Over the past thirty years, attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) has emerged from the relative obscurity of cognitive psychologists’ research laboratories to become the "disease du jour" of America’s schoolchildren. Accompanying this popularity has been a virtually complete acceptance of the validity of this "disorder" by scientists, physicians, psychologists, educators, parents, and others. Upon closer critical scrutiny, however, there is much to be troubled about concerning ADD/ADHD as a real medical diagnosis. There is no definitive objective set of criteria to determine who has ADD/ADHD and who does not. Rather, instead, there are a loose set of behaviors (hyperactivity, distractibility, and impulsivity) that combine in different ways to give rise to the "disorder." These behaviors are highly context-dependent. A child may be hyperactive while seated at a desk doing a boring worksheet, but not necessarily while singing in a school musical. These behaviors are also very general in nature and give no clue as to their real origins. A child can be hyperactive because he’s bored, depressed, anxious, allergic to milk, creative, a hands-on learner, has a difficult temperament, is stressed out, is driven by a media-mad culture, or any number of other possible causes. The tests that have been used to determine if someone has ADD/ADHD are either artificially objective and remote from the lives of real children (in one test, a child is asked to press a button every time he sees a 1 followed by a 9 on a computer screen) , or hopelessly subjective (many rating scales ask parents and teachers to score a child’s behavior on a scale from 1 to 5: these scores depend upon the subjective attitudes more than the actual behaviors of the children involved). The treatments used for this supposed disorder are also problematic. Ritalin use is up 500% over the past six years, yet it does not cure the problem, it only masks symptoms, and there are several disadvantages: children don’t like taking it, children use it as an "excuse" for their behavior ("I hit Ed because I forgot to take my pill."), and there are some indications it may be related to later substance abuse of drugs like cocaine. Behavior modification programs used for kids labeled ADD/ADHD work, but they don’t help kids become better learners. In fact, they may interfere with the development of a child’s intrinsic love of learning (kids behave simply to get more rewards), they may frustrate some kids (when they don’t get expected rewards), and they can also impair creativity and stifle cooperation.

ADD/ADHD is a popular diagnosis in the 1990’s because it serves as a neat way to explain away the complexities of turn-of-the-millenium life in America. Over the past few decades, our families have broken up, respect for authority has eroded, mass media has created a "short-attention-span culture," and stress levels have skyrocketed. When our children start to act out under the strain, it’s convenient to create a scientific-sounding term to label them with, an effective drug to stifle their "symptoms," and a whole program of ADD/ADHD workbooks, videos, and instructional materials to use to fit them in a box that relieves parents and teachers of any worry that it might be due to their own failure (or the failure of the broader culture) to nurture or teach effectively. Mainly, the ADD/ADHD label is a tragic decoy that takes the focus off of where it’s needed most: the real life of each unique child. Instead of seeing each child for who he or she is (strengths, limitations, interests, temperaments, learning styles etc.) and addressing his or her specific needs, the child is reduced to an "ADD child," where the potential to see the best in him or her is severely eroded (since ADD/ADHD puts all the emphasis on the deficits, not the strengths), and where the number of potential solutions to help them is highly limited to a few child-controlling interventions.

Instead of this deficit-based ADD/ADH paradigm, I’d like to suggest a wellness-based holistic paradigm that sees each child in terms of his or her ultimate worth, and addresses each child’s unique needs. To do this, we need to provide a wide range of options for parents or teachers.

 

50 Ways to Improve Your Child’s Behavior and Attention Span without Drugs, Labels, or Coercion 

1. Provide a balanced breakfast.
2. Consider the Feingold diet
3. Limit television and video games
4. Teach self-talk skills.
5. Find out what interests your child.
6. Promote a strong physical education program in your child’s school.
7. Enroll your child in a martial arts program.
8. Discover your child’s multiple intelligences (link)
9. Use background music to focus and calm.
10. Use color to highlight information.
11. Teach your child to visualize.
12. Remove allergens from the diet.
13. Provide opportunities for physical movement.
14. Enhance your child’s self-esteem.
15. Find your child’s best times of alertness.
16. Give instructions in attention-grabbing ways.
17. Provide a variety of stimulating learning activities.
18. Consider biofeedback training.
19. Activate positive career aspirations.
20. Teach your child physical-relaxation techniques.
21. Use incidental learning to teach.
22. Support full inclusion of your child in a regular classroom.
23. Provide positive role models.
24. Consider alternative schooling options.
25. Channel creative energy into the arts.
26. Provide hands-on activities
27. Spend positive times together.
28. Provide appropriate spaces for learning.
29. Consider individual psychotherapy.
30. Use touch to soothe and calm.
31. Help your child with organizational skills.
32. Help your child appreciate the value of personal effort.
33. Take care of yourself.
34. Teach your child focusing techniques.
35. Provide immediate feedback.
36. Provide your child with access to a computer.
37. Consider family therapy.
38. Teach problem-solving skills.
39. Offer your child real-life tasks to do.
40. Use "time-out" in a positive way.
41. Help your child develop social skills.
42. Contract with your child.
43. Use effective communication skills.
44. Give your child choices.
45. Discover and treat the four types of misbehavior.
46. Establish consistent rules, routines, and transitions.
47. Hold family meetings.
48. Have your child teach a younger child.
49. Use natural and logical consequences.
50. Hold a positive image of your child.

Several years ago I worked for an organization that assisted teachers in using the arts in their classrooms.  We were located in a large warehouse in Cambridge, Massachusetts, and several children from the surrounding lower-working-class neighborhood volunteered to help with routine jobs.   I recall one child, Eddie, a 9-year-old African American youngster possessed of great vitality and energy, who was particularly valuable in helping out with many tasks.   These jobs included going around the city with an adult supervisor, finding recycled materials that could be used by teachers in developing arts programs, and then organizing them and even field-testing them back at the headquarters.  In the context of this arts organization, Eddie was a definite asset.

        A few months after this experience, I became involved in a special program through Lesley College in Cambridge, where I was getting my master's degree in special education.  This project involved studying special education programs designed to help students who were having problems learning or behaving in regular classrooms in several Boston-area school districts.  During one visit to a Cambridge resource room, I unexpectedly ran into Eddie.  Eddie was a real problem in this classroom.  He couldn't stay in his seat, wandered around the room, talked out of turn, and basically made the teacher's life miserable.  Eddie seemed like a fish out of water.  In the context of this school's special education program, Eddie was anything but an asset.  In retrospect, he appeared to fit the definition of a child with attention deficit disorder (ADD).

        Over the past 15 years, ADD has grown from a malady known only to a few cognitive researchers and special educators into a national phenomenon.  Books on the subject have flooded the marketplace, as have special assessments, learning programs, residential schools, parent advocacy groups, clinical services, and medications to treat the "disorder." (The production of Ritalin or methylphenidate hydrochloride - the most common medication used to treat ADD - has increased 450% in the past four years, according to the Drug Enforcement Agency.') The disorder has solid support as a discrete medical problem from the Department of Education, the American Psychiatric Association, and many other agencies.

        I'm troubled by the speed with which both the public and the professional community have embraced ADD.  Thinking back to my experience with Eddie and the disparity that existed between Eddie in the arts organization and Eddie in the special education classroom, I wonder whether this "disorder" really exists in the child at all, or whether, more properly, it exists in the relationships that are present between the child and his or her environment.   Unlike other medical disorders, such as diabetes or pneumonia, this is a disorder that pops up in one setting only to disappear in another.  A physician mother of a child labeled ADD wrote to me not long ago about her frustration with this protean diagnosis: "I began pointing out to people that my child is capable of long periods of concentration when he is watching his favorite sci-fi video or examining the inner workings of a pin-tumbler lock.  I notice that the next year's definition states that some kids with ADD are capable of normal attention in certain specific circumstances.   Poof.  A few thousand more kids instantly fall into the definition."

        There is in fact substantial evidence to suggest that children labeled ADD do not show symptoms of this disorder in several different real-life contexts.  First, up to 80% of them don't appear to be ADD when in the physician's office. They also seem to behave normally in other unfamiliar settings where there is a one-to-one interaction with an adult (and this is especially true when the adult happens to be their father).  Second, they appear to be indistinguishable from so-called normals when they are in classrooms or other learning environments where children can choose their own learning activities and pace themselves through those experiences.  Third, they seem to perform quite normally when they are paid to do specific activities designed to assess attention. Fourth, and perhaps most significant, children labeled ADD behave and attend quite normally when they are involved in activities that interest them, that are novel in some way, or that involve high levels of stimulation.  Finally, as many as 70% of these children reach adulthood only to discover that the ADD has apparently just gone away.

        It's understandable, then, that prevalence figures for ADD vary widely - far more widely than the 3% to 5% figure that popular books and articles use as a standard.  As Russell Barkley points out in his classic work on attention deficits, Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, the 3% to 5% figure "hinges on how one chooses to define ADHD, the population studied, the geographic locale of the survey, and even the degree of agreement required among parents, teachers and professionals.... Estimates vary between 1[% and] 20%."  In fact, estimates fluctuate even more than Barkley suggests.   In one epidemiological survey conducted in England, only two children out of 2,199 were diagnosed as hyperactive (.09%)." Conversely, in Israel, 28% of children were rated by teachers as hyperactive." And in an earlier study conducted in the U.S., teachers rated 49.7% of boys as restless, 43.5% of boys as having a "short attention span," and 43.5 % of boys as "inattentive to what others say."

The Rating Game   

        These wildly divergent statistics call into question the assessments used to decide who is diagnosed as having ADD and who is not.  Among the most frequently used tools for this purpose are behavior rating scales.  These are typically checklists consisting of items that relate to the child's attention and behavior at home or at school.  In one widely used assessment, teachers are asked to rate the child on a scale from I (almost never) to 5 (almost always) with regard to behavioral statements such as: "Fidgety (hands always busy)," "Restless (squirms in seat)," and "Follows a sequence of instructions." The problem with these scales is that they depend on subjective judgments by teachers and parents who may have a deep, and often subconscious, emotional investment in the outcome.  After all, a diagnosis of ADD may lead to medication to keep a child compliant at home or may result in special education placement in the school to relieve a regular classroom teacher of having to teach a troublesome child.

        Moreover, since these behavior rating scales depend on opinion rather than fact, there are no objective criteria through which to decide how much a child is demonstrating symptoms of ADD.  What is the difference in terms of hard data, for example, between a child who scores a 5 on being fidgety and a child who scores a 4?  Do the scores mean that the first child is one point more fidgety than the second?  Of course not.  The idea of assigning a number to a behavior trait raises the additional problem, addressed above, of context.  The child may be a 5 on "fidgetiness" in some contexts (during worksheet time, for example) and a 1 at other times (during recess, during motivating activities, and at other highly stimulating times of the day).  Who is to decide what the final number should be based on?  If a teacher places more importance on workbook learning than on hands-on activities, such as building with blocks, the rating may be biased toward academic tasks, yet such an assessment would hardly paint an accurate picture of the child's total experience in school, let alone in life.

        It's not surprising, then, to discover that there is often disagreement among parents, teachers, and professionals using these behavior rating scales as to who exactly is hyperactive or ADD.  In one study, parent, teacher, and physician groups were asked to identify hyperactive children in a sample of 5,000 elementary school children.  Approximately 5% were considered hyperactive by at least one of the groups, while only 1% were considered hyperactive by all three groups." In another study using a well-known behavior rating scale, mothers and fathers agreed that their children were hyperactive only about 32% of the time, and the correspondence between parent and teacher ratings was even worse: they agreed only about 13% of the time."

        These behavior rating scales implicitly ask parents and teachers to compare a potential ADD child's attention and behavior to those of a "normal" child.  But this raises the question, What is normal behavior?  Do normal children fidget?  Of course they do.  Do normal children have trouble paying attention?  Yes, under certain circumstances.   Then exactly when does normal fidgeting turn into ADD fidgeting, and when does normal difficulty paying attention become ADD difficulty?

        These questions have not been adequately addressed by professionals in the field, yet they remain pressing issues that seriously undermine the legitimacy of these behavior rating scales.  Curiously, with all the focus being placed on children who score at the high end of the hyperactivity and distractibility continuum, virtually no one in the field talks about children who must statistically exist at the opposite end of the spectrum: children who are too focused, too compliant, too still, or too hypoactive.  Why don't we have special classes, medications, and treatments for these children as well?

A Brave New World of Soulless Tests 

        Another ADD diagnostic tool is a test that assigns children special "continuous performance tasks" (CPTs).  These tasks usually involve repetitious actions that require the examinee to remain alert and attentive throughout the test.  The earliest versions of these tasks were developed to select candidates for radar operations during World War II.  Their use with children in today's world is highly questionable.  One of the most popular of the current CPT instruments is the Gordon Diagnostic System (GDS).  This Orwellian device consists of a plastic box with a large button on the front and an electronic display above it that flashes a series of random digits.  The child is told to press the button every time a "1" is followed by a "9." The box then records the number of "hits" and "misses" made by the child.  More complex versions involving multiple digits are used with older children and adults.

        Quite apart from the fact that this task bears no resemblance to anything else that children will ever do in their lives, the GDS creates an "objective" score that is taken as an important measure of a child's ability to attend.  In reality, it tells us only how a child will perform when attending to a repetitive series of meaningless numbers on a soulless task.  Yet ADD expert Russell Barkley writes, "[the GDS] is the only CPT that has enough available evidence ... to be adopted for clinical practice."" As a result, the GDS is used not only to diagnose ADD but also to determine and adjust medication doses in children with the label.

