The Evolution of ADHD, Education, and Drugs in America – Part 5

Posted by on August 18th, 2007 | Comments off

Note: I’ve lectured on this subject for over 10 years. This will be the first time I’ve placed my collective thoughts into print. I’ll present the topic as a series of essays.

Sigmund Freud vs. Dennis the Menace

As I mentioned previously, many factors were involved in the cultural shift that altered our perception about children like Dennis the Menace. The cultural shift has made the United States the leading consumer of Ritalin. As a matter of fact, according to the International Narcotics Control Board (INCB), the US now consumes about 90% of the world’s Ritalin supply!

The cultural shift was gradual, but what made us change perception to the point where we consider children like Dennis to have a neurological disorder? To put it plainly, we now consider Dennis to have a problem with his brain. Who would have thought that possible? Well, psychiatrists, actually.

Sigmund Freud, famed Austrian neurologist and psychiatrist who co-founded the psychoanalytic school of psychology was perhaps best known for the theory of the unconscious mind. He proposed that the mind was multi-layered and that these layers could cause physical problems. The notion that the mind possessed a subconscious element was not new. Psychologist William James and colleagues had written about it years before, but it was Freud who advanced the concept by proposing that the subconscious could be systematically studied through psychoanalysis.

For years prior to Freud’s contributions, especially during the 19th century, French sociologist, Auguste Comte’s positivism was favored. Positivists believed that one could come to true understanding of oneself through scientific study and discipline. In other words, one could control oneself and one’s environment through free-will. Freud countered that free will was not possible because we have a subconscious of which we are totally unaware and often act for reasons that are unrelated to our conscious thoughts. These “repressed” thoughts were often directed toward one’s parents; however, individuals could repress different things as well.

Freud’s theory, although greatly altered one way or another, permeated medical practice as it was taught at many medical schools. Universities began to teach it, and it eventually took hold in public education by the 1950s. Even before that time, in mid 1940s, Dr. Benjamin Spock had devised a child rearing philosophy based more on Freud’s theory than on the popular behaviorist model of the time. Spock emphasized the need for parents to understand and treat each child as an individual and to understand their particular needs. Detractors generally cited Spock’s work as “overly permissive” and government spokes people cited him for creating much of the turmoil of the 1960s. But that’s an entire blog unto itself. Point of fact is that as a culture, we understood, disciplined, and dealt with children based on nurturing. If a child had a problem, it was caused by his upbringing. Furthermore, it was thought that the problem could be corrected by nurturing the child and changing the child’s environment, through understanding the child’s needs.

This changed radically in 1980 with the release of the Diagnostic and Statistical Manual III (DSM III).

The other articles in the series “The Evolution of ADHD, Education, and Drugs in America” can be found below.

  1. Dennis the Menace
  2. Henry Ford and Education
  3. Henry Ford vs. Dennis the Menace
  4. Soviet Menace vs. Dennis the Menace
  5. Sigmund Freud vs. Dennis the Menace

he Evolution of ADHD, Education, and Drugs in America – Part 4

Posted by on August 17th, 2007 | Comments off

Note: I’ve lectured on this subject for over 10 years. This will be the first time I’ve placed my collective thoughts into print. I’ll present the topic as a series of essays.

The Soviet Menace vs. Dennis the Menace

In the late 1950s, when Dennis the Menace was just beginning to annoy his neighbor, Mr. Wilson, certain dynamics would once again change the face of education; our nemesis, the Soviet Union, launched Sputnik. The Soviet Sputnik program involved the launch of a series of man-made satellites after testing their viability through unmanned space vehicles. The cold-war fear of the Soviet Union and their possible nuclear superiority also led to the creation of NASA.

Sputnik prompted the U.S. government to increase spending on scientific research and education. This led to the National Defense Education Act (NDEA). The NDEA provided federal money for increased instruction in math & science, as well as foreign language. Another important feature of the NDEA was the forgiveness of loans for higher education; educational expenses for prospective elementary and secondary teachers could be waived. The thrust of the NDEA also reasserted emphasis on academic fundamentals like reading, writing, and arithmetic.

