Monday, November 11, 2013

... And here we go again

"Perhaps parents of children with ADHD shouldn't have sinned so much in their youth. Western medicine can't solve your problems now, only the lord can."

That enlightening statement was provided in the comments section of a recent Washington Post article (not the Times, C! Don't yell yet!) describing one mother's struggle with her son's possible ADHD, and putting it in the larger context of how it can be difficult to diagnose -- and how people can still so blithely choose to disparage the diagnosis. Like, say, the above commenter. 

For the record, I wouldn't have described myself as a "sinner" per se. I pay my taxes. I serve jury duty. I give blood. I have a thing for cheesesteaks, but that really just makes me a bad Jew.

The article itself is fine enough, though maybe sketchy on some details:

[ADHD] is far more prevalent in boys than in girls. Among those given the diagnosis, a small minority suffers extreme symptoms, and in those cases, diagnosis is fairly straightforward. Children with extreme cases tend to have trouble staying engaged in tasks, even those that they enjoy, for any length of time and find it impossible to stay still, particularly in classroom settings.
Really, if that were kiddo's only problem that would be lovely. This leaves out the sensory issues that frequently accompany ADHD, not to mention the issues with social skills, inability to recognize personal space/facial cues, developmental delays that make it near-impossible for kiddo to process emotions sometimes, delayed motor skills that make writing anything a struggle for him (though he's getting better at it). Not to mention the almost physical pain he seems to be in when asked to do a routine task that doesn't interest him (like, say, picking up his toys. Yes, that's fun to deal with). And he's lucky, in that his brain actually shuts off so that he can sleep; other ADHDers have to resort to medication just to get sleep. Also, other disorders frequently co-occur with ADHD -- Tourette's, dyslexia, dyspraxia, Asperger's, etc. So yeah, the sitting still in class? Kind of just the tip of the iceberg. 

“There is no line” that defines who does and does not have ADHD, says Lawrence Diller, a behavioral developmental pediatrician and an assistant clinical professor at the University of California at San Francisco. Except in the extreme, diagnosing ADHD is a “judgment call based on subjective opinion,” he says.

Well, maybe for you it is. I watched the pediatric neurologist run tests on my son -- physical and cognitive. That plus the questionnaires from his teacher and from us, which happened to match up pretty closely. Didn't strike me as a subjective judgment call.

Many doctors and some schools rely on the Vanderbilt Assessment Scale, a questionnaire meant to flag symptoms of ADHD and identify other underlying conditions. It includes general statements — such as “Is distracted by extraneous stimuli” and “Is forgetful in daily activities” — and asks the person completing the form to rank how often each applies to the child throughout the day.
But the test does not provide the necessary insights into a child’s home life — discipline patterns, inadequate learning environments, familial difficulties — Diller says. “If the behavior crosses the threshold on these forms, the parent is likely to be told the child has ADHD, even though there can be a host of other reasons why the kid is acting that way.” The child may also have other problems that have little to do with attention but result in ADHD-type behaviors.

Um, actually we were questioned about our home life too. And the questions on symptoms we answered were more precise than those above. So, different questionnaire then?

The one thing this Diller guy says that I agree with is using the book "123 Magic," which has come in handy for us. Even now, when we don't rely on the technique regularly, if I want to get the kids' attention I'll say, "That's 1." Generally it works.

The article does touch on recent studies showing that low dopamine levels in the brain might be associated with ADHD symptoms, and that stimulant medications increase levels of dopamine. So there's that.

The writer concludes that her son seems to be doing fine in school, so they'll take a wait-and-see approach with diagnosing. Which is totally fine. Great, in fact. But I do kind of wish the writer had put more information into the article. Because I know there have been studies other than the ones she's citing, I know brain imaging as a way of diagnosing ADHD is slowly gaining credence, and if all you read was this article you'd think there were scores of neurotic parents wringing their hands over giving Johnny meds just because he wiggles around in his seat at school. Incompetent teachers! Bad parents! Blah blah blah ad nauseum.

Why do I get so exasperated by these articles? These comments on said articles.

"These newly-invented alphabet-soup "disorders" serve one purpose, and that is to sell expensive and debilitating proprietary medications. Maybe kids would pay attention more, and generally behave better, if they were allowed to bring peanut butter and jelly sandwiches for their school lunch. Meanwhile, school administrators are incapable of making normal, common-sense decisions without first looking up the "correct" (i.e., absolutely inane) response in their little red rule books."
Soooo, the real solution here is that my kid should endanger his classmate's life by sneaking peanut butter into school? Hey thanks, man, you totally nailed it.
(Why is it that kids are so completely cool with the idea of no peanut butter because it's dangerous, and adults get so ranty about it? You want a PBnJ, you make one. Cut the crusts off and everything. Have a blast.)
Also, according to the National Institutes of Health, the earliest known reference to an ADHD-like disorder was by a physician named Sir Alexander Crichton in 1798. Yes, I said 1798. That only counts as "newly invented" if the commenter grew up during the Roman Empire.

"I taught for many years in an elite NYC private school.
Many of my students were taking Ritalin or some other drug if they were not getting A grades.
The parents would not accept that their child was not an Einstein.
That the child was not an A student in every course must [since the child was obviously a genius] be because the student had ADHD. ...

There is a reason in the lower grades boys are more often misdiagnosed with ADHD than girls.
Elementary school teachers are not hired because of their knowledge of the subject matter.
It is not hard for a boy to know more arithmetic than his [usually female] teacher. ..."

So you're 1. male, 2. kind of a misogynist, 3. extrapolating your elite New York experience to the rest of the planet? Because I feel pretty confident in saying that New York is not like anywhere else on the planet. 

Also, I can't emphasize this enough: The medications are not designed to give the kids easy A's. They're designed to help the kids feel comfortable and not overstimulated in a group setting, or improve their executive function skills, or help them build in that "pause" so they can stop and think before taking a potentially harmful action. 

I'm perfectly willing to believe that ADHD is overdiagnosed. But if all you read is articles suggesting (or saying outright) that ADHD is overdiagnosed, then you doubt all diagnoses. That's the part I don't appreciate. Don't make my job harder. Don't make me  wonder what kind of reception kiddo is going to get in a world that seems to largely believe his disorder is a great big lie.

No comments:

Post a Comment