The myth of the ADHD child 101 ways to improve your child's behavior and attention span without drugs, labels, or coercion

THE BIGGEST HOLIDAY of the year for parents is not Thanksgiving or Christmas or Mother's Day or Father's Day. It's the day in September your kid goes back to school - or, as I call it, "Tag, You're It!" day. Very soon, for six sweet hours, five delicious days a week, we hand our children over to the loving ministrations of someone who isn't us. As that glorious day nears, this might be a good opportunity to look at a recent crop of books about parenting. How did you do this summer? Yeah, I know. Me too. Thomas Armstrong's THE MYTH OF THE A.D.H.D. CHILD: 101 Ways to Improve Your Child's Behavior and Attention Span Without Drugs, Labels, or Coercion (TarcherPerigee, paper, $17) is a revised edition of a book that was first published more than 20 years ago, but it is still timely for the many parents who struggle with a question at the beginning of every school year: To medicate or not to medicate? According to the Centers for Disease Control, approximately 11 percent of children in the United States between the ages of 4 and 17 have received a diagnosis of attention deficit hyperactivity disorder. Prescriptions for stimulants like Ritalin and Adderall have increased steadily since the 1990s, with sales of A.D.H.D. medications projected in one study to reach $17.5 billion by 2020. While hyperactivity does exist, Armstrong says, educators and parents expect too much calm from our kids too soon, and as a result we pathologize normal child behavior, particularly boy behavior. As someone who was once vehemently antidrug, I have seen firsthand how medication can change a child's life ("I imagine this is what it's like to feel normal," my son said, after trying Adderall). Nor do I think drugs are a shortterm solution that necessarily leads to acting-out and selfloathing. Quite the opposite: I've seen medication break the shame spiral that comes with doing badly in school because a child is unable to pay attention, even to subjects he or she enjoys. Nevertheless, medication should be a last resort, and "The Myth of the A.D.H.D. Child" provides many excellent alternative strategies. My teenage son's favorite: "Use Touch to Soothe and Calm." "Can we enlist Maria Sharapova for that one?" he asked hopefully. Don't be misled by the title of Sarah Ockwell-Smith's GENTLE DISCIPLINE (TarcherPerigee, paper, $16). It's not "Fifty Shades of Lite Grey"; it's the latest in her series of popular books in the "gentle" genre. The subtitle, "Using Emotional Connection - Not Punishment - to Raise Confident, Capable Kids," is the giveaway. (Side note: Why do parenting books encourage such blabby subtitles?) Her methodology is not about being permissive, she insists. Rather, it's about good planning, "mutual respect and working with children, not against them." She details the many reasons kids behave badly, and her parenting philosophy can be summed up in this observation: "If you want kids to behave better, you have to make them feel better." We need to become like great schoolteachers, she says, figuring out how our children learn in order to help them grow. Very true. But Ockwell-Smith, who has four children herself, is a solemn teacher, and there's something a little exhausting about the methods proposed in this book. It's never enough to praise a good job; what is it about that job that's good? Ockwell-Smith likes specificity, and she has many strongly held ideas about cutting corners. For example, she believes distracting a little kid is a bad discipline tool, because it "prevents children from feeling, expressing and, therefore, managing emotions. . . . You prevent them from discovering that emotions are O.K." That sounds good, but I am not going to let my kid explore his emotional landscape in the middle of a Wal-Mart, over my refusal to buy the Fisher-Price Power Wheels. I am going to give him a couple of M&M's and get the hell out of there. The subtitle of IGNORE IT! (TarcherPerigee, paper, $16) is "How Selectively Looking the Other Way Can Decrease Behavioral Problems and Increase Parenting Satisfaction," or, when translated into my vernacular, "How Locking Yourself in Your Room With a Vodka Gimlet and Reruns of Comey's Testimony Can Make You a Better Parent." The family therapist Catherine Pearlman is not suggesting we la-la-la our way through all behavioral issues: If your child is engaging in unsafe or injurious behaviors, it's time to act. But she believes that some of the most annoying kid problems can be snuffed out once a parent acknowledges one of the unwritten rules of parenting: