One of my greatest frustrations as a physician who cares for individuals with Attention Deficit Hyperactivity Disorder (ADHD) is that everyone, and I mean EVERYONE, thinks that they can do my job. It’s amazing to me how often I hear from parents that they have come for an evaluation because their child’s teacher mentioned to them in a conference that their child might have ADHD. That one doesn’t bother me too much because I can appreciate that a teacher, who is struggling to impart wisdom to a child, is expressing their concern to a parent. But it doesn’t stop there, I’ll hear that the soccer coach said something, then it’s the choir director or the girl scout leader. My kids even think that they are experts, as if they gained a certain knowledge set by just being my off-spring. We’ll be out at the mall and they will lean over to me and say, “Mom, I think that kid up there has ADHD”. Really?!?
The reality is that inattention can be the result of many, many factors with ADHD only being one (and sometimes not even the most important one). I’ll use myself as an example. I have just completed a very intensive week of study at Babson College for their 10,000 Small Business Program. I am mentally drained and exhausted while sitting in the airport writing this blog. I know I’ve got to get this done because my deadline is tomorrow, but I find myself getting distracted every other minute by just about everything. Do I have ADHD because I’m struggling to stay focused to get this task done? The answer is NO! In fact, I have been tested and I know for sure that I don’t have ADHD. What I am right now is tired and being tired often looks like ADHD.
What about the boy in class who frequently puts his head down on the desk while the teacher is talking and writing on the board, does he have ADHD? Or the girl who always seems to be gazing out of the window or lost in thought. Does she have ADHD? If you asked five people to observe those two kids and tell you what they think is wrong, I guarantee you someone will say “ADHD”.
So why are we so quick in our culture to jump to ADHD? Since I haven’t done the research on this topic, I obviously can’t give you a definitive answer. But what I can tell you is that 11% of school-aged children in the United States have ADHD. That is a staggeringly high number. I believe the statistic, but what I don’t necessarily believe is that ADHD is causing problems for all those people. In fact, those individuals with a diagnosis of ADHD often have other conditions that can lead to inattention as well. ADHD’s “kissing cousins”, as I like to call them, include learning disabilities, autism, anxiety, depression, processing disorders, oppositional defiant disorder and obsessive compulsive disorder. Each of these issues can result in inattention. Each of these can lead to difficulty starting or completing a task as well as distractibility.
So how do you know what’s going on? My point is, just by looking, you can’t. Here’s the part that is most disturbing to me as a physician: a lot of parents won’t seek care for their child if they suspect ADHD because they don’t want their child on medication. Would their response be different if the teacher said, “I think your son may have a learning disability” or if the football coach said, “I think your child may be depressed”?
Here’s the take home message, you can’t look at someone who is not paying attention or having difficulty completing a task and determine from that 5-minute observation that they have ADHD. You can’t even observe them for 2 days, 2 weeks or even 2 months and know with certainty just based on that observation alone that they have ADHD. What you can observe and comment on is that their inattention is making it difficult for them to learn or get some tasks accomplished and that is what is most important.
I don’t want anyone to jump to an ill-informed conclusion and then allow the fear of ADHD to prevent them from obtaining real answers that could lead to real solutions. Inattention is an issue; it is one that we know how to thoroughly evaluate and support. Let us in the medical community handle this one. Don’t fear the outcome but embrace that there is a solution. Did you ever think that the girl who always seems to be gazing out of the window may be thinking about her grandmother who has Alzheimer’s and for the last couple of months doesn’t seem to recognize her. Or maybe the boy who is putting his head down on the desk is doing so because he has a visual issue that causes his eyes to hurt after he has read too much. In each case, they need to be evaluated but the treatment is much different. If you, the teacher, the coach, the choir director or even the store clerk expresses a concern, don’t hesitate to have your child evaluated. Only then will you be able to help.
Everybody thinks that if you are a doctor you must be really smart. In fact, that “M.D.” behind one’s name often instills a sense of confidence that intellectually, the physician must know what he or she is talking about. So here is the real deal, you should be confident in your physician’s abilities but not because you think they are smart, but because they have the drive, dedication and work ethic needed to complete the exuberate amount of education and training necessary to get where they are. Don’t make the assumption though that it was easy, and that physicians (and other higher level professionals) relied on just their intellect to make it through . . . speaking from personal experience, it was anything but easy.
After 18 years in practice, about a month ago I had a revelation that I wish I had had back in second grade. I realized that the educational system in this country falls prey to the old saying of “putting the cart before the horse.” Our system is set up to assume that all children learn the same way. Teachers are trained to teach kids using the top two learning styles (visual learning and auditory learning), with a little hands-on, kinesthetic work just to sweeten the pot. The thought is that by using two to three learning styles to teaching children, educators will capture the majority of the class and children will successfully understand the content. But think about this: there are eight (8) learning styles and out of those eight, there are some people who don’t use the visual or auditory learning as their primary way to learn.
