Over the past 30 years or so, ADHD (Attention-Deficit/Hyperactivity Disorder) has grown from an inglorious collection of symptoms into a household name. Approximately 11 percent of children and 15 percent of adolescents in the United States are diagnosed with ADHD. Each American child is 6 times more likely to receive the diagnosis than a child in France and 60 times more likely than a child in Finland. In her recently published book, A Disease Called Childhood, psychologist Marilyn Wedge set out to find out why ADHD became an “American epidemic.” She concludes with a decisive stance against the medicalization of childhood behavior, rampant prescription of stimulants classified as addictive and widespread misrepresentation of research in the name of ADHD.
From the introduction, Wedge is unequivocal in her position: “I believe ADHD is a constellation of symptoms that our society interprets as a medical condition…But in my view ADHD is neither an unnatural condition of childhood nor an illness that requires medication.” Given the already controversial nature of this diagnosis and recent books on the subject – ADHD Does Not Exist, by Richard Saul, for one – this take on ADHD might be jarring for some and a welcome relief to others. Parents of children diagnosed with ADHD may experience some inner dissonance as Wedge challenges many commonly held beliefs, but are likely to appreciate the equal portion of genuine compassion and understanding for what families are going through. She does not argue the nonexistence of ADHD, as Saul did in his book, but rather suggests that there are better ways to address it. In these pages, parents will find that their struggles are not dismissed, but illuminated for all the confusion and uncertainty that comes with this diagnosis.
Despite its relatively junior status among its older psychiatric relatives (e.g., schizophrenia), ADHD has lived multiple lifetimes of twists and turns. In its infancy, then called “hyperkinetic reaction to childhood,” ADHD was considered a disorder of psychosocial origin, meaning that it occurred primarily as a reaction to life experiences. Wedge traces the evolution of ADHD through the different editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders), revealing how hyperkinetic reaction to childhood was combined with another disorder, “organic brain syndrome” (AKA mild brain damage), thus giving birth to a medical explanation of ADHD that is supported in America, but rejected in other developed countries. She explains how, over time, we have come to believe that a diagnosis with a supposedly biological origin is more legitimate than one of a psychosocial origin.
From there, Wedge explores in detail the multitude of influences that led to the rapid spread of ADHD diagnoses and consequent stimulant prescriptions in America. She leaves few stones unturned, examining changes in culture, the influence of Big Pharma on psychiatry, the media, video games and scientific research. While ADHD has remained relatively rare in other developed countries, it has skyrocketed in the United States, leading us to consume 70 percent of the world’s stimulant drugs while only representing 4 percent of its population. Meanwhile, American students have fallen behind those of countries that hardly recognize ADHD as a psychological condition, let alone a medical one.
The medical explanation of ADHD has granted more legitimacy to the challenges facing children everywhere, but it has also forced parents to choose between giving their children highly addictive drugs – sharing the same category of controlled substances as opiates, cocaine and PCP – and setting their child up to face imminent failure, shame and reproach. At the same time, parents are left unaware of countless other effective interventions, chief among them school accommodations, family therapy, dietary changes, and certain extracurricular activities.
As a psychologist who has diagnosed children and adults with ADHD, Wedge’s book struck my own pangs of uncertainty. I too have faced the questions of many concerned parents. “Is it true that ADHD is caused by a dopamine deficiency?” “Does this mean my kid will have to take medication for the rest of his life?” “Is something wrong with my child?” “Will she be tracked differently at school?” Their questions have led me to share my own perspective, which is that in many cases, symptoms associated with ADHD are a natural reaction some kids have to an unnatural circumstance: school. I often explain that people – children especially – are simply not built to sit still at desks and listen to lectures. We often proceed as if quiet absorption of a classroom lesson is the norm while fidgety restlessness is a deviation, but taking notes for hours is a learned behavior, not a natural one. While there is a subset of children that exhibit extreme hyperactivity and inattention from birth, Wedge suggests that our current diagnostic procedures reach far beyond that group.
In pursuit of other options, many parents choose educational opportunities for their children that accommodate, or better yet, take advantage of their children’s learning styles. Here at The Kingsbury Center, for example, a walk through our hallways will reveal students using haikus to learn science facts, working with occupational therapists in the classroom to regulate body movement, tending vegetables in the green house or cooking them in an enrichment cluster. It is also not surprising that Wedge looks to Finland as a model, where special education integrates fluidly with the classroom lesson and the government relies on teacher training, rather than test scores, to produce the best schools.
Wedge makes a compelling and well-supported argument against the medical conceptualization and treatment of ADHD, but she doesn’t stop there. In addition to her exploration of effective schools, Wedge brings us back to basics on matters of parenting. She reminds us of the family hierarchy and reinforces the sometimes forgotten notion that parents really do know what’s best for their children. In her recommendations, Wedge provides general guidelines for parents (e.g., communicating with children, managing difficult behaviors), emerging research on nutrition and behavior, and educational resources to keep parents afloat along the rapids of Internet, television and video games.
In a recent book review, I concluded that “ADHD is a part of a broader problem in mental health [diagnosis]. These problems compound each other and confuse us all. Godspeed to those charged with fixing them.” Given her bold stance, thorough analysis of relevant findings, compassion and vision for the future, it looks like Marilyn Wedge is up to the challenge. With a free copy of the book as my only compensation, I highly recommend A Disease Called Childhood to parents, educators and concerned citizens at large.
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