        There is a broader difficulty with the use of any standardized assessment to identify children as having ADD.  Most of the tests used (including behavior rating scales and continuous performance tasks) have attempted to be validated as indicators of ADD through a process that involves testing groups of children who have previously been labeled ADD and comparing their test results with those of groups of children who have been judged to be "normal." If the assessment shows that it can discriminate between these two groups to a significant degree, it is then touted as a valid indicator of ADD.  However, one must ask how the initial group of ADD children originally came to be identified as ADD.  The answer would have to be through an earlier test.  And how do we know that the earlier test was a valid indicator of ADD?  Because it was validated using two groups: ADD and normal.  How do we know that this group of ADD children was in fact ADD?   Through an even earlier test ... and so on, ad infinitum.  There is no Prime Mover in this chain of tests; no First Test for ADD that has been declared self-referential and infallible.  Consequently, the validity of these tests must always remain in doubt.

In Search of a Deficit   

        Even if we admit that such tests could tell the difference between children labeled ADD and "normal" children, recent evidence suggests that there really aren't any significant differences between these two groups.  Researchers at the Hospital for Sick Children in Toronto, for example, discovered that the performance of children who had been labeled ADD did not deteriorate over time on a continuous performance task any more than did that of a group of so-called normal children.  They concluded that these "ADD children" did not appear to have a unique sustained attention deficit."

        In another study, conducted at the University of Groningen in the Netherlands, children were presented with irrelevant information on a task to see if they would become distracted from their central focus, which involved identifying groups of dots (focusing on groups of four dots and ignoring groups of three or five dots) on a piece of paper.  So-called hyperactive children did not become distracted any more than so-called normal children, leading the researchers to conclude that there did not seem to be a focused attention deficit in these children." Other studies have suggested that "ADD children" don't appear to have problems with short-term memory or with other factors that are important in paying attention." Where, then, is the attention deficit?

A Model of Machines and Disease   

        The ADD myth is essentially a paradigm or world view that has certain assumptions about human beings at its core.”   Unfortunately, the beliefs about human capacity addressed in the ADD paradigm are not terribly positive ones.  It appears as if the ADD myth tacitly endorses the view that human beings function very much like machines.  From this perspective, ADD represents something very much like a mechanical breakdown. This underlying belief shows up most clearly in the kinds of explanations that parents, teachers, and professionals give to children labeled ADD about their problems.  In one book for children titled Otto Learns About His Medicine, a red car named Otto goes to a mechanic after experiencing difficulties in car school.  The mechanic says to Otto, "Your motor does go too fast," and he recommends a special car medicine .

        While attending a national conference on ADD, I heard experts share similar ways of explaining ADD to children, including comparisons to planes ("Your mind is like a big jet plane ... you're having trouble in the cockpit), a car radio ("You have trouble filtering out noise"), and television ("You're experiencing difficulty with the channel selector").   These simplistic metaphors seem to imply that human beings really aren't very complex organisms and that one simply needs to find the right wrench, use the proper gas, or tinker with the appropriate circuit box - and all will be well.  They are also just a short hop away from more insulting mechanical metaphors ("Your elevator doesn't go all the way to the top floor").

        The other feature that strikes me as being at the heart of the ADD myth is the focus on disease and disability.  I was particularly struck by this mindset while attending a workshop with a leading authority on ADD who started out his lecture by saying that he would treat ADD as a medical disorder with its own etiology (causes), pathogenesis (development), clinical features (symptoms), and epidemiology (prevalence). Proponents of this view talk about the fact that there is "no cure" for ADD and that parents need to go through a "grieving process" once they receive a "diagnosis”. "ADD guru Russell Barkley commented in a recent address: "Although these children do not look physically disabled, they are neurologically handicapped nonetheless.... Remember, this is a disabled child." Absent from this perspective is any mention of a child's potential or other manifestations of health - traits that are crucial in helping a child achieve success in life.  In fact, the literature on the strengths, talents, and abilities of children labeled ADD is almost nonexistent

In Search of the ADD Brain   

        Naturally, in order to make the claim that ADD is a disease, there must be a medical or biological cause for it.  Yet, as with everything else about ADD, no one is exactly sure what causes it.  Possible biological causes that have been proposed include genetic factors, biochemical abnormalities (imbalances of such brain chemicals as serotonin, dopamine, and norepinephrine), neurological damage, lead poisoning, thyroid problems, prenatal exposure to various chemical agents, and delayed myelinization of the 'nerve pathways in the brain."

    In its search for a physical cause, the ADD movement reached a milestone with the 1990 publication in the New England Journal of Medicine of a study by Alan Zametkin and his colleagues at the National Institute of Mental Health." This study appeared to link hyperactivity in adults with reduced metabolism of glucose (a prime energy source) in the premotor cortex and the superior prefrontal cortex - areas of the brain that are involved in the control of attention, planning, and motor activity.   In other words, these areas of the brain were not working as hard as they should have been, according to Zametkin.

        The media picked up on Zarmetkin's research and reported it nationally.  ADD proponents latched on to this study as "proof ' of the medical basis for ADD.  Pictures depicting the spread of glucose through a "normal" brain compared to a "hyperactive" brain began showing up in CH.A.D.D. (Children and Adults with Attention Deficit Disorder) literature and at the organization's conventions and meetings.  One ADD advocate seemed to speak for many in the ADD movement when she wrote: "In November 1990, parents of children with ADD heaved a collective sigh of relief when Dr. Alan Zametkin released a report that hyperactivity (which is closely linked to ADD) results from an insufficient rate of glucose metabolism in the brain.  Finally, commented a supporter, we have an answer to skeptics who pass this off as bratty behavior caused by poor parenting."

        What was not reported by the media or cheered by the ADD community was the study by Zametkin and others that came out three years later in the Archives of General Psychiatry.  In an attempt to repeat the 1990 study with adolescents, the researchers found no significant differences between the brains of so-called hyperactive subjects and those of so-called normal subjects.  And in retrospect, the results of the first study didn't look so good either.  When the original 1990 study was controlled for sex (there were more men in the hyperactive group than in the control group), there was no significant difference between groups.

        A recent critique of Zametkin's research by faculty members at the University of Nebraska also pointed out that the study did not make clear whether the lower glucose rates found in "hyperactive brains" were a cause or a result of attention problems. The critics pointed out that, if subjects were startled and then had their levels of adrenalin monitored, adrenalin levels would probably be quite high.  We would not say, however, that these individuals had an adrenalin disorder.  Rather, we'd look at the underlying conditions that led to abnormal adrenalin levels.  Similarly, even if biochemical differences did exist in the so-called hyperactive brain, we ought to be looking at the nonbiological factors that could account for some of these differences, including stress, learning style, and temperament.

The Stigma of ADD   

        Unfortunately, there seems to be little desire in the professional community to engage in dialogue about the reality of attention deficit disorder; its presence on the American educational scene seems to be a fait accompli.  This is regrettable, since ADD is a psychiatric disorder, and millions of children and adults run the risk of stigmatization from the application of this label.

        In 1991, when such major educational organizations as the National Education Association (NEA), the National Association of School Psychologists (NASP), and the National Association for the Advancement of Colored People (NAACP) successfully opposed the authorization by Congress of ADD as a legally handicapping condition, NEA spokesperson Debra DeLee wrote, "Establishing a new category [ADD] based on behavioral characteristics alone, such as overactivity, impulsiveness, and inattentiveness, increases the likelihood of inappropriate labeling for racial, ethnic, and linguistic minority students." And Peg Dawson, former NASP president, pointed out, "We don't think that a proliferation of labels is the best way to address the ADD issue.  It's in the best interest of all children that we stop creating categories of exclusion and start responding to the needs of individual children.” ADD nevertheless continues to gain ground as the label du jour in American education.  It's time to stop and take stock of this "disorder" and decide whether it really exists or is instead more a manifestation of society's need to have such a disorder.

Why I Believe that Attention Deficit Disorder is a Myth

(first published in Sydney's Child [Australia], September, 1996)

by Thomas Armstrong, Ph.D.   

 

        When parents hear me say that attention deficit disorder is a myth, they sometimes become very upset.  They think I'm saying that their kids aren't jumpy, distractible, forgetful, impulsive, or disorganized.  That's not what I'm saying at all.  It's quite obvious to me that our nation's children have probably never been so hyperactive.  The question is, what accounts for this?  Is it a medical disorder called ADD (or ADHD as it's sometimes called)?  I think not.  I think instead that what we've learned to call ADD is instead a number of things all jumbled up together under this simplistic label. 

        Kids can be hyperactive for any number of reasons: because they're anxious or depressed, because they're allergic to milk, because they're bored with school, because they have a different kind of mind and aren't being challenged, because they're overstimulated from television and video games.  I could go on.  The point is that the ADD label makes is too easy to ignore what might be going on beneath the surface of things.  "Oh, he has ADD?  Whew! Glad we know what the problem is now."  But perhaps we don't really know at all.

        Although there is a great deal of support from the medical and scientific community for ADD, once one looks into the literature, things become less clear.  Nobody can actually tell you, for example, how many kids have ADD.  Though the literature traditionally says 3-5% of all children have ADD, I've seen statistics in textbooks that have ranged from .019% (in England where its far less common) to 10% and above.  ADD is in the eyes of the beholder. 

        Many of the "tests" that are used to diagnose ADD are flawed.  The behavior rating scales that ask parents to rate their kids on a scale from I to 5, for instance, in terms of hyperactivity, impulsivity and so forth, are very subjective and parents and teachers often don't agree on what they see in the same child.  The continuous performance tests that are often used to diagnose for ADD are a joke.  One of them is a box that sits on a table.   The child is told that random numbers will appear in a screen on the box.   They are instructed to press the button below the screen whenever a 9 is followed by a 1. What a stupid task! Yet on the basis of this, children are being diagnosed and having their medication levels adjusted.

        As the textbooks themselves declare, "there is no blood test (or other objective test) to tell when a child has ADD." If this is so, then how do we really know for sure if he or she has it?  I've seen studies showing that the symptoms of ADD disappear or lessen under several real life situations: when the child is doing things that interest him, when he's engaged in one-to-one interaction with someone he trusts, when he's being paid to do something, and when he can control the outcomes of his activities.  If ADD can disappear under these conditions, then how can ADD really exist as a medical disorder?

        Many parents tell me that they don't medicate their ADD-labeled children on weekends or holidays. Why?  Because they're not in school and they have more opportunities to behave in active ways.  If this is true, then it's clear to me that at least in those instances, we're using Ritalin and other drugs to control children in specific environments (i.e. restrictive classrooms).   I realize that Ritalin is very effective and for some kids it can make a big difference in their lives.  But it shouldn't be the first thing that parents and physicians turn to at the sign of problems.  On Ritalin, research suggests that kids begin to attribute their actions to the pill, not to their own internal effort.   Studies suggest that many child hate taking Ritalin, yet you don't see this reported anywhere in the ADD literature.  For kids who have that wide-focus attention span (e.g. paying attention to lots of different things rather than one single stimulus), Ritalin can close them down to a fine point of attention, which is great for doing a math page, but can hamper more divergent forms of thinking associated with creativity.

        Probably the thing that bothers me the most about this ADD Phenomenon is its emphasis on negatives.  We're talking here about disease and disorder; we're talking about a psychiatric illness.  Do we really want to be handing these labels out so freely?  In the 1950s, only a very few children were labeled as having these problems by the American Psychiatric Association, and they were grouped under the category: "organic brain syndromes." This was a serious category, that included kids who'd had accidents and illnesses (like encephalitis) that had dramatically impaired areas of the brain important for attention and behavior.   However, over the past four decades, more and more children have been drawn into the behavior and attention disorder web, kids who back then might well have been regarded as "fireballs," or "daydreamers," or "bundles of energy," but would have been seen basically as normal (or even better than normal). 

        I'm very concerned that the literature on ADD has so much to say about what these kids can't do, and virtually nothing about what they can do.  In my own informal research, I've seen countless examples of kids labeled ADD who are musicians, dancers, athletes, leaders, and creative in many other ways.  Why don't we see these kids as basically healthy and creative individuals who may not function as well in certain kinds of environments (for example, the worksheet wasteland of many classrooms), but do great when given a chance to learn in their own way.   Many kids labeled ADD in fact do great when they're fixing an automobile, or doing experiments in their nature lab, or performing in a theater piece.  Many kids with behavior difficulties grow up to become great individuals.  People like Thomas Edison, Winston Churchill, Sara Bernhardt, Louis Armstrong, and Albert Einstein.  Why don't we start using models of growth to describe our highly energetic kids and throw this ADD disease label in the trash basket where it belongs?

 

For more information, read Thomas Armstrong's The Myth of the A.D.D. Child: 50 Ways to Improve Your Child's Behavior and Attention Span without Drugs, Labels, or Coercion (New York:  Dutton, 1995). 

Imagine living a world where everyone was a flower instead of a human being. In such a floral society, it's likely that the psychia­trists would be roses. Now, imagine that the psychiatrist calls in his first patient: a lily. "Hmm," says Rose. "I can see that we might have a problem here!" He looks Lily over carefully and then gives his diagnosis: "I'm sorry to inform you that you have PDD, other­wise known as Petal Deficit Disorder." Lily leaves, saddened and anxious, and the next patient, a bluet, comes through the door. Rose gets out his magnifying glass, examines Bluet minutely, and then declares: "I believe that you have GD, or Growing Disability. You really are much too small!" Bluet exits, feeling punched down a few sizes. Finally, a giant sunflower comes through the door, and the psychiatrist doesn't even have to conduct an examination: "This flower clearly has Hugeism! Unfortu­nately, it's genetic, and there's not much we can do about it."