To a child, there is no such thing as "bad" attention. Screaming and shouting from a parent is better than no attention at all. She discusses the scourge of helicopter parenting, and how we have essentially turned our kids into a nation of tiny Willy Lomans, to whom Attention Must Be Paid. To extinguish irritating behavior and encourage the good stuff, Pearlman suggests parents look at their children the way B. F. Skinner looked at pigeons, using his theory that "what happened immediately following an action would determine if that action would be repeated." The less you react to whining and tantrums, the more quickly kids will figure out another tactic that works - say, niceness. The very fact that someone has felt the need to write a book on how to discuss the president of the United States with children - as if he were an illegal substance, or an S.T.D. - says more about the times we're living in than the particulars of the parenting tips given here. HOW DO I EXPLAIN THIS TO MY KIDS? Parenting in the Age of Trump (New Press, paper, $15.95), edited by Sarah Swong and Diane Wachtell, with commentary by Ava Siegler, is part series of essays, part collection of earnest advice. Writer-parents - including those who are gay, Muslim, Jewish and nonwhite - grapple with the question they say their kids are asking, which is essentially: Why does our new president hate us? This book isn't politically evenhanded, nor was it meant to be, but I did particularly enjoy one essay by a teacher, Molly Knefel, who writes that kids are talking about politics in school like never before - possibly because Potus "speaks in threats that a 7-year-old can understand." We should have never heard of Josh Shipp, if the story he tells about himself in THE GROWN-UP'S GUIDE TO TEENAGE HUMANS: How to Decode Their Behavior, Develop Unshakable Trust, and Raise a Respectable Adult (HarperWave, $26.99, to be published in September) is any indication. As a child in the foster care system, Shipp kept a log of his placements that detailed how quickly he was kicked out for bad behavior. It was usually pretty quick. Then, at 14, he was placed with a guy named Rodney. Rodney, a history teacher and middleschool football coach, knew of Shipp's past, and he became the lucky recipient of Shipp's greatest hits: shoplifting, getting drunk at school, passing bad checks. Shipp couldn't get Rodney to kick him out. Finally, after one particularly egregious incident that involved Rodney bailing him out of jail, Rodney sat him down and said: "You gotta get it through your thick head, son. We don't see you as a problem. We see you as an opportunity." Hearing this was the turning point in Shipp's life. His acquired street wisdom commands our attention as he gives us advice about dealing with our teenagers. "What kids don't talk out, they will act out," he says. Shipp is a motivational speaker and the founder of the youth empowerment group Kids These Days, and his most important premise, supported by research, is a little counterintuitive: No matter how your child behaves, his or her biggest concern is not being able to spend time with you. (Though I think my own son's biggest concern is that I will start dancing in front of his friends.) While Shipp's "pay attention always" approach may seem to contradict Pearlman's "ignore" edict, it really doesn't: They are complementary approaches to kids at different stages of life. Shipp talks about how the job of a parent shifts as a child ages from being an "air traffic controller," essentially having control of every aspect of that kid's life, to being a coach. How to create trust and mutual respect is the meat of this book. Mostly it involves doing stufftogether, never bailing on a promise (outside of a dire emergency) and teaching selfgovernance. Make no mistake, Shipp says: "Teens who are in trouble really, truly, do want to get caught." Shipp is an adult now, but he speaks from the point of view of a teenager, and his book resonates deeply. "The Grown-Up's Guide" also contains some amazing stories of adults handling unimaginably horrific situations. Shipp describes foster parents taking in a 10-year-old whose meth-addict parents had been prostituting him for drug money: How exactly do you turn that around? But the foster parents did. Inspiration doesn't have to be grand or fancy. Sometimes it's a simple idea that leaves you with goose bumps: A kid's life can be transformed by a caring adult who's just a little bit more bullheaded than the kid. JUDITH NEWMAN'S "To Siri With Love: A Mother, Her Autistic Son, and the Kindness of Machines" will be published this month. Her column appears every eight weeks.

