Alex began having disciplinary problems in school during 4th grade. In 5th grade, he broke glass in school and was sent to the psychiatric ward in a hospital. He was diagnosed with ADHD when his parents took him to the psychiatrist who “talked to [Alex’s parents] for 15 minutes, then to Alex for 15 minutes,” and promptly put him on Ritalin. When the medication did not seem to be having any positive effect, the psychiatrist suggested increasing the dosage. However, when it was increased, Alex became so violent that his parents had to hospitalize him again. After another set of assessments, it was determined that Alex actually had bipolar disorder, which shares some characteristics with ADHD when seen in children, and the medication he was put on actually triggered the violent episodes (Nazario, 2005).
Ayo struggled with schoolwork, so he decided to get tested for ADHD. After “only one visit and a series of questions, his doctor prescribed him Adderall.” He was asked how he is doing in school, about his sleeping patterns and health, and a few more questions, but the doctor did not put him through any “actual tests,” and everything was based on Ayo’s input and statements (Kwon, 2010). Fortunately, the only side effect that he got was headaches (which were the reasons why he stopped taking Adderall).
In both cases, the doctors, parents, and students themselves were uninformed, causing for these confusions, and incidents like this could be contributing to the overall sharp increase in diagnosis of Attention Deficit Hyperactivity Disorder in grade-school students all across America.
Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is a “psychological diagnosis in which an individual exhibits a long-standing pattern of difficulty attending to others, focusing attention, listening, and following through; also characterized by physical restlessness and impulsiveness” (NODCC, 2009). The main symptoms are “excessive hyperactivity, impulsiveness and inattentiveness,” but there is a controversy with using these symptoms as the basis of diagnosis because “these symptoms are also signs of normal childhood behavior” (Crowe, 2009). ADHD is currently “one of the most common chronic conditions of childhood” and also the “most common neurobehavioral disorders in child health” (Stein & Perrin, 2003). There are three different types of ADHD, as defined by DSM-IV: the ADHD, Combined Type (exhibits both inattention and hyperactivity-impulsivity symptoms), ADHD, Predominantly Inattentive Type (exhibits inattention but not hyperactivity-impulsivity symptoms), and ADHD, Predominantly Hyperactive-Impulsive Type (exhibits hyperactivity-impulsive but not inattention symptoms) (WebMD, 2009).
There are strong evidences from numerous studies that suggest that there is a trend of rapid increase in diagnosis of Attention Deficit Hyperactivity Disorder in school-aged children in America. In 2003, Centers for Disease Control reported that the prevalence of ADHD diagnosed in children between the ages of 3 and 17 years old currently stands at 5.3 million (Centers for Disease Control and Prevention, 2010). In terms of the rate of diagnosis in children, between the late 1980’s and early 2000’s, diagnosis of ADHD in children 6~18 years in age increased by 500% (Evans, Morrill, & Parente, 2010). Office visit diagnosis went up by almost 250% between 1990 and 1995, and annual outpatient visits for children with ADHD to hospitals rose 130% between 1993 and 2003 (Robison, Sclar, Skaer, & Galin, 1999) (Toh, 2006).
With the rise in diagnosis comes rise in number of prescriptions written out for the children to treat them, most commonly with stimulants such as Adderall and Ritalin. Adderall prescriptions increased from 1.3 million to 6 million between 1996 and 1999, and Ritalin prescriptions increased dramatically in the early 1990’s, and have since then leveled off at around 11 million per year (Frontline, 2001). From 2000 to 2005, according to “Journal of Attention Disorders,” treatment prevalence of ADHD medication prescriptions increased by 11.8% a year for the population as a whole (Grohol, 2007). Between 1996 and 2006, over 40 million Adderall prescriptions have been written (Smith, 2006). To place the numbers into perspective, there was a 700% increase in psychostimulant use in the 1990’s in the United States (LeFever, Arcona, & Antonuccio, 2003).
The increasing trend in diagnosis of ADHD in children has many adverse side effects that are often overlooked, such as negative effects to the children’s psychological health and potential health risks from the prescription drugs for ADHD. It is currently estimated that about 20% of the children currently diagnosed as having ADHD, or over 900,000 children, are misdiagnosed (Michigan State University, 2010).
Self-fulfilling prophecies are always a source of great danger because it is so powerful, and children are very easily influenced by outside sources. If a child is lead to believe that he is not “normal” and is not worth the expectations of the adults around him, he is likely to end up “fulfilling” the “prophecy,” and not live up to his potential. Once the diagnosis of ADHD is placed on the child, “it may be very difficult to perceive his or her behavior any other way but within that framework,” which makes it difficult for the child to crawl out of the negative feedback giving environment (Hartnett, Nelson, & Rinn, 2004).
