Working at a pediatric primary care practice with an increasingly large number of patients seen for Attention Deficit Hyperactivity Disorder (ADHD) and treated with mental health medication, I have decided to explore this trend further to better understand its causes. Statistics reported by the Centers for Disease Control and Prevention (CDC) show that 11% of school-aged children have now received a diagnosis of ADHD, as compared to 6.9% in 1998-2000. This now common condition is marked by three main symptoms: inattention, impulsive behavior, and hyperactivity. Additionally, statistics have shown that many children diagnosed with ADHD, as well as other mental health disorders such as bipolar disorder, anxiety or depression, have higher rates of alcohol or substance abuse, and interpersonal or professional problems. Whereas the causes of ADHD remain unknown, although genetic factors are evident, the manifestation of the condition may lead to functional impairment in academic, professional, family, and social settings. A diagnosis of ADHD, however, is by no means a crippling verdict. It can be successfully managed through behavior modification, medication, and in most cases, a combination of the two works best.
However, doctors who treat children with ADHD have too often received criticism for prescribing medication to children and drugging our youth. Whereas behavior modification therapy is the American Academy of Pediatrics (AAP) recommended first course of treatment for ADHD in younger children, it may not always be sufficient to obtain optimal results, and medication may be necessary. What I have noticed, however, is that doctors may not always be the ones to initially suggest medication as a course of treatment. Too many parents of children with ADHD throw fits in our waiting rooms if the physician is running behind schedule, because they need to get in and out fast, with a prescription for ADHD medication in hand. This may be an indicator that ADHD does, in fact, have a genetic influence, but there is a more important lesson to be noted here: these parents simply do not have the time to wait. In today’s society, we are constantly rushing—whether it is to and from work, school, to pick up our children from daycare, to run a multitude of necessary errands, and so on. Add to that a child who is jumping off walls and banging on tables, or screaming from the backseat, and you will likely be debating if it is acceptable to drink at noon on a Tuesday.
There is yet another factor at play that leads to more parents seeking out medication for their children with ADHD. These children are notorious for acting out in school, simply due to the nature of their condition. It is difficult for them to pay attention, or sit still, and they may often be very disruptive in class. Additionally, many children have different learning styles, and measuring their performance using a standard curriculum may lead to poorer grades. Teachers who are responsible for approximately 30 children each day are statistically likely to have 3 kids in their class (11%) having trouble staying on task. These teachers then reach out to the parents of these so-called problem children, explain to them the difficulties that their child is facing in school, and recommend that he or she be evaluated for possible ADHD by their pediatrician. When the diagnosis is made, behavior modification is the first physician recommended treatment, especially for parents who are wary of putting their child on medication. Whereas medication regulates the brain on a neurological level, behavior modification focuses on the actual problem behaviors that the child exhibits, and tries to overcome them by introducing more structure into the child’s daily life. It is important for the parents to set priorities as far as areas of improvement to tackle with their child. If too many changes are made at once, your child will lose focus and improvement will be minimal in all areas at best. By setting specific goals for your child, such as not interrupting while others are speaking, or raising his or her hand in class before asking a question, improvement is more easily measured. Behavior modification works only if the child recognizes his or her progress, which stems from the parents, teachers, and caregivers noticing and commending the child’s improved behaviors.
However, behavior modification is not always enough, and is not always stable. The child may regress if the established structure is disrupted, or if the child finds himself in a new, unfamiliar environment. For this reason, behavior modification works best in conjunction with medication. Fortunately, the stigma associated with mental health medication, although still present, has significantly reduced over the years, and longer-acting medications with minimal side effects have been introduced. The fact is that medication works—the physicians in our practice receive countless heartfelt thank you’s every day from parents who have firsthand witnessed their child’s behavior improve in school, at home, and in other social settings.
So who is responsible for such an increase in child ADHD diagnoses and medication prescriptions over the years? In our society today, single-parent homes are more and more prevalent, and these parents work tirelessly to provide for their children and to give them a better future. Two-parent homes are no different, as both parents are more likely than not also working long hours. The number of stay-at-home parents has decreased dramatically in order for families to meet their financial obligations. With limited supervision, kids have more freedom and less structure. When the parents do come home from work they are often too exhausted to fully dedicate their time at home to their children as they also need rest, and the children are often exposed to TV shows that do nothing to promote their growth and knowledge but instead may display scenes featuring violence or other harmful material.
At school, teachers have their hands full with children who may not be used to structure and who may be acting out for attention, and in order to teach their class, these teachers need to identify the children who are disruptive to others and do something about them. They encourage the parents of these children to seek out ways to improve their child’s behavior. We have had too many parents call our clinic begging to get an appointment for their child immediately, because according to the parent the child is not allowed to return to school without being on medication, or is driving them crazy in general. The doctors then, upon appropriate diagnosis, recommend a course of treatment, which more often than not also includes medication.
I would like to conclude with this—yes, we have hit an all-time high of children diagnosed with ADHD and treated with medication. However, this is not necessarily a bad thing. The increased number of such diagnoses stems from increased awareness of the condition and its limiting properties on the day-to-day functioning of children afflicted with the condition. The increase in treatment with medication stems from increased evidence and acceptance that the medication, when used in conjunction with increased structure and goal setting, truly works. It allows children who were previously struggling in school, acting out at home or other settings, misbehaving in general, and displaying low self-esteem and the belief that they are inferior to others to achieve improved academic performance, gain new confidence, and have better relationships with those around them. Most of these children quickly show tremendous improvement in their behavior and performance. We have seen so many children who displayed a 180-degree turnaround from all F’s to all A’s with minimal or no side effects. These children also showed higher rates of finishing high school and continuing on to further education, achieving professional success, and having healthier relationships. And at the end of the day, isn’t that what every parent wants for their child?