decade ago and more than double the rate 25 years ago. Nearly 70 percent of these kids are prescribed stimulant medications.”

Unfortunately, I have to agree with those statistics. But the good news is beyond their late teens, particularly the younger, start to shed the ADHD. symptoms on their own and also the meds, which are almost all annoying, tiring, affecting appetite and sleep.

The authors wrote, “Families and physicians must take special care in medicating very young children. Today’s push for performance sets us on a troubling trajectory. A surge in diagnoses would mean more prescriptions despite guidance from professional organizations, including the American Academy of Pediatrics, which recommend that behavioral therapy rather than medication be used as first-line treatment for children under 6.”

I would agree with the authors. Loading up kids under the age of six with these powerful chemicals is counter-productive and dangerous They develop a resistance to taking them given the after affects.

“Too many kids are identified and treated after an initial pediatric visit of 20 minutes or even less. Accurate diagnosis requires reports of impairment from home and school, and a thorough history of the child and family must be taken, to rule out abuse or unrelated disorders.” I agree with that completely.

“Yes, this would be more time consuming and costly in the short term. But just like investing in preschool, spending more today on careful diagnosis and treatment of ADHD. will lead to lifetimes of savings. As the early childhood education movement builds, let’s make sure we proceed with caution. We should fundamentally rethink how we diagnose and treat ADHD., especially for our youngest citizens.”

Funny, I didn’t mention my eldest, my daughter, who was always a calm child, perhaps quiet as an adolescent, but now an active women with one adopted child of her own, and an MSW from Fordham University. Of course, I love them all equally.

Stephen P. Hinshaw is a professor of psychology, and Richard M. Scheffler is a professor of health economics at the University of California, Berkeley, and are the authors of “The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance.”

Jerry Mazza is a freelance writer and life-long resident of New York City. An EBook version of his book of poems “State Of Shock,” on 9/11 and its after effects is now available at Amazon.com and Barnesandnoble.com. He has also written hundreds of articles on politics and government as Associate Editor of Intrepid Report (formerly Online Journal). Reach him at gvmaz@verizon.net.

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