So, now children in the Henry Ford production line model of education, tempered by John Dewey’s experiential, nurturing educational philosophy, were exposed to changes to curriculum based on society’s fear of satellites. Strangely enough, even with the crazy dynamics of the times, children with attention problems existed; however, they were viewed quite differently than today’s ADHD children and actually survived and thrived quite well. Nurturing was expected and practiced at school, boundaries were set and maintained; if you got in trouble at school, you were likely to be in twice as much trouble when you got home. Furthermore, without the demands of incredibly stringent testing in all grades, ADHD children could were not exposed to the demands currently place on them.

But this would change within a decade or so. Due to the emphasis on science and math, curriculum began to be pushed downward. What was once taught at first year university was now being pushed to junior and senior years in high school. Junior and senior high curriculums were pushed downward as well. Over the years, this chain of curriculum change found its way all down to kindergarten. More tests were now needed to assess whether the curriculum changes initiated by both federal and state mandates were making our children smarter and more competitive with the rest of the world.

Another dynamic was causing social change. With an ensuing space race and advancing technology, a new core value system was in play; happiness comes through owning material things like new technology or the next best automobile. To get more things and therefore be happy, one had to make more money. To make more money one had to pursue higher education. To get the opportunity to pursue higher education, make more money, and be happy, one had to perform better at school.

I won’t argue philosophically about material goods bringing happiness, but most research indicates this is not so. What’s important to note here is that we have a definite class system in place; those who perform well at school have access to higher education and happiness, and those who are cast out of higher education to go to technical or trade schools, make less money and are less happy. That’s the perception, anyway.

The other articles in the series “The Evolution of ADHD, Education, and Drugs in America” can be found below.

  1. Dennis the Menace
  2. Henry Ford and Education
  3. Henry Ford vs. Dennis the Menace
  4. Soviet Menace vs. Dennis the Menace
  5. Sigmund Freud vs. Dennis the Menace

The Evolution of ADHD, Education, and Drugs in America – Part 3

Posted by on August 16th, 2007 | Comments off

Note: I’ve lectured on this subject for over 10 years. This will be the first time I’ve placed my collective thoughts into print. I’ll present the topic as a series of essays.

Henry Ford vs. Dennis the Menace

Dennis the Menace began appearing as a comic strip character in the early 1950s. While his physical appearance changed slightly in the 1960s and 1970s, he was still considered a lovable child when I began my teaching career in the mid 1980s. We continued to laugh at his innocent acts of menace toward his family and friends without mention of medication or ADHD.

When I met my Dennis, or John, in the late 1980s, I was astonished that he was viewed by the other staff as ‘uncontrollable’ and ‘unteachable.’ He was considered a problem child. John was a square peg trying to fit in the round hole of an educational machine. The educational world had less tolerance for children like John, and ADHD was about to was about vastly change education – not necessarily for the better.

What had in fact affected John in the 1980s had its roots in much earlier times. A confluence of events was actually creating the perfect storm for the Ritalin revolution. Change was underway in education, mental health, and medicine that produced an enormous shift in American culture. This shift would greatly affect John and all children like him.

Dennis the Menace was not yet created in the early 1930s when Henry Ford’s efficient production line model was adopted into public education. In mass fashion, children were taught in classrooms with rows, using state issued textbooks, aggregately reciting the pledge of allegiance, and instructed at the same pace with the same curriculum by the same teacher. We now had efficient education for the masses.

This model was somewhat tempered by philosopher John Dewey. Dewey received his Ph.D from the School of Arts & Sciences at Johns Hopkins University in 1884. However, his theoretical basis for his Pragmatic school of thought was developed during his tenure at the newly founded University of Chicago beginning in 1899. The Pragmatic school of thought embraced an empirically based theory of knowledge which was further refined at the University of Chicago Laboratory Schools. Dewey developed his ideas for education based on his work at the Laboratory Schools and published Experience and Education in 1938 after many other books. Dewey emphasized a humanistic approach to education where development of problem solving and critical thinking skills were fundamental and paramount to increasing intellect. This contradicted the traditional practice of rote memorization. His philosophy of education also embraced individualization and accounted for the needs and differences among students. This was based upon Dewey’s vision that while a student is a small part of society, they student will in turn strengthen democratic society if he is a critical thinker and problem solver. This is analogous to the pilings in a bride; the stronger the pilings, the stronger the bridge.

