Many children with symptoms of attention deficit hyperactivity disorder (ADHD) actually suffer from a more prosaic malady: lack of sleep.
A recent study, published in the October issue of Pediatrics, examined more than 3,000 5-year-olds and found nearly 20 percent had symptoms of ADHD, while half reported daytime sleepiness.
Agitation and distractibility are not unusual symptoms for children who have not gotten enough sleep. It is quite possible many children medicated for ADHD are really sleep-deprived. When I discussed this on a recent radio show, I suggested that we should go slowly before we diagnose and medicate our children. The evaluation should be thorough and we should look at the overall context of the child’s life, rather than simply medicate the symptoms.
In addition, I suggested that most of our children are overstimulated and that some of these hyperactive symptoms are just the response of their minds and bodies trying to keep up with an unhealthy environment.
One listener was distressed about what she heard. She wrote to me:
“My concern about what you were saying is that you may be encouraging children to be held hostage (by their symptoms) while you and others advocate for important societal changes that would probably work better than medication but are much harder to obtain than a diagnosis and medication.”
I certainly agree that depression, anxiety, hyperactivity and rigid behaviors are illnesses that need to be treated. But they are also symptoms that need to be respected. Because if we respect the symptoms, rather than trying to eliminate them, they might lead us to the real problem.
Several years ago, I saw an 11-year-old girl for consultation. She had been diagnosed with school phobia as she would cry and argue with her parents every day before school. A behavioral therapist had treated her for her phobia but the treatment never worked. Her family doctor put her on medication for the phobia, but that didn’t work either.
After a couple of sessions, she confided to me that she was being molested by an older boy at school who told her that if anyone found out he would hurt her. The phobia was the symptom, not the illness.
Family therapists have long known that a symptom in a child could also reflect a problem in the family. I have seen many children who showed symptoms of depression or anxiety when the real problem was parental conflict or depression. I was recently asked to see a boy who was agitated in school and diagnosed with ADHD. After I saw the family, it became clear that his mother had an eating disorder and the marriage was in trouble. As the family improved, he became less agitated.
This problem is not confined to children. Many adults go to their family doctor for stress-related symptoms or depression and get pills. Yet the real problem is with their lifestyle. So they get medication, which will suppress the symptoms so they can continue living a lifestyle that is unhealthy. Managed-care and pharmaceutical companies largely support this approach, as it is a profitable approach – in the short run. In the long run, the anxiety, depression or stress-related symptoms continue, resulting in lost work, medical problems and a variety of other social ills.
The classic example of treating symptoms is using diet programs for obesity. It is widely known that the failure rate for these programs is well over 90 percent, and any dietitian will tell you that what is required is a lifestyle change and not just a diet change.
Our children are increasingly diagnosed with ADHD, depression and anxiety disorders, and more children than ever are taking psychiatric medication. As a culture, we are becoming more effective at treating symptoms and less effective at treating the problems that cause them.
No, we cannot wait until our society changes. Society changes glacially and children suffer daily. But this ADHD business is a label upon which pharmaceutical companies have made millions, and parents and teachers are controlling overstimulated children chemically.
I am not waiting for society to change, but I am asking parents and professionals to take the time to look at the whole child and not simply to try to manage his or her behavior.
I also understand and respect the other side of the argument. I have seen how destructive ADHD is and what it takes away from children and families. And I have seen how medication can be a lifesaver when used with the right child in the right way. But to medicate a child (or anyone, for that matter) simply to control behavior does everyone a disservice.