PROGRESSIVE EDUCATION MAKES ADD WORSE? Date sent: Sun, 2 May 1999 17:33:51 Subject: [education-consumers] Ritalin and Child-Centered Classrooms To: "ClearingHouse" From: "Gloria Hoffman" \doc\web\99\07\added.txt I am not a researcher of ADD/ADHD or a supporter of CHADD, just a parent with the personal experience of dealing and trying to cope with a child that was diagnosed at age 3 with hyperactivity. The diagnosis of hyperactivity disorder of course has since been change to ADD/ADHD. I do not think that anyone believes that Ritalin has not made a profound change (some good, some bad) in the behavior of children. I think we need to question though why we want to medicate young children because they do not behave in a manner that is acceptable to the educational community. The number of children diagnosed and medicated with ADHD grows larger every year. I think it would be wise to look for a cause of this problem instead of a quick fix with drugs. The educational community from the very beginning blamed ADHD on everyone and everything except faulty educational methods. Our classrooms have changed drastically over the last thirty years. The educational community has adopted many "fads" and philosophies without any evidence that these work with children. Our classrooms are unstructured and the children are undisciplined. We have trapped our children in rooms that are noisy, boring and cluttered with toys. We have removed textbooks and replaced them with videos, coloring papers and arts and crafts projects. We have replaced writing with discussion. We have replaced the desks with tables so that a child no longer has their own "space." The educational establishment's attempt to make everyone the same has completely dumbed down the system. Challenge and competition are nonexistent in classrooms today. The schools no longer ability group children so some children are forced to sit and wait for the others to catch up. Could this possibly be the reason some children are unable to sit still? Could it possibly be that a child cannot focus on one activity during center time because the children are engaged in so many activities? Some children need help with becoming good decision-makers. We have forced the children to make decisions that adults should be making for them so that we can call our classrooms child-centered. We are allowing children to make choices about what they learn according to their interests. Instead we should provide a solid foundation in a basic curriculum and allow them to make choices when they are older and their interests and abilities are more clearly defined. Adults need to be there to observe and guide, but more importantly to listen and then try to understand the needs of our children. It is easy to throw pills at kids. I am not suggesting either that there are not kids that might be severely emotionally disturbed or mentally ill. Drug therapy for these kids is necessary, but we must reconsider medicating the millions of kids on Ritalin for short attention span or excessive movement. I found that when I contacted organizations such as, All Children Learn Differently or CHADD, I was immediately directed to a physician or psychologist that was known to readily medicate children. The schools are also quick to guide parents to CHADD or to physicians that medicate. My goal was to find a doctor that would be willing to work with me to use other methods to help my son control his behavior without medication. We wanted to try the Feingold diet because we were aware that after eating certain foods our son was more active than at other times. The schools never reacted well to this suggestion and although we saw a difference in his behavior, they wanted him medicated. We simply refused to medicate. We knew that he was more active than other children, but felt that some of the problems were a result of his being bored and the active classrooms. He was always marked poorly in behavior, but his grades were always good. I suspect that many of the doctors that recommend drug therapy for children have become very wealthy writing prescriptions, books and delivering speeches to frustrated parents at CHADD meetings. My greatest concern about ADD/ADHD is that there is no medical test for diagnosis. (Let us not forget either that a child does not need to be hyperactive to suffer from attention problems. We simply remove the H if he is not hyperactive.) The physicians provide a checklist of symptoms of ADHD. My husband and I found that most people we knew suffered from the same symptoms listed on the checklist. We felt the checklist simply did not define a problem. The list has changed over the years and more behaviors have been added. Of course, now a child is not just diagnosed with ADD/ADHD either. The doctors have now added a new diagnosis to the mix. Most of these kids are now thought to be sufferers of conduct disorder, oppositional defiant disorder, schizophrenia, and the list grows. This area of medicine is clearly unregulated and parents must search for the right answers alone if they choose not to medicate. The problem of how to deal with the child is compounded by many different opinions on what causes the disease, how to treat it, and who best to diagnose it. Originally, when my son was thought to be ADHD we were advised to see a neurologist, but now any doctor can claim he is an expert in the treatment of ADHD and prescribe drugs. Many people are getting rich from this disease. Psychiatrists, psychologists, pharmaceutical companies, and physicians just to name a few. It is estimated that school districts spend over 3 billion dollars a year on behalf of ADD/ADHD kids. I am certain that research is available to support drugging children. I just think we need to reconsider other alternatives. Mary Dahmer has suggested that biofeedback was an alternative that worked for her son. Some of the other treatments are clearly more time consuming, but might be a healthier alternative