Add (attention deficit disorder) and ADDH (attention-deficit disorder with hyperactivity) are psychiatric labels being pinned on children who present with a certain range of behavioural symptoms. Many of these children following diagnosis are put on Ritalin, a drug which is purported to improve attention span (though not to improve verbal ability!).
The promoters of the use of Ritalin also claim that it can help children to attain their full potential who seem to get very little out of school, who can't sit still, don't take directions well, are easily frustrated, excitable, aggressive . . . and have a short attention span.
Wonder drug indeed! However, in spite of the aggressive marketing of Ritalin its use is often questionable. For most children the road to Ritalin use begins at home or in the classroom. Some medical colleagues talk about the parent "who roars into the surgery with child in one hand and a magazine or newspaper article about Ritalin or ADD or ADDH in the other saying: `I want you to slow my child down before I murder him.'"
In other cases, it is the paediatrician or family doctor who, partly in response to pervasive drug company promotion, first suggests a drug trial. But, in most instances, the initiative comes from the school. The teacher writes to the parent or calls for a parent-teacher meeting or refers the child to a school psychologist or counsellor to express her legitimate concern about a student's behaviour or academic performance, suggesting he is lacking attention or hyperactive and recommending a psychological assessment. Most parents comply, others resist and may even change schools.
The typical list of signs of so-called ADDH includes restlessness, fidgeting, very short attention span, a child flitting from one activity to another, extreme oscillations in mood, clumsiness due to over-activity, aggressive behaviour, impulsivity in school, inability to comply with rules and a low frustration level.
It is the case that children may persistently present with any of the symptoms listed above, but the presence of a "problem" within a child should not be equated with the presence of a biological syndrome. Indeed social and family factors may be the most significant influences bearing on the behaviour of young children and it may be that community attention to these factors rather than the current trend of provision of extra psychiatric and behavioural-modification facilities might bring more relief to the families and schools affected and improve the quality of the lives of everybody concerned.
In any case it is rarely the case that any one cause underlies a behavioural problem. Any assessment needs to be holistic in nature and that includes a biological evaluation as well. It is extremely worrying that ADD and ADDH are being broadcast as actual rather than hypothetical conditions. There is no biological test for these socalled syndromes, but they are implied when a certain range of behavioural symptoms are present.
What is not explained is why the same range of signs can describe children with self-esteem problems, conduct disorders, emotional disorder, school phobia and mild autism. Furthermore, there is no rationale given for the fact that boys are labelled more than girls.
Another fact is that a majority of these labelled children tend to come from disadvantaged homes compared to their better-off peers. There is no doubt that both parenting and teaching are the most difficult professions of all.
There is no training required for parenting and there is no way that teachers are even remotely prepared to deal with the myriad of behavioural, social and emotional problems of children and their besieged parents.
It does not take much common sense to realise that all the difficult behaviour said to be symptomatic of ADDH could, with equal, if not more, conviction and justification be called socially deviant. In other words they are in direct opposition to the needs of parents and teachers for compliance to certain norms, rules and standards of behaviour.
Labelling and drugging children takes some of the responsibility and stress off the shoulders of parents and teachers, but it does not resolve the reasons why children are manifesting these difficulties. It is a short-term solution for the adults; for the children it can sometimes seem as if their cry for help is being heard - but for most it leaves them labelled, drug-addicted and unhelped.
Ironically, the label attention-deficit disorder can be usefully applied to the adults and helping agencies who do not respond to the real needs of the labelled children. Furthermore, many of these children may well be experiencing attention (love) deficit in their homes and classrooms and what may well be needed is for these children to be loved and cherished by all who come into contact with them. Both teachers and parents need all the holistic help they can get.
Dr Tony Humphreys is a consultant clinical psychologist and author of Self-Esteem: The Key To Your Child's Education