 

This story may seem silly, but it serves as a scary metaphor for how we are treating students these days. Instead of celebrating the natural diversity of all our students, we package many of their natural differences into neat little patho­logical categories. We strip away their humanity by using lifeless words and phrases to talk about them: "Judy has learning disabilities"; "Roy has ADHD" (Attention Deficit Hyperactivity Disorder); "Brian was just diagnosed with autism"; "Billy has PDD" (pervasive Developmental Disorder); "Ed's got Asperger's syndrome." By adopting these labels as the dominant descriptors of a student's learning potential, we block ourselves off from understanding who these children really are. In 1949, George Orwell's bleak futurist novel, 1984, showed how words can manipu­late, dominate, and repress authenticity. Unfortunately, in education, we have not been vigilant enough to see that we have been similarly negating the worlds of students through these sterile phrases.

 

Let's look at some examples of chil­dren. Twelve-year-old Billy created Rube Goldberg machines and described the way he thought as "a cross between music and architecture" (Houston, 1982, p. 137). Nadia, 5, drew pictures that were on a par with paintings by a mature adult artist (Self, 1977). Peter, 6, did arithmetic problems by counting the dots on the ceiling tiles in his classroom. Ray, 12, played a leading role in orga­nizing a teacher's recycling center. High school student Chelsea choreographed a dance to remember the elements of the periodic table. Stevie, 9, could find anything that anyone had lost in the classroom or on the school grounds. Brian won the national swim title for his age group in the breast stroke.

 

These students are just a small cross ­section of the many students whom I have worked with, read about, or heard about from other educators. All of them are IKSWAL (Interesting Kids Saddled with Alienating Labels). Unfortunately, in any serious school discussion about these students among teachers, adminis­trators, and support staff, what pre­dominates is a discussion of Billy's learning disability, Nadia's autism, Ray's emotional disturbance, Chelsea's ADHD, or Brian's dyslexia. In catching hold of the diagnostic label, educators have lost sight of what makes each student a fascinating person.

 

What Brain Scans Reveal

 

Some may argue, "But these students really have these disorders! These dis­orders have a neurological basis. This is the brain we're talking about!" Yes, of course, each of these students has a brain -the most complex, mysterious, and multifaceted organ in the universe. That fact in itself should be an argu­ment in favor of seeing students not in terms of a mere label but rather in far more complex and rich terms. Out of trillions of brain connections, how many in each student's brain are actu­ally deficient? And who is to judge the deficiency?  Psychiatrist Rose? Brain researcher Orchid?

 

Several brain scan studies have come out recently indicating what is consid­ered a clear neurological basis for the existence of ADHD (Fine, 2001). These studies-many of them based on find­ings of abnormal frontal lobe func­tioning-have convinced most people in education that ADHD is a biological disorder.  Troubling issues, however, remain.  Eenough to suggest that giving a scien­tific stamp of authority to the labels that we use in our schools may be prema­ture and even ill-founded.

 

First, a recent review of brain-imaging studies indi­cated problems with many of them, including relatively small and often heterogeneous samples and difficulties in establishing accurate and appropriate diagnoses (Hendren, DeBacker, & Pandina, 2000).

 

Second, the causes of abnormalities in the brain scans of children labeled with ADHD may be environmental rather than inborn. Brain scan images change as a result of specific thera­peutic interventions (Schwartz, Stoessel, Baxter, Martin, & Phelps, 1996). More­over, such environmental conditions as stress and trauma may negatively affect neurological patterns, including prefrontal cortical function in children (perry & Pollard, 1998). One plausible hypothesis is that some children diag­nosed with ADHD have abnormal prefrontal lobe patterns because of envi­ronmental trauma (Amsten, 1999).

 

Third, and most impor­tant, many of the so-called abnormalities seen in brain scans may actually point more toward differences than abnormalities. In one brain scan study (Schweitzer et al., 2000), individuals labeled as having ADHD showed more activity in the region of the brain linked with visual­ spatial processing than did  so-called normal individuals, who showed more anterior  or frontal lobe activity. The ADHD-identified subjects reported that while they were doing the required task during the brain scan­ning procedure, they pictured images in their heads. In other words, these scans may not be diagnosing ADHD as much as they are identifying individuals who process information through pictures and images more than through sounds and words - individuals who might be expected to have more difficulty in classroom environments where sounds and words, rather than visualizations, predominate as teaching techniques.

 

Many students labeled with learning, attention, and behavioral dis­orders may have brains that are not necessarily abnormal but,  rather,  different. When we value only restricted ways of learning, behaving, and attending - especially high-stakes-tests learning, sit-down-in-your-seat-and-look-­at-the-blackboard behaving, and focus­-on-the-vocabulary-word attending, ­then we ignore, stifle, or repress the other marvelous things that a student's brain might be capable of doing. Work­sheets, lectures, tests, and labels are bulldozers that are mowing down our students' rich and diverse "brain forests," and we should be concerned. Unfortunately, calling these kids learning different is not going to help, for the term has become a euphemism for learning disabled and many other negative labels that we are using in our schools today.

 

What We Can Do

 

We must be radical and creative in how we think about and describe the learning potentials of students. We can begin by discarding the medical and scientific terminology that we have used to label students; it is too sterile to describe the richness of a student's world as a learner.

 

 Let us bring humanism back into education by employing the wisdom and vocabulary of literature. For example, the wide range of characters from Shake­speare can serve as a template of human variation for describing learning differ­ences in students. We might say for one student, "She is a bit like Puck!"; for another, "He broods like Hamlet"; while for still another, "He's got the spirit of Hotspur!" This approach would require educators, of course, to steep them­selves in the great literary tradition of Shakespeare, which some might view as highly impractical. After all, there's a huge epidemic of SADD, or Shakespeare Attention Deficit Disorder, a crippling cultural disability sweeping across the land.

 

The biographies of great individuals could also serve as an organizing frame­work for understanding students' special gifts. In speaking of a student labeled with a behavior disorder, we might say, "He's a regular Churchill, that kid!"; for a student diagnosed as dyslexic, "He's got that Hans Christian­ Andersen storytelling quality in him"; or for a student who writes with semantic force but is identified with dysorthographia (the inability to spell correctly), "There's an Agatha Christie in her bursting to get out!" Several disability organizations have a discon­certing tendency to use such well­known figures as examples of "famous people with disabilities." Rather than dragging these great individuals down to the level of these sterile disability categories, we should lift up the students weighed down by these labels to something more resembling the rich complexity of human greatness.

 

Finally, we should discard the scien­tific tools of standardized test measures that have been used for making labels and instead explore other assessment tools borrowed from phenomenology, hermeneutics, anthropology, and other qualitative methodologies (Armstrong, 1988; Carini, 1982; Henry, 1963; Nylund, 2000; Sacks, 1996). The test-and-Iabel approach that dominates the special education landscape today serves only to lure educators away from the depths and complexities of real students' lives. Let us nurture all varieties of students' ways of learning - not just as an expression of hope, but as a matter of daily commit­ment and practice.

Thousands of studies tell us what children with ADHD can't do, but few tell us what they can do.  This article presents holistic strategies for helping children with ADHD succeed at home and in school by building on their interests, learning styles, and many talents.

        Eight-year-old Billy, in the front row, will have nothing to do with my demonstration on new techniques for teaching spelling.  During my visit to his elementary school classroom in upstate New York, Bill), is out of his seat during most of the lesson. When I ask the children to visualize their spelling words, however, I am amazed to see Billy return to his seat and remain perfectly still.  Covering his eyes, Billy "looks" intently at his imaginary words-fascinated with the images in his mind!

      Later on, I realize that something more important than a spelling lesson went on that afternoon: Billy was able to transform his external physical hyperactivity into internal mental motion and, by internalizing his outer activity level, was able to gain control over it. This incident occurred some time ago but remains memorable to me. Why?   Because it suggests that internal empowerment, rather than external control, is often the best way to help kids diagnosed as having AD/HD.

 

A Decidedly Unholistic Approach   

        Much of the work currently being undertaken in the field of AD/HD looks at the issue from an external control perspective.   The two interventions touted in almost all books and programs about AD/HD (and in several of the articles in this journal issue) are medication and behavior modification. While these approaches are often dramatically effective with young people with AD/HD, both have troubling features that often receive scant attention.  Some researchers suggest that when children receive medication, they may attribute their improved behaviors to the pills rather than to their own inner resources (Whalen & Henker, 1990).  Others may expect the medication to do all the work and thus neglect underlying issues that may be the true causes of a child's attention and/or behavior difficulties.

        Behavior modification programs, which abound, seek to control children's behaviors through some combination of rewards, punishments, or response costs (the taking away of rewards).  Some programs rely on token economy systems, while others use behavior charts, stickers, and even machines.   For example, the Attention Training System sits on a child's desk and automatically awards a point every 60 seconds for on-task behavior.  The teacher can also deduct points for bad behavior using a remote control.  Students trade points for prizes and privileges.  Although behavior modification programs may influence children to change their behavior, they do it for the wrong reason-to get rewards.  Such programs can discourage risk-taking, blunt creativity, decrease levels of intrinsic motivation, and even impair academic performance (Kohn, 1993).

Looking at the Whole Child   

        Most AD/HD researchers and practitioners see children labeled with AD/HD in terms of their deficits.  Thousands of studies tell us what these kids can't do, but few tell us what they can do and who they really are. (Two exceptions are Crammond, 1994 and Hartmann, 1993.) Where are the studies that tell us what these kids are interested in, what kinds of positive teaming styles or combinations of intelligences they use successfully in the classroom, and what sorts of artistic, mechanical, scientific, dramatic, or personal contributions they can make to their schools and communities?

        A new vision of educational interventions is needed to reflect a deeper appreciation for the whole child based upon a wellness paradigm, rather than a deficit perspective rooted in a medical or disease-based model.  We need to initiate a new field of study to help children with behavior and attention difficulties-one based upon discovering their strengths rather than fixing their faults.  Parents and teachers tell me about cases of AD/HD-labeled kids who are talented dancers, musicians, sculptors, and dramatists.  The AD/HD community needs to conduct research on the positive qualities of these children and what their abilities could mean in contributing to their success in the classroom and in life.

        Such research would develop assessment strategies geared toward identifying their inner capabilities.  Gardner's theory of multiple intelligences (Gardner, 1983) is one possible framework for developing appropriate assessment instruments to help identify such abilities (a refreshing change from the behavior rating scales and artificial performance tests currently used to assess AD/HD in children).  We must develop individualized educational plans (IEPS) that give more than lip service to a child's strengths and that solidly reflect, in their goals and objectives, a desire to help children achieve success (rather than to "overcome their problems").

        While the AD/HD worldview tacitly approves of a teacher centered, worksheet- and textbook-driven model of education (almost all of its educational suggestions are based on this kind of classroom), current research suggests that all students benefit from project-based environments in which they actively construct new meanings based upon their existing knowledge of a subject.  Some research suggests that students with AD/HD do better in environments that are active, self-paced, and hands-on (McGuinness, 1985).  Video games and computers are powerful teaming tools for many of these children.  In fact, their high-speed behavior and thinking lend themselves quite well to such cutting-edge technologies as hypertext and multimedia (Armstrong, 1995).

Finally, interventions need to go beyond strategies such as smiley faces, points, and medications, and reflect a full sense of the child's true nature.  Here are a few approaches for use at home and school that might
help children identified as having AD/HD:

Cognitive   

Use focusing and attention-training techniques.  For example, see how long a child can sit still in a chair using a stopwatch (make it into a competitive game) or help kids visualize their favorite place when they need to calmdown.

Teach self-talk skills.  For example, teach kids to say to themselves: "If at first you don't succeed, try, try again," or show them ways of talking through the steps to solving a math problem.

Help with organizational skills.  Help each student develop a folder that contains sections for each subject, a calendar for due dates, a place to hold accessories, etc.

Ecological   

Use music to calm or focus.  Sometimes rock or rap music may paradoxically calm some kids down just as Ritalin (a stimulant) does.

Limit television and video games to one hour per day and eliminate all violent programming, because research is clear that this provokes aggressive behavior in kids.

Find the time when the child is most alert.  Mornings are usually best for focused work (e.g., seat-work, lectures, etc.); afternoons are best for open-ended activities (e.g., projects, arts, cooperative groups, etc.).

Provide a balanced breakfast.  Research suggests that balancing protein with carbohydrates (e.g., eggs and toast) is better for helping foster focused activity than simply a carbohydrate breakfast (e.g., pastries and orange juice).

Physical   

Emphasize a strong physical education program in the schools.  Include aerobic activity, individual sports (e.g., swimming, gymnastics), walking, and martial arts.

Allow appropriate movement in the classroom.  Give kids chores to do, allow them to use a squeeze ball to keep their hands busy while listening to the teacher talk, give them active projects that involve frequent changes of
seating, teach skills using physical movement (e.g., in group choral spelling, standing up on the vowels and sitting down on the consonants).

Use hands-on teaming.  Give students frequent opportunities to build things with their hands (e.g., dioramas i history, models of science concepts, props for plays in literature) and to use manipulatives (e.g., in math) whe teaming about new concepts.

Emotional   

Provide positive role models.  Study the lives of great people who had difficulty with behavior in school (e.g., Winston Churchill, Florence Nightingale, Louis Armstrong).

Identify talents, strengths, and abilities.  Find out which combination of Howard Gardner's eight intelligences (linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, naturalist, interpersonal, or intrapersonal) each student has most highly developed and use that information to provide appropriate instruction.

Envision positive futures.  Help students see roles and careers for themselves in the world that make use of their special talents and abilities.

Behavioral   

Use behavior contracting.  Let the student have an important say in writing up a contract that includes the problem behavior(s), and what will happen (e.g., rewards, etc.) if the difficulties are removed.