for our children. I firmly believe that the pollutants and additives to our food have a direct effect on our children. For instance, we now know that the hormones and antibiotics added to the food of livestock are having a direct effect on our children and us. Precocious puberty has been linked to the hormones fed to livestock and found in our meats. Could this also affect the behavior our children? I think as Americans we are always looking for a quick and easy fix. Ritalin and Prozac have provided the answers for a complex problem, but at what cost? What adverse effect do these drugs have on our children? What if they have an adverse effect on just a small percentage of the children using these drugs? (The NIH claims some children hallucinate on these drugs.) Is it worth it to risk the chance that just one medicated kid will have an adverse reaction to a drug and decide to pick up a gun and shoot his classmates? Drugs as powerful as these must have some awful side effects. We must weigh the good against the bad. I think we have other alternatives to treatment and we need to search for them. In my ten years of inner city teaching, I never suggested drug treatment to parents. Why were my students so different from the kids today? I suspect it is the lack of discipline and structure in the classrooms. I place most of the blame on NAEYC and their "developmentally inappropriate" program. We need to provide many different learning environments for our children. If a child cannot learn or behave in a DAP classroom maybe we should opt for a structured environment with a challenging academic program. I am submitting the conclusions from the National Institute of Health Consensus Conference Statement made available in November of 1998. I think this statement clearly shows that we do not have enough research or information at this time to determine if drugging our children is safe and effective without consequences or changes that may change the future of children for a lifetime. Attention deficit hyperactivity disorder or ADHD is a commonly diagnosed behavioral disorder of childhood that represents a costly major public health problem. Children with ADHD have pronounced impairments and can experience long-term adverse effects on academic performance, vocational success, and social-emotional development which have a profound impact on individuals, families, schools, and society. Despite progress in the assessment, diagnosis, and treatment of ADHD, this disorder and its treatment have remained controversial, especially the use of psychostimulants for both short and long-term treatment. Studies, (primarily short term, approximately three months) including randomized clinical trials, have established the efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD and associated aggressiveness and have indicated that stimulants are more effective than psychosocial therapies in treating these symptoms. Because of the lack of consistent improvement beyond the core symptoms and the paucity of long term studies (beyond 14 months), there is a need for longer term studies with drugs and behavioral modalities and their combination. Although trials are underway, conclusive recommendations concerning treatment for the long term cannot be made presently. There are wide variations in the use of psychostimulants across communities and physicians, suggesting no consensus regarding which ADHD patients should be treated with psychostimulants. These problems point to the need for improved assessment, treatment, and follow-up of ADHD patients. A more consistent set of diagnostic procedures and practice guidelines is of utmost importance. Furthermore, the lack of insurance coverage preventing the appropriate diagnosis and treatment of ADHD and the lack of integration with educational services are substantial barriers and represent considerable long-term costs for society. Finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain largely speculative. Consequently, we have no documented strategies for the prevention of ADHD. What Is the Scientific Evidence To Support ADHD as a Disorder? The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. However, as of yet, there is no independent valid test for ADHD. Although research has suggested a central nervous system basis for ADHD, further research is necessary to firmly establish ADHD as a brain disorder. Additional efforts to validate the disorder are needed: careful description of the cases, use of specific diagnostic criteria, repeated follow-up studies, family studies (including twin and adoption studies), epidemiologic studies, and long-term treatment studies. Despite the progress in the assessment, diagnosis, and treatment of children and adults with ADHD, the disorder has remained controversial. The diverse and conflicting opinions about ADHD have resulted in confusion for families, care providers, educators, and policymakers. The controversy raises questions concerning the literal existence of the disorder, whether it can be reliably diagnosed, and, if treated, what interventions are the most effective. Until recently, most randomized clinical trials have been short term, up to approximately 3 months. Overall, these studies support the efficacy of stimulants and psychosocial treatments for ADHD and the superiority of stimulants relative to psychosocial treatments. However, there are no long-term studies testing stimulants or psychosocial treatments lasting several years. There is no information on the long-term outcomes of medication-treated ADHD individuals in terms of educational and occupational achievements, involvement with the police, or other areas of social functioning. Short-term trials of stimulants have supported the efficacy of methylphenidate (MPH)dextroamphetamine, and pemoline in children with ADHD. Few, if any, differences have been found among these stimulants on average. However, MPH is the most studied and the most often used of the