Preschoolers are always learning new skills: how to brush their teeth, dress themselves, look both ways before crossing the street, and … now take their Ritalin? On Oct. 15, the American Academy of Pediatrics (AAP) presented new guidelines at their National Conference and Exhibition in Boston MA. One of these guidelines included expanding the age range of children who may be diagnosed with ADHD and prescribed medication. Under these new regulations, children as young as four could be taking Ritalin.
According to The Gale Encyclopedia of Genetic Disorders, “the exact cause of ADHD is unknown”; however, as stimulant drugs treat ADHD by increasing the amount of dopamine in the brain, the common presumption is that ADHD is related to low levels of dopamine. Dopamine is a neurotransmitter that is involved with the brain’s reward system; things such as eating food and having sex are often cited as actions that increase the amount of dopamine in the brain. The supposition here is that children with ADHD have difficulty staying on task because they literally take less pleasure in their work.
According to the 2006 book Should You Medicate Your Child’s Mind?, psychiatrist Elizabeth J. Roberts MD argues that one can only diagnose ADHD if the child is unable to follow through even if they want to. That is, she writes, “If he is able to attend to the tasks that are important to him, your child may just be ignoring the things that he does not like or want to do.” Lack of interest, she outlines, is not ADHD.
Roberts also explains that ADHD cannot be diagnosed when the symptoms could possibly be caused by any other disorder or factor in the child’s life. Her strict guidelines do not seem to be shared by the medical community at large. Roberts names a case where a young girl named Ella, whose family moved constantly, was diagnosed with ADHD after receiving an abbreviated survey by another psychiatrist that showed only that Ella had difficulty concentrating. While often distracted in class, Ella was able to play with dolls quietly for hours on end. Roberts suggested a better diagnosis would be anxiety, induced by the constant change of schools.
A 2006 study conducted by a team in conjunction with the New York State Psychiatric Institute demonstrated slowed growth rates for preschoolers taking Ritalin. The study lasted 70 weeks, and showed that the children taking the medication were on average “one-half inch shorter in height and weighed 3 pounds less than expected” using data on the average growth of US children the same age, as reported in Science News. It was also noted that other side effects of Ritalin had more prevalence in this age group than their older counterparts, with one in 10 of the participants dropping out of the study due to the unwanted reactions. There are multiple possible side effects of Ritalin, including seizures, depression, and difficulty sleeping.
There are alternatives to Ritalin. A study in the Netherlands tested the effectiveness of changing the diet of children with ADHD. As reported in the Guardian, the study saw a group of 50 children diagnosed with ADHD given “foods with the least possible risk of allergic reaction – a combination of rice, meat, vegetables, pears, and water.” Another group of 50 was given no special diet, only instructions given the parents to feed their children healthy meals, and to keep a diary of everything their child ate. The results saw improvement in 78 per cent of first group, as opposed to the second control group, where there was no change.
sA study from 2004, conducted by researchers from the University of Illinois found that within a group of 400 children diagnosed with ADHD, those who spent more time playing outside in a natural setting had reduced symptoms, compared to children who played inside or even outside on manmade structures, as reported on Psych Central. The study was based on long-distance surveys and the results saw little variation between children of different socioeconomic status or sex.
The consensus in the medical community is that ADHD is a real issue, but it often becomes a convenient label to stick on any problem child. Issues of mental health are much more complicated than they seem, and a variety of environmental factors shape our behavior. A child who has difficulty concentrating in school may have difficulties at home, poor nutrition, or difficulty sleeping. Last year, research by a Michigan State University economist, Todd Elder, found that about 20 per cent of ADHD cases are potentially misdiagnosed due to a child’s immaturity in conjunction with their classmates. As reported in Science Daily, “The youngest kindergartners were 60 per cent more likely to be diagnosed with ADHD than the oldest children in the same grade.”
Psychiatry is a difficult field, as most diagnoses are based on behavioral symptoms alone. Because there is such potential for misinterpretation of symptoms, there needs to be more of a graduated process of diagnosis as well as serious measures that prevent irresponsibility within the field. There is some consideration for this in place already: the guidelines from the AAP do state that ADHD behavior must be present in more than one situation, unlike in the case of Ella. Not only this, but behavioral therapy is meant to be a first resort; medication a last.
However, there is little evidence that psychiatrists and parents readily follow these guidelines. In fact, psychiatrics readily form financial relationships with pharmaceutical companies. US Dr. Thomas Insel, who wrote a study on the topic, was quoted in the Prince George Citizen as saying that he believes that this results in “bias in prescribing practices”.
It’s not easy to diagnose a psychiatric disorder. However, in too many cases diagnosis occurs due to the parent’s desire to keep their child running at the same rate on the educational treadmill as the rest of their class, and not out of interest in their child’s current well-being. Some have expressed concerns that our modern, instant, push-button lifestyle has fuelled short attention spans. In this case, nothing is more symbolic of this culture than the instant solution of medication.
// Illustration by Miles Chic
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