Provide immediate feedback.  Videotape a child acting out and show it to him or her right away.  Give answers on tests right away.  Count the number of times a problem behavior occurs and give the child the figure in a nonjudgmental way each day.  Help them keep track of their own behaviors (self-monitoring).

Have consistent routines in the classroom and involve the student in them (e.g., the student is selected to collect papers, to signal others to get ready for lunch, etc.).

Social   

Hold class meetings.  Use these meetings as opportunities to air grievances, work out interpersonal problems between class members, plan for parties, and share other feelings and thoughts about how the class is going.

Use effective communication strategies.  For example, practice using "I" language ("I am disturbed by your language") rather than "you" communication ("You have a filthy mouth"), and help the student practice them as well.

Have the student be a "buddy" to a younger student, so that he needs to become the responsible member of the duo.  Ask him to teach another student something he knows how to do (this helps teach organizational skills).

Educational   

Create a highly stimulating educational environment.  Research suggests that kids labeled AD/HD do better under high-stimulation than low-stimulation conditions (e.g., use role playing, field trips, project building, music, humor, expressive arts, etc.).

Use attention-grabbing strategies, such as a hand signal or musical cue to alert students to the need to begin cleaning up for lunch.

Employ computer software that is interactive, colorful, provides immediate feedback, and is instructionally sound.

        This list provides a far richer storehouse of interventions than the instructional strategies given in the mainstream AD/HD literature-for example, seating the child next to the teacher, posting assignments on a
child's desk, maintaining eye contact, and breaking up assignments into small chunks.   Such a deficit-oriented perspective gives differential treatment to the "AD/HD child." Most of the above strategies, in contrast, are good for all children.   Thus, in an inclusive classroom, the child labeled AD/HD can thrive with the same kinds of nourishing and stimulating activities as everyone else and be viewed in the same way as everyone else: as a unique human being

The Creative Roots of AD/HD   

Because research (Zentall, 1975) has long suggested that many children labeled AD/HD are actually underaroused (Ritalin provides enough medical stimulation to bring their nervous systems to an optimal level of arousal), a strength based approach makes more sense than a deficit-based one,.  By providing these students with high-stimulation learning environments grounded in what they enjoy and can succeed in, we are essentially providing them with a kind of educational psychostimulant that can work as well as Ritalin but is internally empowering rather than externally controlling.

        Remember that a hyperactive child is an active child.  These young people often possess great vitality-a valuable resource that society needs for its own renewal.  Look at the great figures who transformed society, and you will find that many of them were behavior problems or hyperactive as children: Thomas Edison, Winston Churchill, Pablo Picasso, Charles Darwin, Florence Nightingale, Friedrich Nietzsche (see Goertzel & Goertzel, 1962).  As educators, we can make a big difference in the lives of these students if we stop getting bogged down in their deficits and start highlighting their strengths!

Thomas Armstrong, Ph.D., is the author of eight books including The Myth of the ADD Child: 50 Ways to Improve Your Child's Behavior and Attention Span without Drugs, Labels, or Coercion.  

Over the past thirty years, Attention Deficit Hyperactivity Disorder (ADHD) has emerged from the obscurity of cognitive psychology re­search laboratories to become the leading psychiatric disorder of child­hood in the United States. A recent study conducted at the Mayo Clinic stated that as many as 7.4 to 16 percent of all children and adolescents suffer from this disorder (Barbaresi et a1., 2002). The American Psychi­atric Association (1994) has established the following criteria for the ADHD diagnosis: The patient must exhibit behaviors related to inat­tention (e.g., "may fail to give close attention to details or may make careless mistakes in schoolwork or other tasks," p. 78) or hyperactivity/impulsivity (e.g., "they fidget with objects, tap their hands and shake their feet excessively," p. 79). In addition, symptoms must persist for at least six months, be maladaptive and inconsistent with developmen­tal level, impair social or academic functioning, be present in the child before the age of seven, and have influenced behavior in two or more settings (e.g., school and home).

 

There is wide consensus among scientists, physicians, psychologists and educators that ADHD is a genetically influenced, neurologically based psychiatric disorder. Specific genes are believed to give rise to dysfunction in the frontal lobes of the cerebral cortex and their con­nections to subcortical structures in the limbic system and the cerebel­lum. The medical literature also earmarks disrupted dopaminergic pathways in the etiology of ADHD (Barkley, 1990,2002; Giedd et a1., 1994; LaHoste et a1., 1996). Despite the widely held belief that ADHD is a medical disorder, there are compelling reasons to question this assumption (see, for example, McGuinness, 1989; Reid, Maag, & Vasa, 1993; Armstrong, 1997, 1999; Nyland, 2002). First, there is not a single diagnostic test currently available that can definitively establish the presence of ADHD as a neurological disorder. As New York psychia­trist Esther Wender (2002, p. 210) states in her editorial on the Mayo Clinic study: "[ADHD] is identified by a cluster of typical behaviors and has no definitive biological marker. And because the condition cannot be objectively defined, the decision to treat will also be based on diagnostic uncertainties. The published diagnostic criteria lend an aura of objectivity to the diagnosis, but the application of these criteria is based on subjective judgments regarding the accuracy of informa­tion given by parents and teachers."

 

Second, many of the studies that have sought to establish a neuro­logical basis for ADHD have used brain-scan technologies that are still in their infancy, such as Positron Emission Tomography (PET) and Functional Magnetic Resonance Imaging (MRI). Studies of childhood mental disorders that utilize these technologies are frequently riddled with methodological difficulties, such as relatively small subject popu­lations, heterogeneous samples, and problems in measuring the neuro­logical correlates of complex behaviors under highly controlled and artificial laboratory conditions. These factors should temper our ready acceptance of these results (Hendren, DeBacker, & Pandin, 2000).

 

 

 

 

Third, when brain-imaging results reveal differences in a child's brain functioning or structure, it is typically assumed that these dif­ferences are innate and immutable, rather than a response to environ­mental conditions. Brain-scan images are routinely interpreted as if they were neurological fingerprints: indelible and intractable. How­ever, research on other psychiatric conditions such as Obsessive Com­pulsive Disorder (OCD) has demonstrated that psychotherapeutic interventions can significantly alter brain scan patterns (Schwartz, Stoessel, Baxter, Martin, & Phelps, 1996). Furthermore, there is com­pelling evidence that environmental factors such as stress and trauma may trigger neurochemical events in the brain that impair frontal lobe structure and functioning in children (Perry & Pollard, 1998; Arnsten, 1999). These findings suggest that nature and nurture work together in an intricate way to produce behaviors such as those seen in ADHD. Therefore, we must question whether ADHD is "in" the child as a fixed neurological disorder, or whether instead, ADHD symptoms reflect dysfunctional relationships between the child and the environment. There are, in fact, a number of studies, discussed below, that support this premise.

 

ADHD AND ENVIRONMENTAL INFLUENCE

Research studies have demonstrated that children's ADHD symp­toms decrease under a variety of environmental conditions, including when they are engaged in one-on-one learning experiences, when they're being paid to do tasks, when they have access to novel or highly stimulating activities, when they're in control of the pace of learning experiences, and when they're interacting with male authority figures (Barkley, 1990; McGuinness, 1985; Zentall, 1980; Sykes, Douglas, & Morgenstern, 1973; Sleator & Ullman, 1981). From this we can infer that symptoms of ADHD in children might increase when the oppo­site environmental conditions pertain, such as when they're perform­ing in boring or low-stimulation environments, when they're not receiving a meaningful reward for their efforts, and when they're powerless to control the pace of learning tasks. Indeed, if these con­ditions are present in a child's home environment from birth, it is rea­sonable to suspect that they could lay the groundwork for the disorder itself.

 

In a survey of ADHD-diagnosed and "normal" children aged six to seventeen, the odds of a child being diagnosed with ADHD increased in proportion to the extent that they came from a family characterized by adversity, including severe marital discord, low social class, large family size, paternal criminality, maternal mental disorder, and foster care placement (Biederman et al., 1995). Other studies have demon­strated that the quality of caregiving in early childhood predicts dis­tractibility (a key symptom of ADHD) better than early biological markers or temperament, and that a strong overlap exists between symptoms of ADHD and Post-Traumatic Stress Disorder (PTSD) in children, suggesting that early sexual, physical, and/ or emotional abuse may play an important role in the origin of ADHD symptoms for some children (Carlson, Jacobvitz, & Sroufe, 1995; Weinstein, Staffelbach, & Biaggio, 2000).

 

THE SOCIOCULTURAL ORIGINS OF ADHD SYMPTOMS

 

If we expand our exploration of the role of the environment in creating ADHD symptoms to include broader sociocultural factors, we might consider the possibility that the disorder of ADHD is itself a cultural phenomenon that has been socially constructed as a "neurological disorder." There is compelling historical precedence for this type of construction. In the 1850s, for example, a Louisiana physician named Samuel A. Cartwright (1851) contributed a paper to the New Orleans Medical and Surgical Journal, in which he stated that he had discovered a new medical disorder that he named "drapetomania" (an obsession with fleeing). Dr. Cartwright be­lieved that this" disorder" afflicted large numbers of runaway slaves, and that with proper identification and treatment, they could learn to live productive and successful lives back on the plantation (Cartwright, 1851). More recently (1973), the American Psychiatric Association (which played a leading role in defining and legiti­mizing the diagnosis of ADHD) rescinded its diagnosis of "homo­sexuality" as a pathological condition. Clearly, there is ample precedent for the influence of sociocultural context upon the think­ing and discourse of mental health professionals in this country. As social values and norms change over time, so do the classifications of deviance. It has even been suggested, by the former president of the American Psychological Association, Nicholas Hobbs (1975), that society defines itself in part by the categories of deviance it as­signs to its members, especially to its children.

 

In this spirit, a number of educators and mental health professionals have expressed concern that the diagnosis of ADHD in children is an attempt to medicalize behaviors that should more properly be seen as natural responses to the broader social and cultural environment. Thirty years ago, during the social upheavals of the 1960s and early 1970s, Harvard professor Lester Grinspoon observed that:  “Children growing up in the past decade have seen claims to authority and existing institutions questioned as an everyday occurrence. . . Teachers no longer have the unquestioned authority they once had in the classroom. . . . The child, on the other side, is no longer so intimidated by whatever authority the teacher has.. . . Hyperkinesis [a term used to describe ADHD symptoms in the 1960s and 1970s], whatever organic condition it may legitimately refer to, has become a convenient label with which to dismiss this phenomenon as a physical' disease' rather than treating it as the social problem it is. (Grinspoon & Singer, 1973, pp. 546­-547)

After close observation of their own children, with a combined age of 61 years, observations of many other children in the U.S., Canada, Mexico, Israel, Greece, Italy, Swiss, France, Holland, Belgium, England, Scotland, and the Bahamas, and numerous reports throughout recorded history, the authors have determined that a widely-distributed behavioral disorder has somehow been overlooked by psychiatrists. They have labeled this disorder "CHILD"¹. Just like "ADD", "ADHD", and "Asperger’s Syndrome", CHILD is not based on any medical evidence or test whatsoever, but it should nonetheless be a useful diagnosis for mental health professionals, school administrators, and parents.

Symptoms

Stage 1:

• cries when left alone at night
• cries when put into car seat
• cries when being diapered or dressed
• cries when hurt
• naps too long (or) does not nap long enough
• potty-training does not go smoothly
• poor hand-eye coordination
• fussy when teething
• clingy during times of family stress
• dribbling

Stage 2:

• tantrums when frustrated
• incoherent babbling
• climbs onto dangerous areas
• enters roads without looking
• fussy when hungry
• insists on favorite cup at meals
• refuses all vegetables
• clingy following a parent’s return from a trip
• clingy following a move
• clingy following birth of sibling
• clumsiness with frequent dropping and spilling
• continues unwanted behavior even when told to stop
• punishment doesn’t work

Stage 3:

• sudden unexpected movements
• irrational fears that don’t respond to logic
• funny noises, sudden shrieks, inappropriate giggling
• talks to dolls and stuffed animals
• may have imaginary playmates
• fidgets when bored; unable to sit still
• runs and climbs; always on the go
• insists on wearing favorite clothing
• does not come promptly when called
• tells silly jokes
• embarrasses parents in public
• interrupts when parent is on the telephone
• grumpy when tired
• angry when losing a game
• dawdles when hurried
• fights with siblings
• insists on own way of doing things
• punishment doesn’t work

Stage 4:

• prefers playing to doing chores
• stammers when nervous
• doesn’t listen to reason
• selectively forgetful
• talks excessively (or) does not talk enough
• ignores direct questions
• sudden, energetic behavior
• self-centered, egocentric behavior
• walks away when parent lectures
• sullen when mistrusted
• forgets to say "please" and "thank you" despite repeated reminders
• grumpy when ill
• resists structured teaching; prefers own way of learning
• punishment doesn’t work

Etiology

The causes of this disorder are not yet clear, but the authors suspect that the primary cause is premature birth, i.e. birth prior to age 20. This is probably inevitable, as a 20-year gestation would be stressful for the human female.

Prevention

This disorder is not preventable; it appears to be universal among low-age populations. However, there are several approaches that can minimize behavioral difficulties:

• cosleeping
• carrying in the first years
• breastfeeding with child-led weaning
• eye contact
• gentle touch and hugs
• respectful listening
• undivided attention
• validation of feelings
• empathy
• trust
• avoidance of punishment
• natural learning

Prognosis

The prognosis is excellent, as this disorder subsides over time, provided the preventative measures listed above are taken. Drugs are not recommended.

