“ADHD is a fictitious disease.” So trumpeted many memes and much-shared social media posts not long back. You may have seen some of them. And, if you’re like me and many others who suspect that pharmaceutical companies prey off of the fears and insecurities of Americans seated on their sofas, bombarded with constant commercials for this miracle drug or that, you may have found some validation in this.
Trouble is, like much of what makes the rounds on Facebook (think the spurious “privacy statements” that so many people posted and which are thoroughly – and hilariously – debunked by John Oliver), this claim is seriously flawed.
Turns out, while Dr. Leon Eisenberg, in an interview with Der Spiegel, did indeed say something like this, the quotation was taken out of context and may suffer from an inexact translation from the German. What Eisenberg was saying, essentially, and indeed what he is quoted as saying in the very next line in the Der Spiegel piece, is that “the genetic predisposition to ADHD is completely overrated.” In other words, we’re placing too much emphasis on the biological aspects of ADHD and not enough on the situational.
According to the US Centers for Disease Control and prevention, about 11 percent of school-aged children in the US have been diagnosed with ADHD, and by high school 19 percent of boys have been given this label. (That’s a 66% rise since 2000.) Wait, what? Almost 1 in 5 school-aged boys in the US has a serious neurobiological disorder?
Apparently so. And apparently two-thirds of kids diagnosed with ADHD take prescription medication for it, almost exclusively Ritalin, Adderall, Concerta or Daytrana. In fact, ADHD medication annually pulls in 13 billion dollars in the US alone.
In the US, ADHD is generally considered to be a biological-neurological disorder (thus the prescription drugs). But that’s not the case in many other countries. In France, for example, it’s largely thought to have psycho-social and situational causes, and only 0.5% of children are diagnosed with the condition (as opposed, you will remember, to 11% in the US).
So why do so many kids, particularly boys, in the US have ADHD? The truth is that ADHD is a complicated diagnosis. There’s no blood test for it; it doesn’t show up on an MRI. A diagnosis of ADHD involves gathering information from parents, schools, and caregivers, as well as having a full physical examination – including hearing and vision screenings. The symptoms of ADHD (the child is careless; often loses things; is easily distracted; squirms and fidgets; is in constant motion; does not seem to listen, etc.) should persist over a period of at least 6 months. Or at least that’s how it should be diagnosed.
But retired Harvard psychologist Dr. Jerome Kagan complains of “fuzzy diagnostic practices.” Dr. Kagan goes on to say, “Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these 5.4 million kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.”
Dr. Eisenberg, he of the “deathbed confession,” seemed to concur, claiming that “child psychiatrists should more thoroughly determine the psychosocial reasons that can lead to behavioral problems. Are there fights with parents, are there are problems in the family? Such questions are important, but they take a lot of time.” On the other hand, you can “prescribe a pill for it very quickly.”
There are many reasons why the number of kids in the US diagnosed with ADHD has skyrocketed – pressure from parents for a quick fix for their children’s academic woes, increased advertising from pharmaceutical companies promising easy results, overly-broad diagnostic criteria and diagnoses based on a 10-15 minute visit to a pediatrician’s office. But I would add another.
Recess. Or the lack thereof.
Schools in the US have been reducing or eliminating recess and unstructured play time for years, with a sharp decrease after the No Child Left Behind Act of 2001. With the increased demands of standardized testing, schools are devoting more time to Core Curriculum classes, cutting out physical education and recess. (In many schools music, art, family and consumer science, industrial arts and health education have also been shelved or much reduced.) The results are bad.
“I get this feeling in my legs when they want to run and that feeling moves up to my belly and when that feeling moves up to my head I can’t remember what the rules are,” says Nadav Gilboa, a Pittsburgh first-grader. He had recently gone from recess twice a day and Physical Education twice a week to one (shortened) recess and PE once a week, and had begun misbehaving in the classroom. Nadav was not alone. Study after study show that reduced recess time leads to poor classroom behavior and an inability to concentrate. It leads, in fact, to classic ADHD-type behavior.
Think about it a moment. The impetus for getting a child tested for ADHD frequently comes from teachers or school administrators. One of the primary reasons for lack of focus, inattention, and an inability to sit still is lack of sufficient physical movement. Due to limited recess time, kids don’t get that necessary physical movement. And while it’s clearly not as simple as this, the sharp uptick in ADHD diagnoses took off after 2000, just at the time schools were doing away with recess. Hmm.
The American Academy of Pediatrics has this to say. “Recess represents an essential, planned respite from rigorous cognitive tasks. It affords a time to rest, play, imagine, think, move, and socialize. After recess, for children or after a corresponding break time for adolescents, students are more attentive and better able to perform cognitively. In addition, recess helps young children to develop social skills that are otherwise not acquired in the more structured classroom environment.” They summarize plainly: “The American Academy of Pediatrics believes that recess is a crucial and necessary component of a child’s development and, as such, it should not be withheld for punitive or academic reasons.”
For punitive reasons. If a school even has recess anymore, who, ironically, is most likely to be kept behind and not allowed to go out to play? That’s right, the kid who squirms and fidgets, is in constant motion, does not seem to listen. The kid who needs it most. The kid with ADHD.
Finland is often considered to have one of the best educational systems in the world. Do you know what their timetable is like? Forty-five minutes of instruction followed by 15 minutes of unstructured free time. American Timothy Walker went to teach in Finland, and was bewildered by these breaks. Found them unnecessary. And so he changed his fifth-graders’ schedule to allow for more classroom time. By his own account, it was a disaster. He soon realized that students were more attentive, focused and enthusiastic if they were given regular breaks.
It turns out that recess isn’t some frivolous bit of fun, but an absolutely essential part of children’s educational experience. In an article in the Washington Post, Angela Hanscom sums it up succinctly: “In order for children to learn, they need to be able to pay attention. In order to pay attention, we need to let them move.”
So what can you do?
If you have a child diagnosed with ADHD, get them outside and moving as much as possible. Numerous studies indicate that “exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children.”
If you are in the US, contact your congresspersons and express support for the Fit Kids Act. If not, contact your governmental representatives and demand physical education and free play as part of your kids’ daily educational regime.
Contact your local legislators and demand recess policies that promote healthy classrooms. Demand programs that promote walkable communities and bike paths. Walking or biking to school has been shown to improve attention and provide increased performance on tests.
Encourage your school district to have sensible recess policies and include physical education as part of the curriculum for all school levels. Parent-Teacher Associations can have a tremendous amount of influence on local schools, so push for sensible policies which promote physical movement during the school day.
Three programs that your school can be involved in are Fire Up Your Feet, whose mission is “to advocate for safe walking and bicycling to and from schools, and in daily life, to improve the health and well-being of America’s children and to foster the creation of livable, sustainable communities,” Let’s Move!, which, while aimed primarily at eliminating childhood obesity, also encourages increased physical activity, and Peaceful Playgrounds’ Right to Recess campaign, which is pretty self-explanatory.
Only 17% of high school students in the US are meeting the government’s physical activity guideline of 60 minutes a day. At least 30 minutes of that, advises the Institute of Medicine, should be done during school hours. We’re failing our kids, and paying the price in Ritalin.