While Dewey’s pedagogy was not officially adopted by schools, his influence affected national education for a long period and created an environment where nurturing and experience played important roles in rearing children. This would soon change.

The other articles in the series “The Evolution of ADHD, Education, and Drugs in America” can be found below.

  1. Dennis the Menace
  2. Henry Ford and Education
  3. Henry Ford vs. Dennis the Menace
  4. Soviet Menace vs. Dennis the Menace
  5. Sigmund Freud vs. Dennis the Menace

The Evolution of ADHD, Education, and Drugs in America – Part 2

Posted by on August 15th, 2007 | Comments off

Note: I’ve lectured on this subject for over 10 years. This will be the first time I’ve placed my collective thoughts into print. I’ll present the topic as a series of essays.

Henry Ford and Education

The great industrialist and inventor, Henry Ford founded his company on precision and efficiency in the early 1900s. To produce cars for the masses, he would need a method of assembly that could quickly assemble mass produced parts into a complete automobile. His assembly line model rapidly changed the world. Using the assembly/production line model, mass assembly of products became the norm. This in turn produced higher volumes of products available to the masses. Mass production allowed manufacturers to sell products for cheaper prices as well. All of this was based on efficiency. Educationalists were impressed.

Prior to the early 20th century and the assembly line, manufacture was performed by a single craftsman or team of craftsmen. Known as the English System, craftsmen typically would produce each part of a product individually. In the final phase of production, the craftsmen would assemble the components together into a single product. At that time, if changes were needed to the individual parts, the craftsmen would modify the parts to make them fit or work together. While this process was slow and did not produce mass quantities of goods, it produced high quality goods with attention to detail. This practice was similar to our method of teaching in rural one-room school houses where students sat together on benches.

If we envision a student as a basic raw component, like a car chassis, and following the production line model, we could get his wheels on by the end of kindergarten. In first grade we insert the engine. In second grade we put in the brakes. In fourth grade we put on the body. Thus, by the end of high school, we should have a completed student or car as it were.

There would be a need then, to make this process efficient. There would be no more need for small school houses. Big schools would be built where large numbers of students could be housed. Mass transportation would have to be implemented to ensure that large numbers of students could be assembled in the larger schools. Students should sit in rows as this would make it more efficient for the teacher when handing out mass produced work sheets and tests. There would be no need for individualized instruction when a generalized curriculum would fit. By senior year in high school, those students not prepared to move on to higher education (defective parts) can be diverted to technical schools to prepare them for work in the service industry.

And that’s what we did in the early 1900s.

The other articles in the series “The Evolution of ADHD, Education, and Drugs in America” can be found below.

  1. Dennis the Menace
  2. Henry Ford and Education
  3. Henry Ford vs. Dennis the Menace
  4. Soviet Menace vs. Dennis the Menace
  5. Sigmund Freud vs. Dennis the Menace

The Evolution of ADHD, Education, and Drugs in America – Part 1

Posted by on August 14th, 2007 | Comments off

Note: I’ve lectured on this subject for over 10 years. This will be the first time I’ve placed my collective thoughts into print. I’ll present the topic as a series of essays.

Dennis the Menace

Anyone remember Dennis the Menace? As a child, I watched Jay North portray that mischievous blond-headed boy who always got into trouble and annoyed his grumpy neighbor. Dennis was loved back then.

Dennis is the kid everyone seems to have on his street even now. He’s intelligent and uses it to get into everything. Even when he tries to help others out, he still finds trouble. He often acts out without thinking about consequences.

I taught ‘Dennis’ during my second year as a classroom teacher in the North Carolina school system in the mid 1980s. His real name was John. John was the type of boy that the other teachers called ‘hellion’ in hushed whisper in the faculty lounge. The other teachers told me that, “He won’t do anything. Tie a carrot to the end of a stick; he’ll play with it all year.” Instead of being that character we all loved, ‘Dennis’ was medicated.

Being a progressive teacher and not having become cynical, I was determined to save John. Since I had learned nothing at university about unfocused, hyperactive children, I consulted my professors. They advised me to move John closer to my desk; set up an individualized education plan (IEP) that included modifications to John’s curriculum, shortened assignments and instructions; and a daily checklist with rewards.