"While intelligent people can often simplify the complex, a fool is more likely to complicate the simple."
 - Dr. Gerald Grumet

Imagine for a moment that you are visiting a plant nursery. You hear a commotion outside, so you investigate. You find a young assistant struggling with a rose bush. He is trying to force open the petals of a rose, and muttering in frustration. You ask him what he is doing, and he explains, "My boss wants all these roses to bloom this week, so last week I taped all the early ones, and now I'm opening the late ones." You protest that every rose has it's own schedule of blooming; it is absurd to try to slow down or speed this up; it doesn't matter when roses bloom; a rose will always bloom at its own best time. You look at the rose again, and see that it is wilting. But when you point this out, he replies, "Oh, too bad, it has genetic dysbloomia. I'll have to call an expert." "No, no!" you say, "you caused the wilting! All you needed to do was meet the flowers' needs for water and sunshine, and leave the rest to nature!" You can't believe this is happening. Why is his boss so unrealistic and uninformed about roses?

Such a scene would never take place in a nursery, of course, but it happens daily in our schools. Teachers, pressured by their bosses, follow official timetables, which demand that all children learn at the same rate, and in the same way. Yet children are no different than roses in their development: they are born with the capacity and desire to learn, they learn at different rates, and they learn in different ways. If we can meet their needs, provide a safe, nurturing environment, and keep from interfering with our doubts, anxieties, and arbitrary timetables, then- like roses- they will all bloom at their own best time.

My heart goes out to those children who have been labeled "ADHD" ("attention-deficit and hyperactivity disorder"), the latest "learning disability" label. Many educators and researchers believe that these children and their families have been cruelly deceived by the use of these labels. Dr. Thomas Armstrong, a former learning disabilities specialist, changed professions when he "began to see how this notion of learning disabilities was handicapping all of our children by placing the blame for a child's learning failure on mysterious neurological deficiencies in the brain instead of on much needed reforms in our system of education." Dr. Armstrong turned instead to the concept of learning differences, and wrote In Their Own Way, a fascinating and practical guide to seven "personal learning styles" first proposed by Harvard psychologist Howard Gardner. Dr. Armstrong urges us to abandon convenient but harmful labels such as "dyslexia" and focus on the real problem of "dysteachia". He warns that "our schools are selling millions of kids short by writing them off as underachievers, when in reality they are disabled only by poor teaching methods." 

As Armstrong explains, "Children get saddled with diagnostic terms such as dyslexia, dysgraphia, dyscalculia, and the like, making it sound as if they suffer from very rare and exotic diseases. Yet the word dyslexia is just Latin bafflegab for 'trouble with words'... hundreds of tests and programs purport to identify and remediate these "neurological dysfunctions. Yet medical doctors have yet to clearly establish any measurable brain damage in the vast majority of children with these so-called symptoms. It seems clear to me after fifteen years of research and practice in the field of education that our schools are largely to blame for the failure and boredom which millions of children face..."

Are learning disorder labels the "emperor's new clothes" of the schools? Philosophers have an interesting tool called Occam's Razor, a handy device for cutting through preposterous theories: "the simplest theory that fits the facts of a problem is the one that should be selected." What are the facts? It is a fact that many school children, mostly males, have learning difficulties. But it is also a fact that there is a group of hundreds of thousands of children in the world, both male and female, among whom this "genetic" defect is absent: homeschoolers. In this group, learning difficulties are virtually unknown, except for those children recently in school.

If "learning disorders" are present only among children in school settings, and are absent elsewhere, the problem must lie in the learning environment of the schools, not in some mysterious, non-quantifiable "neurological disorder" within the children, or they would be present in homeschooling children too. After all, it is no secret that the schools are failing to do their job: in many areas, literacy rates have actually declined and have never reached the level they were before the existence of public schools. When John Gatto, New York State Teacher of the Year, calls compulsory schooling a "twelve-year jail sentence", we know that something is terribly wrong, and that the fault is not with the children.

Are the labels "hyperactive", "school phobic" and "learning disabled" smoke screens for the school's failure to understand and conform to the actual process of learning? No less an expert than Mary Poplin, a past editor of Learning Disabilities Quarterly, recently acknowledged that "Despite all the quantitative research... there is no evidence that learning disabilities can be objectively identified... attempts at establishing objective criteria for verifying human problems is a convenient illusion behind which we can hide our incompetence in instruction." Educator John Holt reported in Teach Your Own that the president of a leading learning-disability association admitted there was "little evidence to support the disability labels". Holt warns parents of school children to "be extremely skeptical of anything the schools and their specialists may say about their children and their conditions and needs. Above all, they should understand that it is almost certainly the school itself and all its tensions and anxieties that are causing these difficulties and that the best treatment for them will probably be to take the child out of school altogether."

Families who have done just that are relieved to find that their children regain the love of learning which they had in their early years. Unlike school teachers, who see a cross-section of different children each year, homeschooling parents watch learning take place within the same child over many years, and thus learn to respect each child's unique learning style, to trust the child's personal timetable, and to recognize that mistakes are a normal and temporary part of the learning process for everyone. (There is no rush, after all; many homeschoolers who did not read until age ten or twelve nonetheless have done very well in college.) This relaxed attitude on the part of homeschooling parents keeps the child's self-worth intact, makes labels irrelevant, and allows learning to take place as readily as in toddlerhood: homeschoolers regularly out-perform their schooled peers on measures of academic achievement, socialization, confidence, and self-esteem. In fact, Gatto reports that "children schooled at home seem to be five or even ten years ahead of their formally trained peers in their ability to think."

For many years, Holt challenged schools to "explain the difference between a learning difficulty (which we all experience at times) and a learning disability. He asked teachers how they discriminate between causes which lie within the nervous system of the learner and those factors outside of the learner- the learning environment, the teacher's explanations, the teacher, or the material. Not surprisingly, he reported that he "never received any coherent answers to these questions... [yet] this distinction is so crucial that I don't see how we can talk usefully about the learning problems of children unless we make it." Why, then, are teachers so sure of the existence of widespread neurological disabilities? Perhaps they confuse cause and effect: as Holt observes, "Teachers say 'reading must be difficult, or so many children wouldn't have trouble with it.'" Holt argues that "it is because we assume that it is so difficult that so many children have trouble with it...all we accomplish by our worrying, 'simplifying', and teaching, is to make reading a hundred times harder for children than it need be... we think badly, or even perceive badly, or not at all, when we are anxious and afraid...when we make children afraid, we stop learning dead in its tracks."

Indeed, many research studies show that the expectations teachers have about a child's learning abilities strongly influence the child's academic performance. Other studies show a high correlation between children's anxieties and perceptual handicaps- and further show that lowering those anxieties (and treating food allergies, if present) greatly lower the incidence of such difficulties. But we don't need researchers and experts to tell us what is wrong. We need only listen to the children themselves, who have tried for years to communicate their pain, frustration, confusion, and anger. When children are driven to addictive drugs, self-mutilation, and suicide, obviously they are trying to communicate something of critical importance.

Are learning difficulties in reality the understandable response of normal children forced to conform to the abnormal conditions of conventional classrooms? Most tellingly, have the schools failed to see the crucial difference between mere descriptions of common, temporary learning errors worsened by stress, and scientific proof? While the supposed neurological anomalies have never been identified, it isn't difficult to locate abnormal conditions in the learning environment of the schools: fierce competition, physical inactivity (especially difficult for boys); fragmented topics which bear little relationship to the child's own interests and experiences; constant checking- and doubting- of progress; insufficient family time; few opportunities to meet people of other ages; lack of quiet time for privacy and contemplation; constant abrupt changes of topics (preventing in-depth learning); few opportunities for a teacher's undivided attention; discouragement of sharing work and ideas with classmates (a golden opportunity missed); teasing from other frustrated children; the discouragement of self-fulfilling labels, and, above all, the indignity of being a powerless "non-person", whose legitimate needs and attempts to communicate those needs are smothered by institutional defensiveness. All of these difficulties can be avoided in homeschooling- assuming that the government allows sufficient autonomy.

"Labeling is disabling" because children believe what we tell them. If we must label something, let it be the learning environment, not the learner: instead of "hyperactive child", let's concern ourselves with "activity-restrictive" schools; instead of an "attention-deficient" student, we ought to worry about "inspiration-deficient" classrooms; instead of "school-phobic child", we should use honest words such as "anxious" and "frightened", and be very careful when we look for the source of that anxiety. Using Occam's Razor, let's look for the simplest theory that fits the facts, not the most obscure and complicated one. A stressful, punitive, and threatening environment more than sufficiently explains learning problems. There is no need to confuse ourselves with school techspeak, unproven theories, and scape-goating which serve to protect a social institution that has failed our children.

What could be done instead? Mcgill University Professor Norman Henchey recommends that we "rethink the whole notion of compulsory schooling"¹. Henchey advocates the return to homeschooling and "other routes to adulthood...apprenticeship programs, formal and informal learning services, public service. A whole variety of things might be presented to young people." Perhaps then we can honor each child's personal learning style, and, as Armstrong urges, "give children the encouragement they need in order to feel like competent, successful human beings." ² Children are born to learn. They deserve a safe, nurturing learning environment where they can do so, in an atmosphere of patience, respect, gentleness, and trust, not threats, force, and cynicism. As Einstein warned us years ago, "It is a very grave mistake to think that the enjoyment of seeing and searching can be promoted by means of coercion."

Every child is a gifted child.

1 1987 Interview, "Growing Without Schooling",

issue 59 (1987), pages 29-30.

2 Armstrong, Thomas. In Their Own Way: Discovering and Encouraging your Child's Personal Learning Style. Los Angeles, CA: J.P. Tarcher, 1987.

  I thought I was still young when it happened to me: One of my former elementary-school students walked into my university class as a student.  For some teachers, this incident would be no more than an unwelcome reminder of how quickly the years pass.  For others, it might be a pleasant postscript to a rewarding career. For me, it was something entirely different.  You see, I'd had this student in a special-education program many years before.  At that time, Ron was on psychoactive medication for his attention and behavior problems.  I could see he'd settled down.  But as we caught up on the years since fourth grade, he talked of further medication, special schools, labeling, and finally breaking free of it all after high school.  "Mr. A., you should tell people what those medications do to people," he said.

        Ron had begun to recover from his experience.  But sadly, many students with behavior or attention difficulties are just beginning their struggles.  In the late 1970s when I taught Ron, only a few students were being labeled and medicated for attention and behavior problems.  In the 1990s, things have changed considerably.  Ritalin use has skyrocketed 500 percent in the past five years.  As many as 2 million children have been diagnosed as having attention deficit disorder.  And ADD and Ritalin seem to be on the lips of any adult within arm's reach of a child who shows erratic behavior or wandering attention.

No easy answers 

        I'm not opposed to using psychoactive medication for children who are in crisis or for whom other approaches have failed.   In fact, many teachers and parents have told me how their kids have been transformed in a positive way with Ritalin or related drugs.  But I'm concerned that we may be turning too quickly to drugs and labels.    The traits that are associated with ADD--hyperactivity, distractibility, and impulsivity--can result from a number of causes.  For example, a child may be hyperactive or inattentive because of being bored with a lesson, anxious about a bully, upset about a divorce, allergic to milk, temperamental by nature, or a hundred other things.  Research suggests, though, that once adults have labeled and medicated the child--and the medication works--these more complex questions are all too often forgotten.  By rushing to drugs and labels, we may be leaving more difficult problems to fester under the surface.

        Before we push the ADD/Ritalin button, we need to take an intermediate step that enables us to look for other ways of seeing the child and to try nonmedical solutions.  Then if these approaches don't work, we can proceed with the appropriate referrals.

        Many of the following suggestions came from teachers who are taking that intermediate step.  These strategies may help you capture the child's attention--and keep it--without turning to medication.

Teaching strategies   

Give seat work in the morning, when research suggests a child is most focused.   Use the afternoon for open-ended activities.

	Use strategies that incorporate physical movement in teaching basic skills.   For example, try role-playing, drama, or pantomime.
	Give instructions in attention-grabbing ways, such as singing, pantomiming, or using pictures instead of speaking.
	Build art activities into the curriculum.
	Create learning projects based on the child's special interests.
	Teach social and emotional literacy skills such as learning how to make friends, express anger appropriately, and read other people's emotions.
	Teach organizational skills such as how to keep a notebook, study effectively, and manage homework.
	Involve the child in creating rules and consequences.
	Get the child involved in a peer or cross-age tutoring program to increase the feeling of responsibility.
	Give the child plenty of opportunities to make choices.
	Encourage the child to visualize movement as a substitute for actual motion.

Classroom environment

	Allow the child to have a piece of clay, a squeeze ball, or some other object in hand while you lecture.
	Give the child special jobs that allow movement, such as watering the plants or working the film projector.
	Let the student read or do math while moving.  For example, provide a rocking chair for reading.
	Use background music as a study aid.  Believe it or not, rock music calms some kids like Ritalin--a psychostimulant--settles others.

School environment

Work with your physical-education teacher to provide a strong physical-education program so the kids can blow off steam.  Provide breaks during class for physical activity.

Home environment

	Suggest to parents that the child learn martial arts, which teach discipline, focus, and respect.
	Help the parents, child, or both get counseling, psychotherapy, or family therapy if emotional difficulties could be causing the attention and behavior problems.
	Advise parents to make sure the child's breakfast includes both protein and carbohydrates.  This seems to make a difference in a child's behavior and attention span.
	Encourage parents to spend more positive time with the child.

  Changing with the times

In a sense, we live in an ADD society.  Everything is moving more quickly these days, and children are asking us to move along with them.  Let's make sure that we don't saddle some kids with labels and drugs just because we're not willing to make the journey.