Chapter One   The ADHD Blob Rolls Over America and the World   Recently, I happened to catch an old cult classic moviefrom the 1950s called The Blob. It's the story of a tiny gelatinous substancebrought to earth via a meteorite that begins to wreak havoc on a small town inAmerica, devouring everything in its path. As it rolls over people, the blobincorporates them into its mass and as it does so, it grows larger and larger.I won't spoil the story by telling you how the movie ends (Hint: It has somethingto do with climate change), but I will say that while I was watching the film Ithought of America's ADHD epidemic. The notion of there being an attentiondeficit disorder in the human mind began as a tiny blob of an idea when it wasfirst presented in a speech to the Canadian Psychological Association in 1972by its president, McGill University psychologist Virginia Douglas. Shesuggested that what at the time was being called hyperkinesis had more to dowith attention problems than with the behavior of hyperactivity. From there,the ADHD blob grew in size at cognitive science laboratories throughout the1970s (cognitive psychology having displaced behaviorism in the late 1960s asthe psychology field most likely to receive research funding from universities,foundations, and governmental agencies). In 1980, attention deficit disorderwas given official recognition as a psychiatric disorder in the United Statesby the American Psychiatric Association in their Diagnostic and StatisticalManual of Mental Disorders III (DSM-3).   Then, in the 1980s the ADHD blob gobbled up an entirevillage with the founding of Children and Adults withAttention-Deficit/Hyperactivity Disorder (CHADD), a parent advocacy group thatbegan lobbying the U.S. Congress to recognize what was then called ADD as alegally handicapping condition under federal disability laws. In the late 1980sand early 1990s the media began spreading the word about this new phenomenon ontalk shows, in feature articles, and through popular culture (in the 1992 movieWayne's World, for example, Wayne frequently reminded his somewhat scatteredbuddy Garth to take his Ritalin).   Big drug companies, sensing an opportunity to make a hugeprofit from this new attention disorder, started to financially support CHADDand fund individual doctors, ADHD researchers, and professional organizations.In 1997, the federal Food and Drug Administration (FDA) relaxed itsrestrictions on selling drugs to consumers and began permitting ads for ADHDdrugs in women's magazines, on television commercials, and through otherpublicity outlets, creating even broader exposure of ADHD to the publicconsciousness and creating an even greater demand for drugs to treat it.   In the 2000s, the ADHD blob rolled over a huge newcommunity as it extended its reach to include ADHD in adults, through Websites, blogs, social networking sites, chat rooms, and forums that discussedthe impact of ADHD on work, marriage, relationships, and general coping skills.Now, in the 2010s, the ADHD blob has overtaken and digested another largeregion, the world of early childhood, with kids as young as two years old beingidentified as having ADHD and medicated for their attention deficits. As I sitback and contemplate all that has gone on since 1972, I ask myself: Is thereanywhere the ADHD blob, now a gargantuan amorphous entity, has not yet visited?The answer: the rest of the world, where ADHD is spreading rapidly, with ratesrising as much as tenfold over the past few years in some countries.   Why I Call ADHD a Myth   Before I get any further into this chapter, there's onething that I want to set straight. When I say that ADHD is a myth, I amdefinitely not saying that there are no restless, inattentive, hyperactive,impulsive, and/or disorganized children (and adults) in America and the rest ofthe world. I worked for several years as a special education teacher, andduring my tenure, I taught so many kids who displayed these traits that I beganto think that all children acted in this way. I have no illusions about themillions of restless, inattentive, and/or impulsive children out there in homesand classrooms across the country and the world who are exasperating parents,testing the patience of teachers, and creating havoc in families and schools atepidemic levels. The reason I need to stress this fact is that when I wrote thefirst edition of this book twenty years ago, many people (especially those whohad been diagnosed with ADHD or whose children had been diagnosed with ADHD)became apoplectic, thinking that I was saying that they or their kids had noproblems. I have received a fair number of angry letters and emails from peopleover the years who felt that I was insensitive to their issues, blind to theirsymptoms, and completely out to lunch with my proclamation that ADHD is a myth.Not wishing to repeat this unpleasant experience, I need to state here plainlywhat I mean when I say ADHD is a myth. I'm using the word myth in this book interms of its original meaning from the Greek word mythos, which means "story."Over the course of the past forty-five years, a story has emerged to explainwhy some children are restless, inattentive, disorganized, hyperactive, and/orforgetful (among other behaviors). This story has been collectively told bymany different agents of society, including psychologists, psychiatrists,university researchers, educators, parents, the pharmaceutical industry, themedia, and those who have themselves received a diagnosis. Like any myth, it'sa story that has different versions, but overall there's a general consistencyto the basic narrative.   