The growing problem called 'ADHD'

http://www.onlineopinion.com.au/view.asp?article=5099

The growing problem called 'ADHD'

Few would deny that Attention Deficit Hyperactivity Disorder has, in a short
period of about 15 years, moved from an issue of relative obscurity to one
well known to Australians. For this reason, among others, a diagnosis of
"ADHD" and even the existence of the disorder itself tends to be regarded
with suspicion.
While pediatricians may play down diagnostic and stimulant medication rates
for ADHD, from the early '90s Australian statistics show a 2,400 per cent
increase in the prescription of dexamphetamine sulfate and a 620 per cent
rise in methylphenidate. Since then, defined daily doses - the amount
individual children are consuming a day - have also risen steadily.

While there has been mention of a slowdown in prescription rates and greater
caution on the part of pediatricians, recent figures show that since the
inclusion of Ritalin in the PBS, prescriptions for Ritalin rose from 523 a
month in August 2005 to 5,800 a month in January 2006.


Some might argue that this increase is the result of a switch between
Ritalin and Dexamphetamine use because some children may respond better and
experience less side effects from Ritalin than they do dexamphetamine
sulfate. If this were the case, one would expect a corresponding downwards
shift in prescriptions in dexamphetamine. To date statistics to support this
have not surfaced.

What we don't know is how many children are being prescribed
anti-depressants, anti-convulsants and anti-psychotics on top of stimulants.
But we should. Not only that, given that these drugs lack federal approval
for use in children due to issues with side effects such as suicide
ideation, there should be stricter protocols to stop this from happening.

The stumbling block towards a better solution for these children is that the
ADHD debate has been characterised by the need to find a bad guy.
Conveniently for some, parents usually top the list - even when the
suspected villain is bad food, bad television or bad video games. The road
inevitably leads back to the parent, who is seen as either failing to
discipline their children, feed them "healthy" food or spend quality time
expanding their minds.

The hypocrisy underlying this debate is obvious.

Most contemporary parents attend antenatal and settling classes. Fathers now
learn to bath their newborns, change nappies and drive screaming babies
around at night. Mothers are exhorted to attend to their baby's every cry to
produce a secure, attached infant - until bedtime when they must switch to
"controlled crying". Without the support of the extended family or cohesive
community networks, mothers and fathers, to greater and lesser degrees of
success, struggle to achieve the exacting standards set by others.

It has to be said, unpopular though it may be, that it is those others who
stand to benefit when parents fail to reach the bar. Somehow the dubious PR
practices of psychologists who target their local area pre-schools and
daycare centres with flyers offering parenting programs, "aimed at the
prevention and treatment of behavioural and emotional problems in children
between 2 and 12 years", seem to fly under the media radar.

Speaking of which, why has no one asked how parents end up in a pediatrician's
office? In the short storm following the blow-out in Western Australia
stimulant prescription rates, why was it that the focus narrowed on six
pediatricians? While pediatricians are responsible for the bulk of stimulant
prescriptions, to effectively deal with the problem we call "ADHD" we have
to ask how parents come to believe their child might have ADHD in the first
place.

Ultimately pediatricians and psychiatrists are responsible for writing
prescriptions for stimulant medication. That doctors play a large part in
the problem is not in dispute. But if we take a step back from the scene of
the doctor's office and begin to question how parents arrive there and, even
more pointedly, what guides the conversation they have, then we can begin to
unravel this very complex problem and work out ways to reduce it.

Research shows that teachers are often the first to suggest that challenging
behaviour may indicate Attention Deficit Hyperactivity Disorder. Research
also indicates, however, that teacher perceptions of child behaviour are
influenced by factors such as class size. In the US, this has prompted
several states to introduce legislation to prevent teachers recommending
that children be medicated.

So, are teachers responsible for the increase in ADHD diagnosis? Let's
exercise the same caution that we did in the doctor's office and take
another step back to look more closely at the scene of the school.

Teachers are currently being asked to teach to diversity with one hand tied
behind their backs. Over the same 15-year period that "hyperactivity" has
become part of our common lexicon, education systems have recognised the
need for schools to become more inclusive institutions.

Our teachers are now teaching children who would never previously have
entered the gates of the local school. For this, they should be commended.
Instead, they are insulted with talk of "performance pay".

Note however that in those same 15 years, public schooling in Australia has
also experienced the effects of harsh neo-liberal reforms. Public services
such as education and health have been asked to do much more with much less.

Here in Queensland, we have seen what happens when you strip hospital
systems of funding. The increase in ADHD diagnosis in Australia is one
telling symptom of what happens when you abandon public education: a growing
number of children lose out as under-resourced schools and teachers are
forced into a funding play-off.

While schools offer learning support services, many children miss out
because of the way their difficulties in school are described. In
Queensland, a child whose difficulties are described in ADHD diagnostic
nomenclature does not qualify for meaningful support. For these children,
systems rely on teachers to plug a widening gap. The load is lessened when
difficult children are diagnosed with something that qualifies for support
funding or when parents oblige the school by shifting the problem to their
local pediatrician. Often, the result is a prescription for stimulant
medication.

This is a band-aid solution. But . a cheap one!

When Health Minister Tony Abbott announced the inclusion of Ritalin on the
PBS, it was described as a "choice" initiative. Parents could now "choose"
between brands of stimulant medication for their hyperactive, distractive,
impulsive children.

What Abbott neglected to consider is what little choice parents actually
have. In reality, parents cannot influence their child's behaviour beyond
the school gate in any other way. Nor can they influence what is happening
in the classroom. If teachers are struggling with a range of diverse
learning styles and abilities in a class of 30 seven-year-olds, yet being
judged by the performance of their students in benchmark tests, then they
are forced to seek support by other means.

Support, however, is tied to disability categories. On the ground, this
means that teachers are being forced to seek diagnoses for children on the
margins. Some children have difficulties that qualify for meaningful
support. Many fall out of those neat little boxes - bright, intelligent,
forgetful, inquisitive, disruptive children who require more redirection,
more explanation, more repetition, more time, more energy, more help.

These are the children who end up in pediatrician's offices. These are the
children whose parents will learn to speak the lexicon of ADHD.

In this way, an ADHD diagnosis functions as an "escape clause", so society
can keep pretending traditional schooling methods and structures are
working. Through such a narrow lens, the problem is the child and never the
system.

The challenge to state and federal governments is to fund public schools and
teachers in proper accordance with the value of education instead of
spending yet more money on subsidising Ritalin - or on rolling-out policy
that fosters a user-pays system along with a now flourishing private tuition
market that few can afford.

Given that stimulant medication operates mainly during school hours, the
million-dollar question becomes: how many parents would still medicate their
kids if schools were better able to engage and support them? Most parents
simply want to get their child through school to lead happy and successful
lives. We must find other, better ways of making this happen.

Substantially reducing class sizes to allow for creative teaching,
increasing the number of teacher aides, reintroducing space in the
curriculum for art and physical education, and having subject-specialist
teachers on rotation to prevent boredom and teacher burn-out are all
responsible ways to help avoid behaviour problems in schools.

Problem is: this costs much more than the $1.5 million or so a year that
Tony Abbott reckons Ritalin will cost Australian taxpayers.

It means we can't have our cake and tax cuts too. It means that it's time
for politicians to act responsibly and stop buying votes. And it's time for
the rest of us to make them.