The reason I speak of a hoax in the case of "attention deficit disorder" is that there is no such "mental disorder" to "diagnose" and "treat." And the reason I speak of a great hoax is that the less competent medical practitioners use this phony "diagnosis" as a warrant to "treat" millions of school children (over 5,000,000) per year by intoxicating them with brain-disabling narcotics. And make no mistake about the power of Ritalin to disable and eventually shrink the brain. It differs little in its destructive effects from cocaine and the amphetamines, and is fast becoming the drug of choice among addicts in high schools and colleges. Children in middle schools and high schools who are required to take Ritalin daily at school are now selling their pills to their friends who want to get a quick fix. Of late the victims of pill pushers are fast becoming pill pushers themselves!

Attention is a form of consciousness... and not something that can be observed.

Medical practitioners have chosen the word "attention" as the key to one of 400 or so "mental disorders" they've listed in their "diagnostic manual." They say that some children don't "have" enough attention to succeed in school, and that it is wise to try to increase their attention with stimulant drugs. They say these children can't pay attention even if they try to.

Holding therapy is a practice described and recommended in the book Holding Time, by Martha Welch. It consists of forced holding by a therapist or parent until the child stops resisting or until a fixed time period has elapsed; sometimes the child is not released until there is eye contact. Although this technique was initially intended for autistic adults, it has also been used for autistic children, teenagers and younger children with "attachment disorders", and infants with "residual birth trauma".

Proponents of this practice defend it as being "for the child's own good," the very same justification that many use for spanking and other punishments. Because it is labeled "therapy", it can be difficult to regulate this practice by professionals or to help parents to recognize its dangers.

I consider this practice to be completely at odds with attachment parenting, which is above all a relationship based on mutual trust. It can be immensely difficult for a child to regain full, genuine trust after being forcibly held – regardless of the parent’s "good intentions" or the resulting surface behavior. As Alice Miller wrote:

I regard [holding therapy] as a kind of violation. People with the best intentions just don’t feel what they are doing when they violate the rights of another person - the child. The aim is to release forbidden, repressed feelings, but the violence of this technique makes it absolutely impossible to benefit from such a release.¹  Force, the therapy implies, is used for the child’s own good, and the child will be rewarded and loved for his tolerance in letting it happen. He will come to believe that force contributes to his well-being and is ultimately beneficial. A more perfect deception and distortion of someone’s perceptions is barely imaginable.²

It is human nature to resent and resist the use of force. The use of forced holding by a parent will inevitably engender strong feelings of fear, confusion, helplessness, anger, and betrayal as the child’s natural attempts to break free are disregarded by those they have come to love and trust. When held by force, the child finally understands that freedom comes only by giving in to outside control - a dangerous lesson to give to a young child. Their will can be broken, but that is not what I would call psychological health. Imposing any action by force on a child, who is in no position to make an informed choice, is unconscionable. Even if there were an emotional "breakthrough", it would be at a great hidden cost, as there is no way to avoid the child's feelings of anger, frustration, resentment, and betrayal. These intense feelings cannot be measured in the present, nor can their future ramifications be known. Like spanking and all other forms of punishment, the child may appear to comply, while his deeper feelings become submerged until they can be more freely expressed. Further, where force is used, the authenticity of any "success" is forever in doubt. When a child cannot say "no", what does his "yes" really mean? The coerced child has learned to feign attachment behavior. Such dissimulation is at the core of the sociopathic personality.

The use of force on a child is always a risk factor, and is never justified unless the child's life or health is immediately endangered, and there is no better alternative. There are alternatives, many of them, to nearly all parental acts of forced submission. For the unhappy or out-of-control child, the best alternative is prevention through meeting the child's legitimate needs (undivided attention, food, sleep, attention to hidden allergies, relief of family stress factors, etc.) Where force is simply unavoidable (the proverbial child running into a street), it should be kept to the barest minimum possible, and followed by gentle explanations and apologies. Forced holding where there is no immediate danger should be challenged on humanitarian grounds that to me are self-evident. And far from having health benefits, as proponents claim, it may also pose a serious psychological risk:

... one of the most important advances in our understanding of health and disease in the past few decades... has been identifying the prototype of pathogenic (disease creating) situations - being trapped in adverse or threatening circumstances and being unable to either fight or flee. When we can only passively submit, our health tends to deteriorate.³ On the other hand, being in a position to take the initiative is health enhancing.

Excerpted from The Scientification of Love by Michel Odent, 1999.

There is yet another compelling reason to challenge this procedure: how can we justify forced holding in a society where children are cautioned - for good reason - to "say no" to unwanted touch? Whether by a parent, therapist or stranger, physically overpowering a helpless child is wrong. Justifying it by calling it "love" or "therapy" is a violation of the child’s trust and understanding of life as he has come to know it. Like all other forms of forced compliance, forced holding associates love and submission. Delusional defenses are likely as the child tries to comprehend and make sense of something he knows in his heart to be a distortion of what love should look like.

Gentle, empathic approaches are far less stressful for all concerned than forced holding, more effective for the long term, and more respectful of the child, who deserves above all our love and compassion. How sad that something as lovely as having a child in our arms - when the desire is mutual - has been perverted into such a heartless practice.

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Jan Hunt, B.A. Psychology (Magna cum Laude), M.Sc. Counseling Psychology, is the Director of the Natural Child Project, the B.C. Coordinator for the CSPCC (Canadian Society for the Prevention of Cruelty to Children), a member of the CSPCC Board of Directors, and Editorial Assistant of the Society's quarterly journal Empathic Parenting. She is also a member of the Board of Directors for Attachment Parenting International and the Advisory Board of The Child-Friendly Initiative. Jan has published articles in that journal, The Times-Colonist, Monday Magazine, Nelson Daily News, Growing Without Schooling, Reader's Digest, Compleat Mother, and numerous other periodicals in Canada, Australia, and the USA.

Her parenting column "The Natural Child" appeared in Natural Life Magazine from 1989 to 1998. One of her columns, "Ten Reasons Not to Hit Your Kids" was selected as an appendix to Alice Miller's book, Breaking Down the Wall of Silence  (New York: Penguin USA, new edition 1997). Jan is the parent of a 19-year-old son who has homeschooled from the beginning with a learner-directed approach.

For years I have been telling parents and educators that the kind of reading difficulties afflicting perfectly normal children in our schools today are being caused by the teaching methods and not by any defect in the children themselves. The educators have been telling us for years now that the reason why so many children are having problems learning to read is because of a learning disability they've been born with. In fact, the official position of the federal government on this issue is summed up in the 1987 Report to the Congress of the Interagency Committee on Learning Disabilities which defined "Learning Disabilities" as follows (p. 222):

Learning disabilities is a generic term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities, or of social skills. These disorders are intrinsic to the individual and presumed to be due to central nervous system dysfunction. [Our emphasis.] Even though a learning disability may occur concomitantly with other handicapping conditions (e.g., sensory impairment, mental retardation, social and emotional disturbance), with socioenvironmental influences (e.g., cultural differences, insufficient or inappropriate instruction, psychogenic factors), and especially with attention deficit disorder, all of which may cause learning problems, a learning disability is not the direct result of those conditions or influences.

In other words, according to government researchers, all learning disabilities are due to "central nervous system dysfunction," regardless of all other factors, including teaching methods. In fact, the federal government is pumping millions of dollars into research on the genetic causes of dyslexia.

But what if we are able to prove beyond a shadow of a doubt that dyslexia is caused by the teaching methods? Would that alter the course of government research? Probably not, for there is a private researcher in North Carolina by the name of Edward Miller who has already offered such proof to the government, only to be rebuffed by officialdom. After all, if what Miller says is true, then millions of dollars of research money will have been wasted.

Are there people who are born dyslexic? Yes, but they are afflicted with so many other problems that their inability to learn to read is simply only one of them. There are children born with all sorts of handicaps and defects that are recognized at birth or soon after. Some of these handicaps reflect neurological problems. But many of these children are quite educable. However, the dyslexia we are talking about is the kind that afflicts children who have come to school with perfectly good speech, hearing, eyesight, equilibrium, etc. In fact, some of these so-called dyslexics are some of the brightest and physically healthiest students in their classes. Miller calls their reading problem "educational dyslexia," that is, dyslexia, or reading disability, caused by the teaching method.

Some parents will ask: how is it that my Johnny began to show signs of dyslexia in the first grade, before he had had any formal reading instruction? Miller has found the answer to that question. It all starts at home with preschool readers. Miller discovered that when preschoolers memorize as sight words the entire texts of such popular books as Dr. Seuss's The Cat in the Hat and Green Eggs and Ham, they develop a block against seeing the words phonetically and thus become "dyslexic." They become sight readers with a holistic reflex rather than phonetic readers with a phonetic reflex. A holistic reader looks at each word as a little picture, a configuration, much like a Chinese ideograph, and tries to think of the word it represents. A phonetic reader associates letters with sounds and sounds out the syllabic units which blend into an articulated word.

What this means is that parents should teach their children to read phonetically before giving them the Dr. Seuss books to read. They should avoid having their children memorize words by their configurations alone, because once that mode of viewing words becomes an automatic reflex, it will create a block against phonics.

In other words, failure to teach a child to read phonetically, but requiring the child to memorize hundreds of sight words produces educational dyslexia. Incidentally, a sight word, by definition, is a word learned without reference to the sounds the letters stand for. Nowadays, publishers are selling books for preschoolers with audio tapes so that the child can learn to read by the sight method without the help of his or her parents. Thus, the child will develop a reading handicap without the slightest idea that what he or she is doing is harmful.

How do we know it's harmful? By what happens when the child enters school and proceeds upwards to the third grade. In kindergarten and the first grade, all will seem satisfactory, for most schools now use the sight method, and a child who enters school having already memorized a large number of sight words will be ahead of those students who haven't. Everybody will be pleased by the child's performance. But as the child moves into the third grade where the reading demands are much greater, involving many new words which the child's overburdened memory cannot handle, the child will experience a learning breakdown.

But the problem, as we have indicated, can also show up in the first grade where the teaching method is phonics-based. This is often the case in many private and religious schools where reading is taught phonetically. If a child enters the first grade in such a school after having already memorized several hundred sight words from preschool readers, that child will most likely have already developed a block against learning to look at words phonetically. That's why we see "dyslexia" among some first graders.

In other words, there are two ways of looking at our printed or written words: holistically or phonetically. If you are taught to read phonetically from the start, you will never become dyslexic, for dyslexia by definition is a block against viewing words phonetically. Phonetic readers become good, independent readers because they have developed a phonetic reflex. To them literacy is as natural and effortless as breathing. A holistic, sight reader, on the other hand, must rely on memorization of individual word forms and use all sorts of contextual strategies to get the word right.

Edward Miller has devised a very simple word-recognition test that dramatically illustrates the difference between a holistic and a phonetic reader. The test consists of two sets of words: the first set consists of 260 sight words drawn from Dr. Seuss's two books, The Cat in the Hat and Green Eggs and Ham, and the second set consists of 260 equally simple words taken from Rudolf Flesch's phonetically regular word lists in Why Johnny Can't Read. Both sets of words are at a first-grade level.

A child who is already a phonetic reader will sail through both sets of words without any problem. But a holistic reader might sail through the sight words at high speed with no errors, but then slow down considerably and make many errors in the phonetic section even though these are simple first-grade words.

That the words in the two Dr. Seuss books were to be read and learned as sight words was confirmed by Dr. Seuss himself in an interview published in Arizona magazine in June 1981. He said:

They think I did it in twenty minutes. That d -- ned Cat in the Hat took nine months until I was satisfied. I did it for a textbook house and they sent me a word list. That was due to the Dewey revolt in the Twenties in which they threw out phonic reading and went to word recognition, as if you're reading Chinese pictographs instead of blending sounds of different letters. I think killing phonics was one of the greatest causes of illiteracy in the country. Anyway, they had it all worked out that a healthy child at the age of four can learn so many words in a week and that's all. So there were two hundred and twenty-three words to use in this book. I read the list three times and I almost went out of my head. I said, I'll read it once more and if I can find two words that rhyme that'll be the title of my book. (That's genius at work.) I found "cat" and "hat" and I said, "The title will be The Cat in the Hat."

Thus, even Dr. Seuss knew that "killing phonics" was a cause of illiteracy in America. But somehow that insight, made by America's most famous writer of children's books, has escaped our educators.

Holistic readers are indeed handicapped by the way they are taught to read. They are taught to look at words as whole pictures, which means that they are not bound to look at a word from left to right. They simply look for something in the word-picture that will remind them of what the word is. Thus they may actually look at a word from right to left, which accounts for the tendency of dyslexics to reverse letters and read words backwards. Also, holistic readers are encouraged by their teachers to substitute words, as explained by a whole-language advocate quoted in the Washington Post of Nov. 29, 1986. The headline reads, "Reading Method Lets Pupils Guess; Whole-Language Approach Riles Advocates of Phonics." The article states:

The most controversial aspect of whole language is the de-emphasis on accuracy. American Reading Council President Juli a Palmer, an advocate of the approach, said it is acceptable if a young child reads the word house for home, or subtitutes the word pony for horse. "It's not very serious because she understands the meaning," said Palmer. "Accuracy is not the name of the game."

When does accuracy become the name of the game in Ms. Palmer's system of education? Probably, never, for if you teach children in primary school, through invented spelling and word substitutions, that accuracy is not at all important, they may never acquire a sense of accuracy, unless forced to do so by the demands of the workplace.

