According to the CDC, 3%-7% – or 5.4 million – of school-aged children have been diagnosed with ADHD. In addition, the CDC also reports that 66% of the children with an ADHD diagnosis have been treated with medication. Medication seems to usually be the first course of action when a child is not performing well at school and at home. But is the need for medication always indicated? Is it always the best option? Here are a couple of negatives to the widespread treatment of ADHD with stimulant medications.
- Some experts believe that the negative long-term effects of taking stimulant medication far outweigh the benefits of taking the medication. According to NeuroCore, a treatment facility for people with attention difficulties, long-term use of Ritalin or other stimulants can result in decreased cardiovascular health.
- Several other conditions mimic the symptoms of ADHD, such as stress, lack of sleep, anxiety, and the like. Because much of ADHD screening involves observing behaviors, other conditions can be confused with ADHD, resulting in a child being misdiagnosed and then taking unnecessary medication.
Is it really ADHD?
I believe that before we label a child with anything, we first must exercise due diligence and learn as much as possible about the challenges the child is facing, what might be causing those difficulties, and what we can do to help them without resorting to testing and labeling or medication. There are things we can do to help children with attention difficulties without resorting to medication as a cure-all. Here are some thoughts:
- Sleep is a big issue when it comes to attention or the lack of it. A child who does not get to bed early enough will not be able to listen and focus the next day. A very predictable bedtime routine will help with this. Use earplugs, white noise machines, and a calm orderly bedtime routine. Darken the room, avoid stress near bedtime, and try to avoid anything that will stimulate the mind of the child before bed, such as wild car chases on TV or discussing a troublesome situation with the child.
- Structure is your friend when you have a child with attention or self control issues. Someone I read over a decade ago (I wish I could remember who it was) suggested that in order to prevent undesirable behaviors, we train children beginning at a very young age on how to behave in every situation they will encounter. The author called these situations “frames.” One frame is called “How we behave at the table.” Instructions can include things like, “stay seated until your food is gone,” “wipe your mouth with your napkin,” “take your plate to the kitchen when you are finished,” or whatever else your family decides is important. There are many other frames. Bedtime, riding in the car, being in a store with a parent, getting dressed, taking care of one’s things, preparing for school in the morning, eating at a restaurant--and the list goes on and on. Explicitly teach your child what you expect him to do in each situation. Structure and information is your friend and will be his as well.
- Lessen the stress and you will see a calmer child. Some things that often bring stress to a child include loud, agitated discussions between parents, hurrying too much, too much packed into a day, not enough time to have free play, not enough physical movement, pushing a child to perform, competition, and the list could go on and on.
In his book A Mind at a Time, Mel Levine M.D. claims that children with ADHD are struggling with deficiencies in the area of mental controls, and that these mental controls fall into three broad categories: control over mental energy, control over intake of information, and control over output. (See page 57 and following.) These controls affect every part of life from social to academic.
Control over mental energy. Mental energy is required for thinking, focusing, planning what to do, listening, and working at a task. If a child is lacking in mental energy, ironically the result is hyperactivity. The child will need help bringing his/her focus back to where it should be. The tricky part about focus, however, is that too often in school children are expected to sit, listen, pay attention, and work for hours at a time. They are just not equipped for this kind of focus. In addition, too often the work they are given is dry, boring, under-stimulating, and irrelevant. We want those behaviors in place, but we demand the desired behavior in place of enticing the child with learning activities that are fresh, exciting, relevant, and hands-on. Some tips for keeping content vibrant:
- Teach in short blocks of time. Fresh, new content should be limited to 10 to 15 minutes and then time to use the new information so that learning will deepen.
- Involve the children in hands-on learning as frequently as possible. Don’t tell them; let them figure things out using their hands and concrete materials.
- Use the element of surprise. Hook them into the lesson in a way that grabs their attention. This might be a story, a novel object, or a question that attracts the child to your content.
- Novelty is your friend. Take the lesson to another room, into the hall, out on the driveway, or on the porch. Tape sight words or math facts in a line down a hall and let your child hop and skip as he learns.