Although ADHD medications are very helpful to many children in toning down the restlessness, impulsivity, and inattention in many, they can also have many negative side effects such as loss of appetite, stomach pain, insomnia, weight loss, growth rate reduction, development of muscle tics, and in some cases, serious conditions such as cardiovascular problems (Kam, 2010) (Landau, 2010) (USA Today, 2009). Even if the children do not exhibit strong side effects and keep on taking the medications for years, the concept of having the children on these medications is “worrisome because of the unknown impacts of long term stimulant use on children’s health” since stimulant medication usage in children is a relatively new phenomenon (Michigan State University, 2010).
Centers for Disease Control and Prevention lists genetics, brain injury, environmental exposures (ie: lead), alcohol and tobacco usage during pregnancy, premature delivery, and low birth weight as some biological risk factors for ADHD (Centers for Disease control and Prevention, 2010). However, it is relatively clear when looking at the statistic that there was over 500% increase in ADHD diagnosis in children 6 through 18 years of age between the late 1980’s and early 2000’s, that the biological factors are most likely not the only ones. There are other possible causes that could be accounted for in the rise of ADHD diagnosis, such as lack of proper knowledge about the disorder, and possible benefits that could be gained from the ADHD diagnosis.
In most cases, the referral process for a student to be diagnosed with a learning disability begins in the school. Many parents come into the pediatrician’s office based on a recommendation from the student’s teacher, but psychiatrists warn that a teacher suggesting that a child has ADHD is “inappropriate and dangerous,” and it is “not [the] teacher’s place to make diagnoses or to recommend medication” because they are not qualified or informed enough to do so, and are very likely to not take into account other factors in the child’s life that could cause attention problems such as chronic fears, parental deaths, chronic otitis media, and learning disabilities (Landau, 2010) (WrongDiagnosis, 2010). Sometimes, even pediatricians are not the ideal people to consult in diagnosing ADHD, because unlike psychiatrists, pediatricians are not trained to do comprehensive assessment to properly diagnose many disorders that may exhibit similar symptoms as ADHD (Nazario, 2005).
The child’s age can also be a factor in a diagnosis when a teacher and doctor’s perception of what is “normal” becomes distorted. It is possible, due to the cut-off dates in schools, for a child to be almost a whole year younger or older than another, and when in the lower grades, this naturally creates a cleft in intellectual and emotional maturity. Even in kindergarten, the youngest in the grade were 60% more like to be diagnosed with ADHD than the oldest ones, and by the time the children reached 5th or 8th grade, the youngest were more than twice as likely to be prescribed stimulants. The perception of teachers in these cases was skewed by the fact that they were assessing the children by comparing them “against classmates of a different age set,” and therefore different maturity levels in many aspects (Michigan State University, 2010).
There are many potential benefits that a diagnosis of ADHD can bring to the student and those around him, including IEPs or 504 plans, “excuses” for poor behavior or work, and “easy fix” solutions, such as medications. Individualized Education Program require that students with “delayed skills or other disabilities” be “eligible for special services that provide individualized education programs in public schools, free of charge to families,” and a 504 plan mandates that “children with disabilities receive modifications or accommodations to help them learn, even if they don’t qualify for special education” (U.S. Department of Education, 2010) (Bachrach, 2008) (Fay, 2010).
Children diagnosed may also be “excused” from taking full responsibility of common behaviors displayed by children with ADHD, such as having hard time paying attention, being easily distracted, forgetting things, fidgeting, talking too much, or acting impulsively (Centers for Disease Control and Prevention, 2010). This may be an incentive for parents to obtain the diagnoses for their children, to establish that their children are not doing certain things because they are “bad students,” but rather, because they have a disability that needs accommodation for.
Medication as “quick and easy fix” for ADHD is very inviting to teachers and parents, especially because the medications most often prescribed for ADHD, such as Adderall and Ritalin, are so well known and connected to the disease (Landau, 2010). The eagerness to use medication may also be facilitated partly by insurance companies’ willingness to pay for medications over therapies, and the fact that doctors and even large advocacy groups for people with ADHD (such as Children and Adults with Attention Deficit/Hyperactivity Disorder) is sponsored partly by the drug companies that make these medications (USA Today, 2009) (Kluger, 2010).
As educators, the best interest of the students should come first. This large increase in diagnosis of children with ADHD may reflect the American society’s overall desire to classify everyone, especially those who are “out of the line,” or not conforming in the “appropriate” manner. Children may be a little less mature than their peers, for whatever reasons including age, but when society try to put all of the children into neat lines and they stick out, they are automatically labeled to have a learning disability, ADHD, or other disorders to “explain” the behavioral difference. Change in the way society views the differences not as disabilities, but as individuality is necessary in order to become a truly integrated and diverse nation that America is known to be, and though there may be many positive aspects to being diagnosed with ADHD if one truly has the disorder, parents, teachers, and doctors must be aware of the negative consequences that surround diagnosis of ADHD, the medication, and the psychological and social problems that may follow it. They must also be aware of the potential dangers they could be placing the child in if the diagnosis was a mistake. Teachers must try their hardest so misfortunes such as the one that came upon Alex, or worse, will not occur to their own students.
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