A Disease Called Childhood

A Disease Called Childhood: By Marilyn Wedge 

Wedge sets out to answer one question, “Why is ADHD an American epidemic?” Why is ADHD more diagnosed in America than anywhere else in the world? Wedge looks at many different factors including the rise of pharmaceutical companies marketing to doctors to medicate, an increase in screen time and consumption of unhealthy food, and a decrease in physical activity.

Wedge starts out with a how the components of ADHD are defined:

INATTENTION

1.     Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities

2.     Often has difficulty sustaining attention in tasks or play activities

3.     Often does not seem to listen when spoken to directly

4.     Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

5.     Often has difficulty organizing tasks and activities

6.     Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

7.     Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)

8.     Is often easily distracted by extraneous stimuli

9.     Is often forgetful in daily activities

HYPERACTIVITY

1.     Often fidgets with hands or feet or squirms in seat

2.     Often leaves seat in classroom

3.     Often runs or climbs excessively in inappropriate situations

4.     Often has difficulty playing quietly

5.     If often “on the go” or acts as if “driven by a motor”

6.     Often talks excessively

IMPULSIVITY

1.     Often blurts out answers before questions have been completed

2.     Often has difficulty waiting for a turn

3.     Often interrupts or intrudes on others

A history of ADHD

ADHD first appeared in 1968 in the DSM (Diagnostic and Statistics Manual) II labeled as “hyperkinetic reaction to childhood.” It was believed that the cause for hyperkinetic reaction was psychosocial. This means that the symptoms were a reaction to stress in the child’s social environment or emotional conflicts that they were dealing with.

In 1980, a newer edition of the DSM (DSM III) ADD or Attention Deficit Disorder replaced hyperkinetic reaction to childhood and included new criteria: distractibility, disorganization, short attention spans, procrastination, and acting impulsively. All of these behaviors had to last for 6 months. ADHD finally made its way onto the seen in 1987 in the DSM III R (revised). The revision did not make a distinction between ADD and ADHD, however they believed that there were predisposing factors in the central nervous system as well as “disorganized/chaotic home environments.” This was a fundamental change in how disorders had been applied previously. Instead of diagnosing due to a cause, a disorder was now diagnosed based on symptoms. In 1994, the DSM IV differentiated between an inattentive type and hyperactive type of ADHD. The DSM V further expanded the diagnoses by extending the age of onset of symptoms to start at 3 years of age. Since 1987, the amount of children diagnosed with ADHD has reason from 3% to 12% in 2014. With the increase in diagnosis there has been an increase with medications. Today 15-40% of high school students take amphetamines to boost their grades and attention spans.

It would be natural to assume that an increase in ADHD diagnosis in the United States would lead to an increase of ADHD in other cultures as well. However, you would be mistaken. Wedge explores other cultures reaction to the rising rates of ADHD and finds that many cultures have very low levels of ADHD. She particularly looks at France and wrote the book: “Why French Kids Don’t have ADHD.” When the DSM III came out with ADHD, French Psychiatrists did not take a medical approach to the disorder, instead they took a psychosocial approach.

They considered the whole child in his/her social context—family, personal history, experiences at school, and relationships with friends. They took a long, hard look at the role of parenting and how that shapes the growth and development of their child. In France, structure and predictability make a child feel safe and secure. The few things that French parents are most strict about are mealtimes, the amount of screen time and bedtime. Mealtimes are a time for socialization within the family and an opportunity for a child to have a healthy meal. The French believe that a child feels happier and safer with limits and structure in their lives.  Without structure, the children rule the house instead of the parents. Therefore, instead of medicating their children, French psychologists educated parents on these subjects with wonderful benefits and a substantially lower rate of ADHD.

Big Pharma

During the late 1970s, as the DSM III was readied for publication, pharmaceutical companies were becoming a large force in the medical community. Big Pharma doled out large sums of money for research for particular drugs and their affect on different diagnosis: especially ADHD. One of the largest companies, Pfizer financed symposia to train 6,000 primary care physicians in the use of PRIME-MD. PRIME-MD allowed doctors to use checklists to make a psychiatric diagnosis in an average of 8 minutes. This was at the same time that the popular antidepressant, Zoloft was introduced. Wedge traces the relationship between Big Pharma and ADHD to one pediatrician: Charles Bradley. Charles Bradley opened a hospital in East Providence for his daughter Emma, who had encephalitis and children with similar conditions that could not afford medical care. The complex included open fields for children’s sports, scouting activities, and outdoor play in a natural setting. Nearby, a pharmaceutical company, Smith, Kline & French launched a new drug, Benzedrine. It was a nervous system stimulant used for decongestion of nasal passages. They discovered that the drug had favorable results that improved mental alertness and concentration. The company gave out free supply to interested doctors, including Charles Bradley. He hoped that the drug would relieve severe headaches in some of his children.