The ADHD Myth   ADHD is a neurologically based disorder, most probably ofgenetic origin (although prenatal smoking and lead poisoning are also known tobe contributing factors), which afflicts around 11 percent of America'schildren aged five to seventeen. Significantly more boys appear to have thisdisorder than girls (boys, 14 percent, girls, 6 percent), although girls whohave evaded detection for years are increasingly being identified as having theversion of ADHD that is referred to as "ADHD Inattentive Type." ADHD ischaracterized by three main features: hyperactivity (fidgeting, trouble playingquietly, always moving, leaving classroom seat, talking excessively),impulsivity (blurting out answers in class, interrupting others, havingproblems waiting turns), and/or inattention (forgetfulness, disorganization,losing things, making careless mistakes, being easily distracted, daydreaming).Current thinking has identified three major groups of ADHD children, one groupthat appears more hyperactive and impulsive, another that seems moreinattentive, and a third that has all three features. The symptoms must havelasted at least six months, have originated by the age of twelve, and have beenobserved in multiple settings (for example, home and school).   There are no lab tests, biomarkers, or other objectivemethods available to diagnose this disorder. Assessment tools include parent,child, and teacher interviews; a thorough medical examination; and the use ofspecially designed behavior rating scales and performance tests. There is noknown cure for ADHD, but it can be successfully treated in most instances usinga psychostimulant medication such as Ritalin, Adderall, or Concerta. Other drugshave also been used as well, including antidepressants such as Wellbutrin,blood pressure medications such as clonidine, and norepinephrine reuptakeinhibitors such as Strattera. Nondrug interventions include behaviormodification, parent training, a structured classroom setting, and informationgiven to parents and teachers on the proper way of handling ADHD behaviors athome and in school.   There is no known cause of ADHD, but current thinking hasit as involving structural abnormalities in the brain and biochemicalimbalances in areas of the brain that are responsible for attention, planning,and motor activity, including the striatum, the cerebellum, the limbic system,and the prefrontal cortex. Neurotransmitters that appear to be dysregulated inADHD include dopamine and norepinephrine.   Children who have been diagnosed with ADHD can experiencesignificant school problems, suffer from low self-esteem, have difficultyrelating to peers, and encounter problems in complying with rules at homeleading to conflict with parents and siblings. Some kids with ADHD also havelearning disabilities, conduct disorders (destructive and/or antisocialbehaviors), Tourette's syndrome (a disorder characterized by uncontrollablemotor or verbal tics), and/or mood disorders including depression and anxiety.While ADHD seems to disappear for some children around puberty, it canrepresent a lifelong disorder for up to 80 percent of those initiallydiagnosed.   Although this description of ADHD omits many fine pointsand details and although there are disagreements within the ADHD community inregard to some of these issues, I believe there is very little in mydescription that most ADHD experts would seriously dispute. I want to emphasizeagain, however, that this is a story. It may be supported by thousands ofmedical studies, as claimed by a 2002 International Consensus Statement on ADHDsigned by more than eighty of the leading authorities in the field, but it isstill a story gleaned from those research findings. We should remember that inancient times, myths were stories that people told to account for unexplainedphenomena in their lives (for example, wars, storms, illness, and death). Heretoo we have an unexplained phenomenon: Millions of children in our culture arerestless, inattentive, impulsive, and disorganized despite our best efforts toparent and educate them, and as in ancient times, we want to have a way ofmaking sense of this situation. Naturally the storytelling elements used in themodern age (research, clinical data, epidemiological studies, and so on) arefar more sophisticated than those used in ancient times (such as supernaturalentities, magic, and divine revelation). Nonetheless, the intent is still thesame: to provide a coherent narrative, easily understood by the average person,for why millions of children are not acting in the way that we suppose theyshould act.   