What we do know is that when you impose an inaccurate, subjective ideographic teaching technique on a phonetic-alphabetic writing system which demands accurate decoding, you create symbolic confusion, cognitive conflict, frustration and a learning breakdown. In addition, I strongly suspect that attention deficit disorder, otherwise known as ADD, is a form of behavioral disorganization created by a teaching disorganization. It is the symbolic confusion, cognitive conflict, learning blocks and frustration caused by holistic teaching methods that literally force children to react physically to what they instinctively know is harming them. They may not know exactly what it is the teacher is doing that is harming them. But they certainly know that they are being harmed. How? By the simple circumstances of their position.

When they entered school at the age of 5 or 6, these children felt very confident, very intelligent. After all, they had all taught themselves to speak their own language very nicely without the aid of teachers or school. And when they enter school, they expect to be able to learn to read with the same competence. And, normally, this is what happens when they are taught to read phonetically and begin to master our alphabetic system.

If children they are taught to read holistically, mastering our alphabetically written words becomes a superhuman task. And because the teaching method seems to defy all logic and common sense, their minds react against such teaching just as their stomachs would if some sort of poison were eaten. The stomach throws up, rejecting the poison, and I suspect that ADD is a form of mental rejection of pedagogical poison.

What other defense does the child have against pedagogical poisoning? What Ritalin does is lower the defense against such poisoning. The child becomes a docile, defenseless victim of whatever nonsense the teacher is inflicting on the child. And the child is usually dumped into Special Education for the rest of his or her academic career.

According to Lori and Bill Granger, authors of The Magic Feather: The Truth About "Special Education":

Parents of children in Special Education classes have noticed that their kids become more and more passive and dependent the longer they are in Special Education. . . . Special Education teaches kids how to be failures and to live with being failures. It segregates kids from "normal" kids by putting special labels on them, putting them in separate classrooms, putting them in separate schools, and making certain that not too much is ever asked of them or expected of them. . . .

Evidence for a "neurological" basis for LD is vague at best. . . . Some of the more revered books in this field, which purport to convey "facts" on the "neurological" basis of learning disabilities, are nothing more than wishful thinking. . . . Education trade journals are full of debates about learning disabilities that would shock parents of children who have been routinely labeled LD.

Fortunately, homeschoolers are in the best position to guard their children against the kind of pedagogical poisoning that is turning millions of normal children into LDs. They can begin teaching their children to read phonetically as early as the child wishes. Above all, they must avoid having their preschoolers memorize words holistically without any knowledge of the letter sounds. If you tell children that letters stand for sounds, they will begin to understand what our alphabetic system is all about.

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Samuel L. Blumenfeld is the author of six books on education, including How to Tutor and Alpha-Phonics, which are widely used by homeschoolers in teaching their children to read phonetically. His book on the reading problem, The New Illiterates, revealed for the first time the true origin of look-say: Rev. Thomas H. Gallaudet's method of teaching the deaf to read. Dr. Blumenfeld has spoken at many homeschool conferences and is a frequent guest on radio talk shows. He holds a Bachelor of Arts degree from the City College of New York, an honorary Doctor of Laws degree from Bob Jones University, and publishes the monthly Blumenfeld Education Letter.

 In 1851, a Louisiana physician and American Medical Association member, Samuel A. Cartwright, published a paper in the New Orleans Medical and Surgical Journal wherein he described a new medical disorder he had recently identified.  He called it drapetomania (from drapeto, meaning "to flee," and mania, an obsession), and used it to describe a condition he felt was prevalent in runaway slaves.  Dr. Cartwright felt that with "proper medical advice, strictly followed, this troublesome practice that many negroes have of running away can be almost entirely prevented."

        In the last 20 years, we have witnessed the birth of a new medical disorder--attention-deficit disorder--which has grown from a relatively rare neurological condition (under other names) during the 1930s, 40s, and 50s to a condition today said to afflict millions of children and adults (a recent Time magazine cover story even suggested that President Clinton may have ADD and could be "only a pill away from greatness"). Attention-deficit disorder (or, more recently, "attention deficit hyperactivity disorder"--the syndrome has changed names at least 25 times in the past 120 years) has the support of thousands of scientific studies, the American Psychiatric Association, the U.S. Department of Education, and many other solid institutions in this country and worldwide.  Yet, like Dr. Cartwright's "drapetomania," ADD may in fact come clothed in scientific respectability yet have disturbing social overtones which are scarcely acknowledged by the wider educational community.

        Social critic Ivan Illich once wrote that "each civilization defines its own diseases.  What is sickness in one might be chromosomal abnormality, crime, holiness, or sin in another.  For the same symptom of compulsive stealing one might be executed, tortured to death, exiled, hospitalized, or given alms or tax money." So far, few attempts have been made to analyze the social meaning of "attention-deficit disorder" in our time.  However, one does not have to probe too far beneath the surface to discover some interesting-and troubling-features of ADD

        Why, for example, does identification Of ADD vary so widely from one social context to another?  Studies reveal that up to 80 percent of the time, ADD cannot be identified in the physician's office, presumably because the one-to-one social context with a (frequently) male authority figure mediates against the occurrence of symptoms.  In another study, trained clinicians from different countries were shown tapes of children and asked to diagnose them.  In a country with stricter behavioral norms--for example, China--there was a greater likelihood of an ADD diagnosis than in a country such as the United States.  On the other hand, in some countries, such as England, a diagnosis of hyperactivity is much less likely (one study on the Isle of Wight identified only two children out of 2,199 as hyperactive).

        One has to ask, then, what are some of the underlying social influences that may have served to shape the invention Of ADD as a category of disorder in our culture?  The answer to that question, I believe, is complex and many-faceted.  On one level, it's possible to revive some of the concerns that Nicholas Hobbs, a former president of the American Psychological Association, had in the mid-1970s concerning the labeling of children.  Mr. Hobbs pointed out that "a good case can be made for the position that protection of the community is a primary function of classifying and labeling children who are different or deviant." He noted that the Protestant work ethic (as elaborated upon by social theorists such as Max Weber) may be one set of American values which may permeate our nation's penchant for classifying unruly children.  Mr. Hobbs writes:
"According to this doctrine ... God's chosen ones are inspired to attain to positions of wealth and power through the rational and efficient use of their time and energy, through their willingness to control distracting impulses, and to delay gratification in the service of productivity, and through their thriftiness and ambition." Such a society might well be expected to define deviance in terms of distractibility, impulsiveness, and lack of motivation--the same traits frequently used to describe children suffering from ADD.

        Alternatively, ADD may have arisen in our society precisely because of the loss of those same values.  As Harvard University professor Lester Grinspoon and his collaborator Susan B. Singer pointed out over 20 years ago, "our society has been undergoing a critical upheaval in values. Children growing up in the past decade have seen claims to authority and existing institutions questioned as an everyday occurrence. ... Teachers no longer have the unquestioned authority they once had in the classroom. ... The child, on the other side, is no longer so intimidated by whatever authority the teacher has."  Grinspoon and Ms. Singer felt that "hyperkinesis" [the term used in the 60s and early 70s to designate ADD-type behaviors], whatever organic condition they may legitimately refer to, has become a convenient label with which to dismiss this phenomenon as a   physical 'disease' rather than treating it as the social problem it is."

        Another cultural view might look at the rise of electronic media as a contributing factor in the emergence of "attention deficit disorder." The fact is, we live in an attention-deficit society.  During the 1992 political campaign, CBS News attempted to introduce an innovation in its newscasts: 30-second sound bites from the politicians to give the viewer more 'depth" into their views.  The project had to be abandoned because the average adult viewer could not sustain his or her attention that long (the industry average for sound bites is around seven seconds).  If this is true of adults--who grew up during the days of radio and early TV--then how much truer it is of today's children, who are inundated with Nintendo, the Internet, MTV, multimedia, and more.

        These kids live life in the fast lane, and have evolved new ways of paying attention to cope with the increased pace.   Media expert Tony Schwartz pointed out that "today's child is a scanner.   His experience with electronic media has taught him to scan life the way his eye scans a television set or his ears scan auditory signals from a radio or stereo speaker." What kinds of cultural values, then, might be present in a situation where an adult brought up in Marshall McLuhan's linear, one-step-at-a-time, print-oriented culture is responsible for assessing ADD in a child who has been fed on fast-paced electronic information from birth?

        Such children may have particular difficulties in traditional classroom environments where they must sit for long periods of time, listen to monotone lectures, and pore over textbook and worksheet material that bears little resemblance to real life.  Interestingly, research suggests that children labeled ADD do most poorly in environments that are boring and repetitive, externally controlled, lack immediate feedback, or are presided over by a familiar, maternal-like authority: in other words, the typical conservative "back to basics" classroom (a classroom that currently seems to be undergoing a resurgence in popularity).

        Unfortunately, this kind of classroom is deadly not only for the so-called ADD kid but for all kids.  John Goodlad's monumental study of 1,000 U.S. classrooms in the 1980s was particularly instructive on this issue.  The study, A Place Called School, was especially critical of the lack of exciting learning activities: "Students reported that they liked to do activities that involved them actively or in which they worked with others.  These included going on field trips, making films, building or drawing things, making collections, interviewing people, acting things out, and carrying out projects.  These are the things which students reported doing least and which we observed infrequently." All children suffer from this deprivation, but it may be that children labeled ADD react most intensely to this lack of stimulation.  Several studies, especially those by Sydney Zentall at Purdue University, suggest, in fact, that just as the amphetamine-like substance Ritalin may help stimulate manv of these kids to an optimal level of arousal, so too can stimulating learning environments also help to focus and calm. I'm reminded here of the canaries that were kept by coal miners deep in the mines.  If the level of oxygen fell below a certain level, the canaries would fall over on their perches and die, warning the miners to get out fast.  It's possible that children who have been labeled ADD are the canaries of modern-day education; they may be signaling us to transform our nation's classrooms into more dynamic, novel, and exciting learning environments.  ADD may, then, be more accurately termed ADDD, or attention-to-ditto-deficit disorder.

        Finally, just as it is essential to see Dr. Cartwright's drapetomania as a product of the racial bigotry of his times, so too it's critical that we not sidestep the way in which racial prejudices enter into the ADD controversy in today's admittedly less bigoted but nevertheless still racially troubled times.  ADD was in fact stopped from being declared an officially handicapping condition by Congress in 1990, largely because of the efforts of a coalition of 17 educational, social, and political organizations including the National Association for the Advancement of Colored People.  Among the concerns raised by the coalition was the strong feeling that ADD could be used to stigmatize minority groups.  Debra DeLee, then a spokesperson for the National Education Association, wrote: "Establishing a new category [ADD] based on behavioral characteristics alone, such as overactivity, impulsiveness, and inattentiveness, increases the likelihood of inappropriate labeling for racial-, ethnic-, and linguistic-minority students." The work of award winning journalists such as Todd Silberman and his colleagues at the The Raleigh News and Observer in Raleigh, N.C., have shown how special-education classes are often disproportionately filled with minority students.

        The issues that I've raised above are almost never discussed in the ADD community.  The general consensus seems to be that ADD is a discrete medical entity that exists in any and all social contexts, but is harder to identify in some social settings (requiring more acute diagnostic skills)  or simply wasn't identified in earlier times or in other cultures because of the lack of proper scientific knowledge.  It holds stubbornly to its medical paradigm and resists the influence of other worldviews (including the sociological one presented here), hoping that the world will eventually unite in accepting ADD as a legitimate medical disorder.   One wonders, however, as societal values and structures change over time, whether "attention-deficit disorder" will go the way of all historical labels (remember that "moron" was once a diagnostic term in the 1930s) and give rise to new terms, and new groups of "disordered children."

Many children seen at the National Reading Diagnostics Institute in Naperville, Illinois have received a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Yet in-depth reading evaluations of these youngsters often reveal that rather than having an attention disorder, they are simply kinesthetic learners they need to engage in gross motor (large-muscle) activity to learn best. Once they are given the opportunity to learn through the proper methods, their ADHD-like behavior often disappears.

It is interesting how many students are now being labeled "attention disordered." Years ago, only medical practitioners determined whether a child had an attention disorder, and the numbers were small. Now, teachers, relatives, and next-door neighbors are quick to point out the characteristics of ADD. Increasing numbers of youngsters are routinely placed on ”trials” of Ritalin, without first ruling out other factors that could be causing apparent ADHD symptoms. A kinesthetic learner may not need medication so much as innovative teaching methods.

There are four basic types of learners: visual, auditory, tactile and kinesthetic, While types may overlap, visual learners tend to work best with visual stimuli, while auditory learners relate best to lecture-techniques and verbal material. Tactile-oriented students absorb new information most readily through their sense of touch, such as when tracing letters made from sandpaper.

Kinesthetic learners require body movement and action for optimal results: they need to move around, use their muscles, explore. Flashlight writing is an example of a kinesthetic technique. Writing letters in sand or shaving cream is both a tactile and kinesthetic method. Kinesthetically oriented children find it stressful to be asked to ”look and listen” for long periods of time. Imagine the frustration of having your hands tied, your mouth covered, and your eyes blindfolded, so that you could neither gesture, speak, or see. Kinesthetic students face similar frustration when they are not allowed to move in a classroom. To relieve stress, they seek to break out of these constraints. When faced with several hours of desk work, for which they are required to ”sit still,” they tend to get up to sharpen their pencil several times, they ask to go to the rest room, or they drop things, so they can get up to retrieve them, They may seek to be class monitors, to run errands. If they can’t engage in these activities, they will at least begin to move while in their seats: wiggling their legs, leaning back in their chairs, rocking, or tapping their pencils. When these actions are also not acceptable, they may resort to misbehavior as part of a psychological need to move. Teachers consider many of these behaviors as red flags for an attention (or behavioral) disorder.

