Part I of II
As an observer of children for many decades, I’ve noticed that attention deficit hyperactivity disorder is now the most prevalent psychiatric illness of young people in America, affecting 11 percent of them at some point between the ages of 4 and 17. The rates of both diagnosis and treatment have increased so much in the past decade that one wonders whether something that affects so many people can really be a disease.
Current neuroscience research indicates that people with A.D.H.D. are actually hard-wired for newness-seeking. They have slow-moving and undernourished brain reward circuits, so much of everyday life feels routine and boring.
To compensate, they are drawn to new and exciting experiences and get impatient and restless with the regimented structure that characterizes our modern world. In short, people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.
From a teacher’s perspective, children with A.D.H.D. show a lack of focus and attention and demonstrate impulsive behavior. However, if you have the “illness,” the real problem is that, to your brain, the world that you live in essentially feels not very interesting. Children who take medicine to help them “focus,” would presumably otherwise find sitting in a traditional classroom unendurable and lose concentration quickly. However, when something is new and stimulating, they can maintain their interest without treatment.
Diagnoses of A.D.H.D. for children has increased 41 percent in recent years, according to the Centers for Disease Control and Prevention. This includes almost 7 percent of all young people who are on medication. Most alarmingly, more than 10,000 toddlers at ages 2 and 3 were found to be taking drugs, far outside any established pediatric guidelines.
Some of the rising prevalence of A.D.H.D. is doubtless driven by the pharmaceutical industry, whose profitable drugs are the mainstay of treatment. Others blame burdensome levels of homework, but the data show otherwise. Studies consistently show that the number of hours of homework has remained steady for the past 30 years. Lack of enthusiastic parental involvement may be another factor. It is certainly easier to medicate a child than to spend the time required to work on the issues presented. This is research begging for a dissertation.
Another factor that may be driving the “epidemic” of A.D.H.D. is the contrast between the regimented and demanding school environment and the highly stimulating digital world, where young people spend much of their time outside school. Digital life, with its vivid gaming and exciting social media, is rife with immediate gratification where practically any desire or fantasy can be realized in the blink of an eye. By comparison, school would seem even duller to a novelty-seeking kid living in the early 21st century than in previous decades, and the comparatively boring school environment might accentuate students’ inattentive behavior, making their teachers more likely to see it and driving up the number of diagnoses.
Adults with A.D.H.D have far more freedom to choose the environment in which they live and the kind of work they do so that it better matches their cognitive style and reward preferences. If you were a restless kid who couldn’t sit still in school, you might choose to be an entrepreneur or carpenter, but you would be unlikely to become an accountant.
In school, these curious, experience-seeking kids would most likely do better in small classes that emphasize hands-on learning, self-paced computer assignments and tasks that build specific skills. This will not eliminate the need for many kids with A.D.H.D. to take psychostimulants. But let’s not rush to medicalize their curiosity, energy and novelty-seeking; in the right environment, these traits are not a disability, and can be a real asset.
Not every high-energy or impulsive child has A.D.H.D. It is not a learning disorder, though it certainly affects learning. It is a complex cognitive and behavioral disorder. Clearing up this misconception is crucial to understanding both the disorder and the treatment. Children with A.D.H.D. have deficits in many of the functions we develop to manage ourselves and accomplish tasks. These difficulties not only put them at a disadvantage in terms of learning; they are often associated with disruptive or problematic behavior, in school, at home and even socially.
The good news is that there are very effective treatments for children with A.D.H.D.—not only medications, but also finely tuned behavioral therapies. There are techniques that can substantially minimize problematic behaviors and allow children to function more happily and successfully in the context of both their families and their classrooms. And because children with untreated A.D.H.D. can be difficult for teachers to manage—consuming a frustrating amount of your time and attention—techniques to help them function better are good for the rest of the class, too.
Medication can make an inattentive child more available for instruction; an impulsive child better able to stop a behavior that might get him in trouble; a hyperactive child more aware of the needs and desires of others. These and more are also the goals of behavioral intervention.
School creates multiple challenges for kids with A.D.H.D., but with patience and an effective plan, children can thrive in the classroom. There are practical strategies for learning both inside and out of the classroom. With consistent support, these strategies can help the A.D.H.D. child meet learning challenges—and experience success at school. These strategies will be discussed in Part II.
Dr. Wallace Greene is a veteran educator with a distinguished career in a variety of school settings. He is the founder of the Sinai Schools and is currently the executive director of The Shulamith School For Girls in Brooklyn.
By Wallace Greene