- Break tasks into specific parts to be done in sequence. Short bites.
- Supply cold water to keep the brain hydrated and the child alert.
- Let him stand up to work, swing her legs, or walk around the room while reading.
- Provide ample physical activity that will pump oxygen into the brain.
- Provide a challenge with specific goals to shoot for and applaud achievement.
Control over intake of information. Any environment is full of things to pay attention to. Visual elements, sounds, movements all vie for attention. Children with attention challenges need help with selecting what to pay attention to. They can learn to help themselves with this if you talk to them about what to focus on. Here are some simple tips:
- I can use my index finger to point to the place on the page I need to be paying attention to. For example, when working a math problem, I will point to it with my index finger. This tells my brain, “Pay attention to THIS.”
- When doing work that requires focus, I will sit facing a blank wall free of visual distraction.
- If sounds keep sapping my attention, I can use headphones or earplugs to block out sounds.
- When doing a page of math problems, I will cover all but one line with paper to block out all the other problems. As soon as one problem is done, I will point to the next. At the end of row one, I will jump up, touch my toes or walk around the room once, then come back and slip the paper down to uncover the next row.
- When my teacher is speaking, I will look at her face and ignore everything else. (Teacher, keep it short and to the point!)
- When I hear my teacher giving me directions, I will whisper/repeat what he said to myself so I will pay attention to it. (Teacher, consider writing your directions on a whiteboard for those children who absorb directions better if they are not oral).
- I will keep everything off my desk when I am working, and I will shine a lamp right on the place I need to focus.
Control over output. This is one of the most distressing aspects of hyperactivity in children – the lack of impulse control, the failure to plan ahead, and the discordant choices they often make. But children can learn to help themselves if we spend time with them and give them very specific, concrete tools. Children can understand their own areas of challenge and must understand if they are to help themselves. We often say, “Look before you leap,” or “think before you speak.” But this is the very thing that many children don’t do well. Here are some ways to help children help themselves in the area of their actions and choices.
- Before I act, I will STOP, count to five, and then I will ASK myself, “If I do this, what will happen?” The challenge is to teach the child to pause. Tapping his hand against his leg for five beats is a tangible way to create some thinking time. It can be a physical routine that becomes a habit. Before I act, I will STOP, TAP, ASK.
- Before I act, I will realize that I have many OPTIONS for what to do. I might not want to do the very first thing that comes to mind. If someone calls me a name, my impulse is to slap them, but I am going to STOP, TAP, and ASK myself if there are other options available to me.
- As I am working I will PACE myself. If I have a page of math problems, I will need 15 minutes for the whole page. This means I need 5 minutes for each row. I will point to each problem, and if I tend to go too slow and fall into a daydream, I will be careful to immediately point to the next problem. If I have the habit of rushing very fast and making a lot of mistakes, I will slow down. When I finish one problem, I will look at it one more time to make sure I did it right.
- When I am doing something, I will ask myself “How is this going?” Does it look good? Am I rushing so fast that I can’t read my own writing? If I am dusting the furniture, am I getting ALL the dust?
- When something goes really super well, I am going to pay attention to what I did that made it work well for me. That way, the next time I have similar work, I can look at my notebook to see what I did that helped me out the most.
In the early stages of learning to STOP, TAP, and ASK, it might help to have something visible with which to cue the child. You could hold up a red ping pong paddle for a silent and visual reminder to stop. Or, you might find a red knit glove, stuff it tightly and affix it to a dowel and use that as a friendly stop sign. The main thing is to begin the practice of teaching your child to self regulate. When your child no longer needs you to hold up the stop sign, her own reminder can be something she comes up with. Whatever she chooses to use as her reminder is great. She could wear a smooth pendant under her shirt, a simple band around her wrist – what the object is does not matter.
Start small and finish well
As with any skill that is new, it will take time to develop a habit. Children aren’t Olympians at age two. They start to become Olympians by taking a few little steps and falling a lot. But over time, with practice, by repeating new habits until they become second nature, the skills become refined and result in success!