I followed their instructions implicitly. John sat right next to my desk. The modifications to his curriculum quickly began to change John’s self-esteem. We got work done everyday and his math and reading ability began to improve. His parents, however, only had eighth grade educations. They failed to return John’s checklist after a couple of days. They also didn’t have the skills to provide positive reinforcement at home. To my dismay, John’s father began to hit him with a leather belt. Corporal punishment was still used at school, so this wasn’t unusual, even though I didn’t approve.

A few days later, John came in and placed his forehead on his desk behind folded arms.

No more than three feet from my right hand, I nudged him and said, “Didn’t you get enough sleep last night?”

He looked up at me without the mischievous twinkle, his eyes a little bloodshot. He pushed a folded note at me across my desk. “Medicine,” he said.

The note was from John’s family doctor. It was actually a checklist for me to complete that would assist the doctor in determining dosage. I completed 4 checklists without seeing much change in John’s groggy demeanor. The hellion was gone, his spark was gone, but he was manageable at home. At least John’s father wasn’t beating him anymore.

The other articles in the series “The Evolution of ADHD, Education, and Drugs in America” can be found below.

  1. Dennis the Menace
  2. Henry Ford and Education
  3. Henry Ford vs. Dennis the Menace
  4. Soviet Menace vs. Dennis the Menace
  5. Sigmund Freud vs. Dennis the Menace

Study finds divorce increases Ritalin use in children

Posted by on August 14th, 2007 | Comments off

ADHD does not seem to be a condition like pregnancy where one is either pregnant or one is not. Rather it is a matter of degree. Some children and adults range from mildly inattentive to profoundly inattentive. The degree seems to be directly affected by a variety of environmental factors including divorce, parenting skills, etc. More frequently than not, drugs are prescribed to allay the symptoms. Obviously, they do not affect core issues that affect the child like divorce, marital discord, or learning disabilities.

Study finds divorce increases Ritalin use in children

HELEN BRANSWELL
Canadian Press
June 4, 2007 at 8:46 PM EDT

TORONTO — Children whose parents divorce are nearly twice as likely to be prescribed Ritalin in the aftermath of the split, a Canadian study reports.

But the author, a sociologist from the University of Alberta, cautioned against concluding that children of divorce are over-prescribed the drug, which is used to treat Attention Deficit and Hyperactivity Disorder, or ADHD.

Lisa Strohschein said the data she used can only identify the phenomenon and cannot reveal why Ritalin use rates are double when children of divorced parents are compared to children whose parents stay married.

“I’ve got the what, but not the why,” Ms. Strohschein said from Edmonton.

Ms. Strohschein suggests there may be a variety of answers. Some kids may need the drug to cope with the stress of the split, some kids may have ADHD and some kids may be getting a drug they don’t really need.

“The problem is I can’t be clear about it,” she said.

“I mean, I would love to be able to say ‘Yes, it’s divorce. That’s the problem,’ But it’s not necessarily so. It could just be our perceptions about divorce — and that’s the thing that makes me really cautious here.”

“(But) I don’t want to come out on the other side, either and say ‘Ritalin is bad’ because I think it clearly does help some kids.”

The psychiatrist-in-chief of the Hospital for Sick Children in Toronto said the study should serve as a reminder to doctors to move cautiously when prescribing Ritalin or other methylphenidate-based drugs to children in these circumstances.

“What we need is a deeper understanding of this issue, at the level of the primary care practitioners,” said Dr. Abel Ickowicz.

“Because . . . if we are going too quick to prescribe medication, like Ritalin, like methylphenidate, we may not only be masking the normal process of adaptation to divorce, but we may be contributing to the degree of distress the children of divorce are experiencing.”

The study, published in the Canadian Medical Association Journal, used data gathered by Statistics Canada through its National Longitudinal Survey of Children and Youth. The survey, which was first conducted in 1994, is completed every two years; Ms. Strohschein used data collected between 1994 and 2000.

Previous researchers had identified the fact that children who live in a household with only one parent or with a parent-step-parent combination were more likely to be on Ritalin than children growing up in households with both parents.

But it wasn’t clear whether the increased use was among all children in a single-parent household — in other words, children whose parents had divorced, children who had lost a parent to death and children born to a single mother — or whether some subset of these children was more heavily prescribed the drug.