stimulants. These short-term trials have found beneficial effects on the defining symptoms of ADHD and associated aggressiveness as long as medication is taken. However, stimulant treatments may not "normalize" the entire range of behavior problems, and children under treatment may still manifest a higher level of some behavior problems than normal children. Of concern are the consistent findings that despite the improvement in core symptoms, there is little improvement in academic achievement or social skills. The current state of the empirical literature regarding the treatment of ADHD is such that at least five important questions cannot be answered. First, it cannot be determined if the combination of stimulants and psychosocial treatments can improve functioning with reduced dose of stimulants. Second, there are no data on the treatment of ADHD, Inattentive type, which might include a high percentage of girls. Third, there are no conclusive data on treatment in adolescents and adults with ADHD. Fourth, there is no information on the effects of long-term treatment (treatment lasting more than 1 year), which is indicated in this persistent disorder. Finally, given the evidence about the cognitive problems associated with ADHD, such as deficiencies in working memory and language processing deficits, and the demonstrated ineffectiveness of current treatments in enhancing academic achievement, there is a need for application and development of methods targeted to these weaknesses. What Are the Risks of the Use of Stimulant Medication and Other Treatments? It is well known that psychostimulants have abuse potential. Very high doses of psychostimulants, particularly of amphetamines, may cause central nervous system damage, cardiovascular damage, and hypertension. In addition, high doses have been associated with compulsive behaviors and, in certain vulnerable individuals, movement disorders. There is a rare percentage of children and adults treated at high doses who have hallucinogenic responses. Drugs used for ADHD other than psychostimulants have their own adverse reactions: tricyclic antidepressants may induce cardiacarrhythmias, bupropion at high doses can cause seizures, and pemoline is associated with liver damage. What Are the Existing Diagnostic and Treatment Practices, and What Are the Barriers to Appropriate Identification, Evaluation, and Intervention? The American Academy of Child and Adolescent Psychiatry has published practice parameters for the assessment and treatment of ADHD. The American Academy of Pediatrics has formed a subcommittee to establish parameters for pediatricians, but those guidelines are not available at this time. Primary care and developmental pediatricians, family practitioners, (child) neurologists, psychologists, and psychiatrists are the providers responsible for assessment, diagnosis, and treatment of most children with ADHD. There is wide variation among types of practitioners with respect to frequency of diagnosis of ADHD. Data indicate that family practitioners diagnose more quickly and prescribe medication more frequently than psychiatrists or pediatricians. This may be due in part to the limited time spent making the diagnosis. Some practitioners invalidly use response to medication as a diagnostic criterion, and primary care practitioners are less likely to recognize comorbid (coexisting) disorders. The quickness with which some practitioners prescribe medications may decrease the likelihood that more educationally relevant interventions will be sought. Diagnoses may be made in an inconsistent manner with children sometimes being overdiagnosed and sometimes underdiagnosed. However, this does not affect the validity of the diagnosis when appropriate guidelines are used. Some practitioners do not use structured parent questionnaires, rating scales, or teacher or school input. Pediatricians, family practitioners, and psychiatrists tend to rely on parent rather than teacher input. There appears to be a "disconnect" between developmental or educational (school-based) assessments and health-related (medical practice-based) services. There is often poor communication between diagnosticians and those who implement and monitor treatment in schools. In addition, followup may be inadequate and fragmented. This is particularly important to ensure monitoring and early detection of any adverse effect of therapy. School-based clinics with a team approach that includes parents, teachers, school psychologists, and other mental health specialists may be a means to remove these barriers and improve access to assessment and treatment. Ideally, primary care practitioners with adequate time for consultation with such school teams should be able to make an appropriate assessment and diagnosis, but they should also be able to refer to mental health and other specialists when deemed necessary. What Are the Directions for Future Research? Basic research is needed to better define ADHD. This research includes the following: (1) studies of cognitive development, cognitive processing, and attention/inattention in ADHD and (2) brain imaging studies before the initiation of medication and following the individual through young adulthood and middle age. ===================================================================== EDUCATION CONSUMERS CLEARINGHOUSE networking and information for parents and taxpayers on the internet Subscriptions & Archives: http://education-consumers.com or You are currently subscribed to education-consumers as: arthurhu@halcyon.com TO UNSUBSCRIBE: Send a blank email to leave-education-consumers-989462S@lists.dundee.net ===================================================================== For less mail, click on the following link and choose 1) a daily digest, 2) a daily list of subjects, or 3) no mail (read postings on Web) http://lists.dundee.net/scripts/lyris.pl?enter=education-consumers For more help & info: http://www.lyris.com/help or