He found that it did not have much of an effect on headaches, but a dramatic improvement in their concentration and behavior. However, Bradley also found that there were some unexpected side affects with Benzedrine including insomnia, appetite loss nausea, dizziness, and fearfulness. He found that the drugs improved academic achievement on the first day, but only temporarily modified behavior. Bradley wrote about his research in the Yale Journal of Biology and Medicine, but unfortunately it had the unintended effect that he wanted. It opened the door for psychiatrists to associate children’s behavioral symptoms with biological brain problems, opening the door to overmedication. They saw the short-term benefits, but did not take the long-term effects into consideration.

Wedge believes that medication may be beneficial, but as a last resort. Before using medications parents should use a checklist of possible causes of the child’s symptoms:

1. Adverse childhood experiences such as physical or sexual abuse, or neglectt
2. Inappropriate discipline or absence of discipline
3. Chaotic and disorganized home
4. A parent’s illness, injury loss of employment, or chronic unhappiness
5. Unhealthy diet
6.  Excessive screen time
7. Divorce or chronic marital problems
8. Conflict with a teacher or boredom in the classroom
9. Insufficient sleep on an ongoing basis
10. Insufficient physical exercise
11. Misinterpretation of a child’s normal behavior during a developmental phase.

A Change In American Schools

Wedge believes that American schools need to have a dramatic change in the way we educate our children. Looking at Finnish schools (which repeatedly score high on Internationally standardized tests), school starts later, there is not as much homework given, children eat healthy lunches, and for every 45 minutes of lesson time, children have 15 minutes break for free play. Finland’s student scored first in reading and science, second in math, and third in problem solving on the global PISA (Program for International Student Assessment) test. Teachers in Finland are treated with the same prestige that doctors and lawyers receive in the United States. Acceptance into post-secondary education programs is very competitive with only the top 10% of students being offered slots. Children that are identified as needing extra help at a young age are able to receive extra attention in Finnish school because it is a nation-wide priority. I believe that all of these changes would be beneficial for our students and the lead to a decline of ADHD diagnosis.

Dietary Interventions

Wedge has an entire chapter devoted to the negative effects unhealthy food can have on attention and impulsivity. She gives an interesting history of the ingredients of M&M’s in the United States and in Europe. In the United States artificial food dyes including Red #40, Yellow #5 and #6 and Blue #1 and #2 are all used in their M&M’s where in Europe dyes are extracted from natural foods—beets for red, carrots for orange, and saffron for yellow.  Unfortunately, a lot of children are allergic to these artificial dyes, which affects their school performance and behavior. The distinction between the two cultures can be traced back to the 70’s. Long story short, Europe took a stance against artificial dyes, while the United States did not.

Wedge’s healthy diet for children:

·      A hearty breakfast

o   Containing protein and omega-3 oils (walnuts, fish or a vitamin supplement)

o   Peanut Butter on whole wheat toast

o   Scrambled eggs cooked in canola or olive oil

o   French toast made from whole-wheat bread

o   Unsweetened granola, muesli, or whole-grain cereal wit milk and fruit

o   Oatmeal with chopped walnuts, flaxseed or Brazil nuts

o   Grilled cheese with whole-wheat bread.

o   All accompanied with a glass of milk

Screen time

Wedge describes a study done by Dimitri Christakis at the University of Washington that found attention problems increased by 20% for every extra hour of screen time. Another study found that there was a difference between what types of television programs children watched. The study split 60 four-year olds into three groups. One group colored a piece of paper, one watched the PBS show Caillou, and another watched SpongeBob for nine minutes. After their television time, the children were given a series of tests that looked at attention and concentration. The results of the study showed that children that watched SpongeBob did significantly worse on the attention and memory testing than the children in the other two groups. The performance between those that colored and those that watched Caillou had no significant difference. It is than safe to conclude that screen time can be valuable, but it is important to note what type of television children watch. It is hypothesized that the fast-paced nature of SpongeBob can be too stimulating and therefore shortens the attention span of children that watch the show frequently.

The rise of electronics in the form of iPads and iPhones is definitely affecting the attention span of our children and should be taken very seriously. Wedge proposes that children under the age of 3 do not use those electronics at all and after the age of 3, to limit screen time to educational programs that are not fast paced.

All in all, I believe that the author raises some serious questions about the history of ADHD and the other ways that we can help children with hyperactivity and attention problems without prescribing medications. I think this book is a must read for all.