Ms. Strohschein compared prescription rates among 4,151 children whose parents hadn’t divorced and 633 children who had. She found that 3.3 per cent of children in the two-parent families were prescribed Ritalin; among the children whose parents had divorced, that figure rose to 6.1 per cent.

The study notes a number of potential explanations for the doubling of the usage rate.

One possibility is that the stress of the divorce aggravated a child’s existing behavioural problems to the point where Ritalin would actually be helpful, she hypothesized.

It is known that ADHD can run in families. In addition to passing on the condition to their children, parents with ADHD-type behaviour might be more likely to divorce — a theory that points towards appropriate use of the drug.

Another possibility is that in divorce, the natural emotions children experience — anxiety, sadness, anger — may manifest themselves in behaviour that is mislabeled as ADHD-like, or that parents and doctors may be anticipating problematic behaviour because of the stress of divorce. The study suggested this type of rationale would reflect inappropriate use.

Dr. Anton Miller, a developmental pediatrician and child health researcher at the University of British Columbia’s Centre for Community Child Health Research, said it’s possible no single answer applies across the board for these children.

“None of them is an outlandish kind of suggestion. They probably all have some validity,” he said.

“It’s certainly possible in some instances that ADHD might have been prematurely diagnosed…. But I would caution anybody (against) saying ‘Well that’s why all these children are getting medication.’ “

“But there is a possibility that in a proportion of the cases we need to try and figure out how much that does happen in the real world and try and advocate … for children to have thorough and really in-depth assessments for these kinds of behaviour and emotional problems.”

Ms. Strohschein agreed: “I think the take-home message is just to be careful not to make that broad assumption that kids must necessarily be doing poorly when their parents divorce. Some kids will do better, some kids will do worse.”

The Last Normal Child and ADHD

Posted by on August 13th, 2007 | Comments off

Dr. Lawrence H. Diller’s book, The Last Normal Child: Essays on the Intersection of Kids, Culture, and Psychiatric Drugs, is a fascinating and provocative work. As an experienced developmental/behavioral pediatrician, Diller examines the current trend to quickly diagnose attention deficit hyperactivity disorder (ADHD) and the perfunctory prescription of stimulant drugs even when there is scarce evidence regarding academic improvement, social improvement, or long-term efficacy.

Diller’s perspective is quite evenly balanced; he prescribes stimulant medication for ADHD when indicated, but only as part of thorough assessment and comprehensive management program.

It is clear that Diller believes that ADHD is being over diagnosed. He states that over the last 15 years brand name stimulant production has increased by an astounding 1700% and generic stimulants by more than 3000%!

The number of U.S. children taking psychotropic drugs has doubled over the last ten years. We currently have more than 4.5 million children under 18 taking psychotropic drugs – mostly stimulants. Perhaps even more alarming are the percentages of ADHD children being reported by the Centers for Disease Control (CDC): typically common rates between 5% to 7% are reported in children in Colorado and 5.5% in California. However, as many as 10.5% of children in Louisiana are diagnosed with ADHD as are 11% of children in Alabama.

Diller suggests that the rampant diagnosis and pharmacological treatment of ADHD might be related to the fact that, “The drug industry hijacked American psychiatry in the 1990s….Insurance companies structure doctors’ reimbursement so as to reward short visits, ones in which a prescription brings the session to a definite conclusion.”

Diller also suggests that the Individuals with Disability Education Act of 1990, actually accelerated pharmacological treatment as well as the ADHD diagnosis because its amendment in 1991 now included ADHD as a diagnosis that makes a child eligible for special services and accommodations in public schools. As parents quickly learned, an ADHD diagnosis could gain their child special services and testing accommodations.

The pharmaceutical industry parleyed this trend by targeting parents with direct ADHD drug advertising. Parents, having diagnosed their child via the effects of the advertising campaign, could now approach their family practitioner to request stimulant drugs as a remedy. Diller suggests that many parents welcomed a brain-focused diagnosis that relieved them of responsibility for problem behavior.

The book encompasses far more than I’ve described here and is well worth reading. It is an excellent, balanced perspective that provides insight into the staggering $3 billion juggernaut known as ADHD.