So what does this mean? This means that some kids will struggle in school. Some kids may even fail just because they are not being taught in a manner in which their brain can adequately process the information and really learn. Understand that the way most school systems are set up in this country, it is not until these kids fail to perform to their expected capabilities that teachers and parents become concerned. But by then the damage has most likely already been done. I know that sounds dramatic, but have you thought about the consequences of failure? Low Self-Esteem. Depression. Anxiety. School Avoidance. Defiance. Those are all things that can be consequences of a child not being able to acquire the information they are supposed to, and have the innate ability to, learn.
Along with my revelation, I had an epiphany: We should seek to understand how a child learns before we even begin to try to teach them. I know that sounds like a reach, a little too idealistic but it really is possible. In fact, it’s quite easy, and simple, to get an idea of how your child may learn just by doing learning style surveys. You don’t have to go to a psychologist, developmental specialist, or doctor; these surveys can be found online! I will say, though, for parents who are interested in ensuring that there are absolutely no obstacles to your child’s learning, I would encourage obtaining baseline cognitive testing through a clinical psychologist. Unfortunately all that glitters isn’t gold and there is a catch: traditional health insurance companies don’t cover this type of testing unless there is proof that the testing is indicated for poor academic performance. But still, this doesn’t mean that you shouldn’t consider the testing. There are resources everywhere, you just have to figure out which ones are available to you.
One last thing: let’s not forget that learning occurs outside of the classroom as well. Kids aren’t born knowing how to tie their shoes, how to make their beds, or how to clean their rooms. Wouldn’t it be nice to know when your child requires hands-on demonstration (kinesthetic), written instructions (visual) or verbal cues (auditory) to learn these tasks the first time? Better yet, wouldn’t it be nice to know that turning off the television for a musical learner is actually counter-productive? Hmmm . . . something to think about.
Why not consider setting your child up for success before waiting for them to fail? Just a thought.
Recently, I was asked by a colleague if I would be willing to go into a local detention center to provide medication management for a young adult she was counseling. This young man had been in and out of the detention center several times previously. But this time, he expressed to my colleague that he was ready to do whatever was necessary so that he would not return to the facility once he got out. Prior to his detention, he had been given two diagnoses: Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder. He and his mother had concerns about medication so he had never tried them. Now, he was ready to take whatever medication was necessary.
I gave my colleague the “green light” in regards to prescribing him medication. But I had one condition: both the young man and his mother had to make a commitment to understand the foundational issue for what was going on in his life and had to be willing to do the work to fix it. Medication is never the answer; it is only a tool.
In the end, logistic issues prevented me from working with this young man, but it did get me thinking. Can we identify at an early age which juveniles are going to get caught up in the prison cycle? If so, how do we prevent it? The answer to the first question is “yes” but the prevention piece is hard. Some of you may be familiar with the phenomenon known as the “School to Prison Pipeline.” The “pipeline” speaks to the funneling of students from the school house to the jail house, most often because of the zero tolerance policies employed by school systems (which developed after the 1999 Columbine High School massacre) and the overuse of undertrained school resource officers in the schools. Comparatively speaking, the “pipeline” is disproportionately full of Black and Hispanic students, as well as students with disabilities. These students funneled into the “school-to-prison” pipeline often find themselves suspended (and sometimes expelled) from school for non-violent (though sometimes violent) offenses. Eventually, they will find themselves in jail. Let’s put that into perspective:
These statistics got me thinking. If 68% of incarcerated males didn’t finish high school, we can either ignorantly believe that they didn’t want to be in school or maybe school was just too difficult. But for most students, school is an awesome place to be, if they don’t get excited about the actual learning, then the social aspects are usually significant enough to keep most students there. I’m a firm believer that any child who hates school to the point of avoidance has some underlying issue. Is ADHD enough? Personally, I don’t think so. If you have noticed, it seems like everybody who is not successful in school has ADHD. It is true that a lot of people have it, but you would be amazed at how many other conditions exist with ADHD. These conditions include learning disabilities, processing disorders, mood issues like anxiety, depression and bipolar disorder and let’s not forget the neurodevelopmental disorders like autism. Far too often, it is these other conditions that impact learning and success in school far more often than ADHD alone. A recent study published by the American Academy of Pediatrics in September 2015 showed that a diagnosis of ADHD can forestall a diagnosis of Autism by up to 3 years.
So, here is my premise. We should re-describe the phenomenon from School to Prison Pipeline to Preschool to Prison Pipeline. Why? Because many of these children present as early as age 4 with behavior problems, focus issues and resistance to the learning environment. I’m wondering if we did a better job of identifying, treating and supporting these youths at as early an age as possible could be impact the number of individuals to find themselves in the pipeline. Not only that, I am finding that there is a genetic component to many of these issues and if we can treat parents and other family members could we finally break a cycle?
Only time will tell but I and my staff are working diligently one patient at a time to ensure that we don’t contribute to the pipeline.
I hope I got you thinking . . .