Another frustration kinesthetic learners face is poor achievement. Any type of learner can be successful. But of all the learning styles, kinesthetics are least likely to receive appropriate teaching. When reading is taught in the primary grades, most of the instruction involves the teacher talking (auditory) and using displays, either on the chalkboard or in books or handouts (visual). The teacher introduces new letters, words, or word families verbally and has the class repeat them (auditory), then write them (tactile). In kindergarten students generally take part in group activities involving songs with various actions and routines (kinesthetic), Projects requiring large-muscle movement are also common at that level, However, from first grade on, seat work predominates, and creative, kindergarten-type activities rapidly diminish. Not coincidentally, it is at this point that teachers often start complaining about "ADD behaviors" in some of their students.

Unfortunately, remedial reading instruction, tutoring, or even a specific learning disabilities program may not be successful if a student’s learning type has not been properly identified. Frequently the approach is just “more of the same,” using the same types of techniques as in the classroom. A thorough reading evaluation and customized approach, however, often results in rapid progress.

At the National Reading Diagnostics Institute, we recommend kinesthetic techniques before prematurely applying a label of attention disorder. An ounce of prevention, in the form of instruction matched to learning style, is worth years of remediation or special programs using inappropriate techniques.

When your child reaches the toddler stage you may discover that he has more energy, is more active, and less disciplined than most other kids of comparable age. At first you'll be pleased that he is outgoing and alert, not lethargic and withdrawn. Then, after chasing him day after day from one exploratory mishap to another, you may find that your reservoir of patience and stamina has been exhausted. That's when you'll begin to wonder whether his boundless energy is a blessing, after all. You may even worry that his behavior is abnormal; that he is "hyperactive" or a victim of "attention deficit disorder" (ADD), "learning disability" (LD), or "minimal brain damage" (MBD), all of which are so often diagnosed today.

My purpose in this chapter is to warn you of the hazards of making that diagnosis yourself, and of letting anyone else - doctor, teacher, or friend -do it for you. Once your child is given one of these labels there is a strong probability that he may be subjected to some unacceptable risks.

Professional counseling and drug treatment for children who exhibit exaggerated but perfectly normal developmental behavior has become almost epidemic in the United States. Largely because of pressure from school authorities, many American parents have lost faith in the legitimacy of their own decisions and in the accumulated wisdom of their parents, relatives, and friends. They've been led to believe that doctors and mental health professionals have the only answers to questions that previous generations answered quite effectively themselves.

If kids were made with cookie cutters, like the gingerbread man, norms could be set for your child's developmental behavior and the level of activity that he should display. Happily, they're not, with the result that no two children are precisely alike. That's frustrating for teachers, doctors, and every other professional who believes that everything in life should go by the book. It is not uncommon today for a child who is so active and inattentive that he gives his teacher fits to be diagnosed as "hyperactive" or "brain-damaged", treated with depressive chemicals, and isolated in the "learning lab" at school.

The possibility that your exceptionally active but perfectly normal child could be branded with one of these derogatory labels - none of which has a valid scientific definition - is not remote. The number of children who have suffered this fate has risen by 500,000 in the last five years. It could happen to your child if he displays some of these behaviors, which are on the checklists that psychologists use: doesn't always listen to directions; fidgets and won't sit still; daydreams in class; butts into situations that are none of his business; is slow getting ready for school; shows off when other children are around; or is more physically active than the other children in his class.

Your reaction to that list is probably the same as mine. I would begin to worry if a child didn't display most of those behaviors. Then I'd devote my attention to trying to diagnose why he is behaving like a vegetable! But when he does display them, the mental health professionals are likely to give him drugs that often do turn him into something resembling a vegetable!

Avoid Drugs for Behavior Modification

If some of your child's behavior is more exaggerated and thus more annoying than that of other children you know, don't endanger him by exposing him to therapy or drugs. Instead, search for the environmental factors - at home, in school, or among his peers - that may be causing emotional problems. What pressures on your child are producing the behavior patterns that are unacceptable to his teachers and to you? Search also for dietary allergies that may be at the heart of his problems. Meanwhile, try to relieve some of the emotional pressure that his behavior is causing, provide strong emotional support at home, and let him know that he has you on his side when he encounters trouble outside your home.

In my experience, if it is carried out objectively and thoroughly, this approach usually works. Certainly, if it does, it is a desirable alternative to professional counseling that may cause your child to be labeled hyperactive, MBD, or ADD. If that happens, your child's school will probably place him in a special education program and assign him to a "learning. laboratory", which will brand him as inferior among his peers. (In some schools the learning lab is derisively labeled - by the kids who aren't in it - as the "loony lab"!)

I don't believe any child deserves that fate simply because he is harder to manage or harder to teach than the others in his class. This should concern you, but you should be even more concerned if psychoactive drugs, such as Ritalin or Cylert, are prescribed for your child. Educators and doctors who label a child hyperactive or learning disabled, and then suggest treating him with chemicals, always defend their recommendations by asserting that it will improve the child's ability: to learn. They know that you will respond to this more positively than to their true motivation, which is to drug your child into near-somnolence so he will be more manageable and less of a nuisance in the classroom.

No one has ever been able to demonstrate that drugs such as Cylert and Ritalin improve the academic performance of the children who take them. The major effect of Ritalin and similar drugs is on the short-term manageability of hyperkinetic behavior. The pupil is drugged to make life easier for his teacher, not to make it better and more productive for the child. If your child is the victim, the potential risks of these drugs are a high price to pay to make his teacher more comfortable.

Dangerous Side Effects of Ritalin

What are the risks to your child if he is put on Ritalin or a similar drug? First, there is ample evidence that they are prescribed inappropriately, administered carelessly, and have side effects that are dangerous in themselves. Add to that the fact that they obviate the need and the incentive to discover what is really troubling your child, and you have a package that exemplifies contemporary medical practice and educational policy at their worst.

In the prescribing information for Ritalin that the manufacturer, Ciba-Geigy, supplied for the Physician's Desk Reference, the company acknowledges that it does not know how Ritalin works or how its effects relate to the condition of the central nervous system. It warns against the use of the drug in children under the age of six and admits that its long-term safety is unknown. It also notes that suppression of growth in those who take the drug has been noted in some cases and that there is some clinical evidence that it may provoke convulsive seizures in some patients.

The prescribing information then goes on to the potential side effects, which are so frightening that I will quote them directly from the book (the italicized phrases are mine)

Nervousness and insomnia are the most common adverse reactions but are usually controlled by reducing dosage and omitting the drug in the afternoon and the evening. Other reactions include hypersensitivity (including skin rash), urticaria [swollen, itching patches of skin], fever, arthralgia, exfoliative dermatitis [scaly patches of skin], erythema multiforme [an acute inflammatory skin disease], with histopathological findings of necrotizing vasculitis [destruction of blood vessels], and thrombocytopenic purpura [a serious blood clotting disorder], anorexia, nausea, dizziness, palpitations; headache; dyskinesia [impairment of voluntary muscle movement], drowsiness, blood pressure and pulse changes, both up and down; tachycardia [rapid heartbeat], angina [spasmodic attacks of intense heart pain], cardiac arrhythmia [irregular heartbeat,; abdominal pain, and weight loss during prolonged therapy.

There have been rare reports of Tourette's syndrome. Toxic psychosis has been reported in patients taking this drug; leukopenia [reduction in white blood cells] and/or anemia; and a few instances of scalp hair loss. In children, loss of appetite, abdominal pain, weight loss during prolonged therapy, insomnia, and tachycardia may occur more frequently; however, any of the other adverse reactions listed above may also occur.

This is the kind of information about a drug that the manufacturer is compelled by law to share with the doctors who will prescribe it. Unfortunately, there is no law requiring that the doctors who prescribe the drug share the information about its potentially damaging or fatal effects with you. That is why I have provided so much information about Ritalin, which applies, as well, to its counterparts.

If your child's teacher, school principal, counselor, or pediatrician attempts to pressure you into accepting chemical treatment for your child’s behavior patterns, reject the advice out of hand. There is no benefit that justifies the risks, nor can they be justified in order to spare his teacher the annoyance of having him talk out of turn or squirm in his seat.

Look for Emotional Pressures as Cause

Don't accept a teacher's assessment of your child's behavioral shortcomings without investigating whether they may be the result of his or her interaction with him. Irreconcilable personality conflicts are not uncommon, and if one exists between your child and his teacher, the teacher may be the problem if he or she is not dealing equitably and sympathetically with your child. In that case the answer is to change teachers, not to use drugs to try to alter the behavior of the pupil.

While you are endeavoring to correct any conditions that are causing problems for your child at school, look for others that may be troubling him at home. If he is insecure because of stress among other family members, try to resolve those problems or at least avoid exposing him to the tensions that exist. If there are difficulties with his playmates or others outside your home, try to resolve those. Then turn your attention to the possibility that his hyperactive behavior may stem from allergies to food or other substances. There is substantial evidence that nutritional approaches may succeed in improving his emotional condition and behavior.

I must caution you that your pediatrician may not be sympathetic to this approach. The late Dr. Benjamin Feingold, the pioneer of dietary control of hyperactive behavior, encountered great skepticism from others in the medical profession. That's not surprising, because doctors chronically reject non-medical solutions to problems they believe belong to them. Don't let that discourage you. Nervous system symptoms related to food hypersensitivity have been described by one observer after another for at least half a century. More recently, there has been a mass of clinical evidence which demonstrates that the Feingold diet does work with many children.

Dr. Feingold, who was chief of the allergy clinics of the Kaiser Foundation in California, zeroed in on chemical food additives - colorings, flavorings, preservatives, stabilizers, and others - as the principal contributors to hyperactive behavior. He recommended eliminating these chemicals from the diet by substituting natural foods for the highly-processed items found in most American pantries and refrigerators. There is overwhelming clinical evidence that this approach is often successful.

Dr. Feingold's results have been duplicated by many others. Dr. William G. Crook, a pediatrician and allergist at the Children's Clinic in Jackson, Tennessee, reported on another study at a food allergy symposium. He said that hyperactivity was related to food allergy in about three-fourths of the cases in a study of more than 100 children who were overactive.

Dr. Crook observed precisely what Dr. Feingold and many parents have experienced: children can be helped by using elimination diets to identify offending foods. He identified milk and refined cane sugar as the leading culprits in a list that also included corn, wheat, eggs, soy, citrus, and other items.

If you have an overactive child with behavior problems, don't turn to drugs prescribed by your doctor until you have determined what success you have with food you can buy from your grocer!

Question Diagnosis of Brain Damage

You should also be extremely wary of any suggestion that your child's behavior patterns stem from some form of brain damage or disorder. These conditions do exist in some children, of course, but the number is far fewer than the number of such cases that are diagnosed. Psychiatry is such an imprecise science, if it can be called a science, that its practitioners rarely agree on a diagnosis. Experiments have been conducted which show that psychologists and psychiatrists can be expected to agree with each other on a diagnosis only about 54 percent of the time. That's so close to the law of averages that you could consult a cabdriver and a carpenter and get the same result.

Nevertheless, on the basis of questionable diagnosis, your child may be recommended for psychotherapy if his behavior varies from what the mental health practitioner chooses to consider the "norm". Children who are correctly diagnosed as having brain or neurological damage or actual psychoses may benefit from treatment, of course. But short of that, there is little evidence that psychological counseling helps, and considerable evidence that it may actually aggravate a child's psychological/emotional problems.

The inadequacies of psychotherapy have been revealed repeatedly in follow-up studies of populations that exposed to psychiatric treatment. One well-known study points out that the spontaneous remission rate in patients with psychiatric conditions is 70 percent for both adults and children. Another study, reporting on a 20-year follow-up of patients at the University of Wisconsin, compared patients who were counseled with those who applied for but never received counseling. The most positive conclusion the study could reach was that counseling seemed to do no harm!

Another study of youths in Cambridge and Somerville, Massachusetts, was even less reassuring. It compared a group that had been counseled for five years, on a one-to-one basis with a personal counselor, to another group that received no therapy at all. Almost without exception, psychological therapy appeared to have a negative effect on these youngsters in later life. Begun in 1939, this 30-year follow-up found a solid correlation between therapy and criminal behavior. More of the men who had received psychotherapy as youths were convicted of serious crimes and multiple crimes than those who had no treatment at all. Those who had the longest and most frequent contact with counselors had the highest incidence of antisocial and criminal behavior.

Finally, a 1980 review of 120 studies of psychotherapy for juvenile delinquents found that those who received counseling fared worse, in terms of subsequent behavior, than those who didn't. A report on this research in the Toronto Globe & Mail summed it up in this paragraph:

If you want to stop a juvenile delinquent from robbing, raping, and clubbing people, don't send him to a social worker, a psychiatrist, a psychologist, a group home, or a therapeutic community, and don't make any efforts to counsel his family either. They all fail and some may even make him more violent than when he began.

There are, to be sure, some specific childhood mental and neurological disorders that stem from brain and neurological damage. Many of them are the consequence of medical interventions that I have discussed earlier in this book, e.g., cerebral-palsy, Down's syndrome, Tourette's syndrome, autism, etc.

If your child is the victim of one of these conditions, professional help is appropriate, if for no other reason than to explore innovative treatment that may appear - such as the nutritional supplementation methods in the management of mongolism and other causes of mental retardation pioneered by Detroit's Henry Turkel, M.D., and Ruth Harrell, M.D., of Old Dominion University. However, if your child is suffering from this kind of condition – rather than behavioral manifestations that simply make him more difficult to manage than other children – you’ll know the difference. Your best course is to seek professional help when it is clearly needed, but to avoid it if you are told that your child is suffering from a "learning disability", an "attention deficit disorder", or some other vaguely defined condition. The mental health professionals have yet to prove that any of these alleged disorders even exists!