What to do with a rowdy, inattentive child? Give up, diagnose, medicate.
Alarmingly, that’s what is happening to many kids who exasperate their parents and teachers — and boys are up to four times as likely as girls to be slapped with an ADHD tag, which in itself is disturbing.
The symptoms of Attention Deficit Hyperactivity Disorder, as determined by US psychiatrists in 2000, are gender neutral.
Yet we have stereotyped it as a male issue, and the younger the child, the more at risk he is of being misdiagnosed and prescribed stimulant medication such as Ritalin, the side effects of which can include decreased appetite, stomach aches, dizziness, sleeplessness and even suicidal thoughts.
Research released this week on more than 311,000 students in Western Australia has found that children aged six to 10 who were born in June (the last month of the school year intake in that state) were twice as likely as their classmates born in the previous July (the first month) to be medicated for ADHD.
Three-quarters of those were boys.
The “late birth date effect” was less dramatic but still significant among 11-15 year olds.
The findings, published in the Medical Journal of Australia, mirror those of other large-scale studies in North America and Taiwan and renew fears that children’s wellbeing is being compromised by adults who are not qualified or too quick to judge.
Lead researcher Martin Whitely, a visiting fellow at Murdoch University, says the criteria for diagnosing ADHD are sloppy and subjective, resulting in “crazy distortions”.
Teachers, Mr Whitely says, could be assessing children according to their class year level rather than their relative age, and mistaking immaturity for a psychiatric disorder.
Moreover, if ADHD is a neurobiological disorder as claimed, then a child’s date of birth or gender should be irrelevant.
The definition of ADHD, according to the international psychiatry bible DSM-5, is a “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”.
I’ve seen lots of kids who fit this description, girls as well as boys, but frequently it’s the adults around them who seem to be the problem.
I’m talking about teachers with no clue how to control a class or effectively discipline a disruptive student; parents who let their kids run amok in shopping centres, cafes or cinemas; and other adults in positions of care and responsibility who shrug off unacceptable behaviour as “kids being kids”.
Mr Whitely goes as far as calling ADHD a “meaningless label” that is confused with normal, if annoying, childhood behaviour.
Writing in The Conversation, he says this stops people from looking at what’s really going on with certain kids.
If a child is easily distracted, playing too loudly, fidgeting in class, avoiding homework, or interrupting the teacher, then he or she has ADHD?
Give me a break.
Worryingly, rates of prescribing medication for ADHD are on the rise, both in Australia and overseas, which would suggest that some doctors are willing to treat with amphetamines what can be cured with tough love and patience while maturity kicks in.
Shaun Rudd is Queensland chair of the Australian Medical Association. The Hervey Bay GP says while some children are appropriately diagnosed with ADHD, a large and increasing number are misdiagnosed.
Parents, often supported by teachers in their unqualified assessment, march in to a doctor’s room and demand a prescription.
Dr Rudd says while some children benefit from being on medication, others do not need it and their behaviour could be improved with better parenting.
Setting boundaries, enforcing limits, saying no instead of yes after endless nagging, and refusing to indulge tantrums and other attention-seeking actions are cornerstones of good parenting.
They apply in the classroom as well. Kids need to be praised for positive behaviour and not rewarded, with undue fuss, for the negative.
Parents also have a responsibility to send their children to school as well-equipped as possible to learn. At a minimum, this means ensuring they get a decent sleep, eat a healthy breakfast, and arrive at school on time.
Teachers also need to be better prepared. When studies show that burnout is greatest in the first five years of teaching and that dealing with difficult children is a key contributor, then more must be done to support educators as they tackle the demands of the modern classroom.
Some kids act out due to boredom, particularly if they are very bright, others due to frustration, if they can’t grasp the work as presented. Others still are struggling with bullying, trauma or various forms of neglect.
And let’s not forget that children learn and develop at their own pace.
Turning to ADHD as an easy explanation for problematic behaviour fails to do justice to the little people in our care.
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