As we'll see in the next chapter, my biggest problem withthe ADHD myth is that it's just not a very good story. Yes, it looks good onthe outside with the fine veneer of medical authority, scientific rigor, andgovernmental support. However, when one digs deeper into the story,inconsistencies start to appear, other interpretations of the same data beginto emerge, and alternative stories to account for the same restless,inattentive, and impulsive behaviors start to appear, especially when weinclude other fields of inquiry beyond neuroscience, psychiatry, and clinicalpsychology, such as sociology, anthropology, evolutionary biology, economics,gender studies, media studies, developmental psychology, and family systemstheory. In the next chapter, I discuss some very specific problems with theADHD myth, and in subsequent chapters, I share a number of alternativeinterpretations or stories that can also account for the millions of restless,inattentive, and impulsive children in our homes and schools.   Chapter Two   Why the ADHD Myth Is Not a Very Good Story   A good story has certain essential elements in it. Itshould have a compelling beginning, a strong middle, and a convincing andconclusive ending. The ADHD story, on the other hand, has a feeble beginning, aconfusing middle, and an ending that appears wildly out of control. ADHDhistorians often like to situate the beginnings of the disorder in an 1845German storybook of morality tales for children called Struwwelpeter(Shock-Headed Peter). The book contains a poem titled "Fidgety Phillip" about achild who wiggles, giggles, tips his chair, and can't sit still. Thisdescription would fit many young children alive on the planet today. Finally,he pulls off the tablecloth (with the food still on the table) and hides or istrapped underneath it. Again, we're talking about an incident that could happen(and probably has happened) to many families at one point or another in theirlives. The book of poems from which this story was taken also includesvignettes of a child with poor grooming habits, a boy who won't eat his soup,and a boy who goes outside during a storm with an umbrella and is sent flyingthrough the air. What are the current disabilities for which these particularpoems provide historical beginnings?   The History of ADHD: A Bad Novel in the Making?   The second foundational event occurring at the beginningof the ADHD story concerns a British doctor named George Still. In a series ofthree lectures to the Royal College of Physicians in 1902 London, Still spokeabout children who possessed a "morbid defect of moral control" not accountableto "feeble-mindedness" or medical illness. To use this as one of the key plotpoints for the beginning of a story about a disorder now said to afflict morethan six million children in the United States alone is, and I say this assomeone who has written fiction myself, a weak literary move. Still was talkingabout only a very few children (he cites around twenty in his lectures), not 10percent of all children worldwide. The children in his case studies behaved inways not even remotely similar to the American Psychiatric Association's DSM-5criteria for ADHD. Still's patients defecated in bed, stole, and lied; one evenwent up to two kids in the playground and "banged" their heads together inThree Stooges fashion, causing them great pain. Finally, Still attributes thebehaviors of these children to a "moral defect," constructing a cause that isabsent from today's neurobiological thinking about the origins of ADHD(although he does claim to be able to identify moral defects by the size of thechildren's heads!). To use a single fictional child in a poem, and twentychildren from medical case files to serve as the beginning of a story affectingthe lives of millions of children and adults worldwide is, in my opinion, tobuild a narrative structure on quicksand.   From its humble and irrelevant beginning, we advance tothe middle of the story, when things start to get a bit confusing and a littlecrazy. After World War I, children who had survived the worldwide encephalitisepidemic and apparently displayed symptoms looking like ADHD were said to besuffering from "post-encephalitic behavior disorder." In the 1930s, two Germanphysicians, Franz Kramer and Hans Pollnow, referred to children with ADHD-likesymptoms as having "hyperkinetic disease of infancy." Based on cases ofchildren who had shown these symptoms after suffering from actual brain damage,doctors in the 1940s began to use the term minimal brain damaged to describechildren who acted this way. In the 1960s, many scientists became dissatisfiedwith this term because of the absence of any detectable brain damage, so theycoined a new term to describe these kids' situation: minimal brain dysfunction,or MBD. In 1968, with the publication of the second edition of the psychiatricbible, The Diagnostic and Statistical Manual of Mental Disorders, the termhyperkinetic reaction of childhood became the correct nomenclature to use indescribing and diagnosing this disorder. Even with all these name changes, thenumber of children considered to be suffering from whatever term happened to beused at the time was very small. Excerpted from The Myth of the ADHD Child, Revised Edition: 101 Ways to Improve Your Child's Behavior and Attention Span Without Drugs, Labels, or Coercion by Thomas Armstrong All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.