Sunday, October 20, 2013

Arguing the hypothesis

Kiddo was supposed to be getting moving yesterday, and getting ready for karate class. Instead he was hunting down his plastic sword so he could have swordfights with, I dunno, the air? and intently trying to build a truck out of Legos. (He has a book showing different Lego creations you can make, and he seems to regard it the way I do a recipe book -- as useful source material.) He didn't want to put his uniform on, he didn't want to pick out a change of clothes for after class, and the more DH and I nagged and warned him, the more stubborn and upset he got, until he went into full-on screamy meltdown mode and refused to even sit in the chair for time out. I had to take him by the shoulders and sit him down.

He calmed down after that, and after time out was done, he and I hugged and apologized to each other and he was able to get his shoes on and go. And he was giggling and goofing around like the whole thing had never happened. Typical. (Not neurotypical. But typical.)

He hasn't had a meltdown like that in a long time. Seeing one all over again reminded me that it has been a long time, and he's been better able to hold it together when asked to complete tasks. It also reminded me how horrible those meltdowns are, and how stressful to deal with, and how almost exasperating it can be to watch him having totally forgotten about it two minutes later. I almost expect scenes like that to have some sort of emotional aftereffect. Like a meltdown hangover, if you will. But no.

This morning at church (UU fellowship but "church" is fewer syllables), kiddo only kicked his legs against the pew a few extra times before I glared him into stopping. So that was fine. Generally the problem is after services, when I go downstairs to collect the kids from RE class and they're jumping around the room and stealing extra snacks from the snack table. This time, some of the other boys were goofing around on bongos (yes, bongos. Just go with it) and cracking silly jokes, and kiddo found this all so hilarious that he went into extra-hyper overdrive, giggling madly, bouncing around, trying to join in. Generally when he gets like that, it's Code Red for "get him out of the room before he really goes too far and hurts himself/hurts someone else/damages property." He was so wound up I practically dragged him out of the room, after several unsuccessful attempts to get him to voluntarily walk out. And then of course a well-meaning elderly lady stopped me to tell me about how when her kids -- or grandkids, I didn't really hear her -- were being just like little jumping beans, she would make them do somersaults, or something like that. I didn't really hear her because in the time it took her to stop me and tell me all about jumping beans, my kids had already run upstairs and were heading right for the parking lot. Hey thanks for the advice. You know what would've been more useful? Staying out of my way so I could more effectively keep the kids away from moving cars. Just a thought.

I mention all this as a leadup to this article in the Times, which I notice is being namechecked all over the Twitters today so people can trash ADHD as being trumped-up and fake and a big conspiracy by Big Pharma and incompetent bureaucratic schools etc. First of all, you think ADHD is fake? You take my kids to church. Second of all, that's not exactly what the article is saying.

The writer's point -- and she acknowledges up front that she has ADHD herself, which alone is some sort of breakthrough here, because generally Times stories about ADHD only talk about how college kids are OD'ing on stimulants -- is that the rise in diagnoses might be related to sociological factors as much as medical need. First of all, she notes:

Most children are given the diagnosis on the basis of a short visit with their pediatrician. In fact, the diagnosis can be as simple as prescribing Ritalin to a child and telling the parents to see if it helps improve their school performance.

Right, I agree, that's no way to diagnose. I keep harping on the fact that general practitioners shouldn't be making these calls. That's why we went to a pediatric neurologist.

The sociologists she quotes say that the policy shift making ADHD kids eligible for academic accommodations -- extra time on tests, etc. -- made the diagnosis more appealing, and linking school funds to students' test scores coincided with a jump in ADHD diagnoses in some states. 

Well, my kids are going to have to take standardized tests no matter what I think of them, so I won't go into that now. I can only speak for myself here: I didn't push to have kiddo evaluated so he would get better grades. I pushed because he couldn't function at school and he couldn't function at home. I pushed because the screamy fit he had yesterday used to be an everyday occurrence, and just being around him was mentally exhausting. Stick that on your standardized test.

A psychiatry professor she quotes offers this:

Schools used to punish kids who wouldn’t sit still. Today we tend to see those kids as needing therapy and medicine. When people don’t fit in, we react by giving their behavior a label, either medicalizing it, criminalizing it or moralizing it ...

Oh, if only kiddo's entire problem had been sitting still in class.

The problem with this article -- and don't get me wrong, I think it's generally a well-written, well-researched article -- is that it operates on several assumptions. One, that all kids diagnosed with ADHD automatically get fed stimulants. There are, in fact, no hard numbers in the article about how many of those kids actually do take stimulants. Some families can and do operate without them. Two, that the only ways ADHD shows up are in academic underachievement and fidgeting in the classroom. This completely leaves out issues like 1. inability to read social cues, 2. no understanding of "personal space" (really a subset of 1), 3. lack of "executive function" skills, 4. delayed behavioral/emotional development, 5. delayed motor skills, 6. hyperfocus (granted hyperfocus can be a bit of a plus sometimes). And none of this touches on frequently co-occurring (or "comorbid") disorders like Asperger's, Tourette's, dyslexia/dyspraxia or OCD/anxiety disorders.  

Are there not-incredibly-educated authority figures out there looking for a quick-fix solution, or a way to game a funding system? Let's say it wouldn't surprise me. But I don't think that should take away from the fact that ADHD is real and there is genetic evidence to support that (as the writer says, early on). Unfortunately, all that the commenters on this article seem to have gotten out of the article is that kids today watch too much TV and eat too much sugar and never ever play outside, and that's the whole goshdarn problem.

Oh yeah? Kiddo gets restricted screen time and loves playing outside every chance he gets. (Like today, when we were on the playground for an hour.) As for the diet ...

Me: "Hey, sweetie, we're going to have chef salad for dinner this week."

Kiddo: "Yay!"

And yet he still has ADHD. How about that.


  1. The Times is a shitty paper. I am thinking of getting a tattoo proclaiming it's wretchedness. Anybody who thinks it's not real can kiss my fat, white ass. I AM FULL OF THE CURSING TODAY.

    1. Man, you are. :) Technically speaking, the commenters on the story were saying ADHD isn't real. The story said it's real but might be overdiagnosed due to lazy doctors and opportunistic school officials. To be fair about it.