I recently read yet another article in a Jewish publication stressing the importance of having your child tested for attention deficit disorder if he is having trouble at school or finds paying attention difficult. I would have yawned if I hadn’t gotten so frustrated. The fact of the matter is that there is no scientific test for ADD. It’s a condition diagnosed by clinical evaluation – and grossly over-diagnosed at that.
There is no question in my mind that some kids have a bona fide psychiatric disorder. If an eight-year-old boy walks into my office and has his hands in the potting soil of my plants before he even sits down, medication is in order if I can rule out problems at home and some rare medical conditions. Usually, the improvement after medication is clear to all.
But non-hyperactive ADD is different. A seventeen year old came to see me last week and confided that he was sure he had this type of ADD because he was able to focus much better after taking some Adderall. He undoubtedly was telling the truth. But that doesn’t mean he had an illness that warranted treatment. I hardly think a baseball player who improved his home run production with steroids or a cyclist who peddled faster with EPO had an underlying disorder before his “treatment.” I am quite sure that if I gave my staff 5mg of Ritalin each day they would focus better and get more done. That doesn’t mean they have ADD.
The downside to giving medication to anyone who complains of not being able to focus – as many psychiatrists do – is that it absolves individuals of personal responsibility. If a child on Ritalin misbehaves at school, his teacher doesn’t blame him but rather the medication (“the meds aren’t working”). The child becomes a passive victim rather than a responsible agent.
Diagnosing children with ADD arguably helps parents much more than children. Parents no longer have to feel guilty or responsible for their child falling behind in school or not learning. By assigning a “condition” to the child, the psychiatrist essentially says, “It’s not your parenting, it’s the illness.”
It’s important to realize that we focus on something better if we are either good at it or interested. I’m sure that if I went with my wife to a quilting conference I would be easily distracted, wouldn’t retain information well, and might even be fidgeting away. But if the two of us went to hear the local college basketball coach talk about his new zone defense, I would be able to repeat, and probably expound on, his talk right afterward.
The same principle applies to schoolwork. I have found a high correlation between kids who come to me for an ADD evaluation and the difficulty they experience in reading at grade level. Reading is an integral part of schoolwork, but if a kid is not good at it, he is not likely to stay focused. That doesn’t mean he has ADD. He simply is uninterested.
We have to remember that some of us are better at certain things than others. I have seen a decrease in tolerance over the years from parents and teachers for the inevitable discrepancies in scholastic abilities between kids. Way too often the bottom half of a class gets referred to the local mental health practitioner for ADD testing for no reason other than they are in the bottom half.
I recall evaluating the junior-high son of a local professional who was quite flustered by his sons C’s in school. When asked, though, the father told me he had gotten C’s and D’s at the same age. My “treatment” was to help him and his wife redefine their expectations and present a more supportive, encouraging posture for their child.
The home environment has a great deal to do with how we perform in school. Strife or tension in the home can cause anxiety in a child that will certainly affect his ability to concentrate. But who needs to be treated here – the family or the child?
When kids are young, parents should focus on making learning enjoyable and the home as conducive to learning as possible. In grade school, catching up with basic skills by playing games that involve reading or math will tend to make the process more enjoyable. In early teenage years, tutorial help in weak subjects pays big dividends later. For older kids, providing structure and clear limits are in order since the responsibility for learning is more on their shoulders.
If a parent has problems instituting a plan along these lines, seeking professional consultation may be in order. The professional can be a schoolteacher or a clinician. However, if the former already has ten percent of his or her class being treated for ADD, or the latter “specializes” in prescribing medication for ADD, be wary. Hang on tight to the concept that the ability to learn and concentrate is a skill that comes naturally only to a minority of the population. For the rest of us, it needs to be developed and refined through years of hard work and perseverance.Dr. Joel Fine
About the Author: Dr. Joel Fine lives in Vacaville, California where he has been in private practice for 22 years. He has written and spoken extensively on healthcare-related topics and is the author of the recently-published “Arc of the Covenant: A Psychiatrist Tracks His Path Through Judaism.” He can be reached at firstname.lastname@example.org.
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