We’re not paying enough attention to ADHD

Like a fourth-grader who keeps jumping out of his chair, the uptick in America’s ADHD epidemic demands our attention.

According to a new report in Academic Pediatrics, the number of doctor’s visits by children being given a diagnosis or treatment for attention deficit-hyperactivity disorder jumped to a total of 10.4 million in 2010, representing a 66 percent increase over the year 2000.

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To try to account for the continuing rise, we are falling back on familiar explanations: Growing awareness of a genuine disorder. Increasing exposure to environmental toxins. Overdiagnoses due to overanxious parents. We also return to timeworn debates: Is the disorder, with its symptoms of forgetfulness, distraction and impulsivity, real? And if so, should we medicate?

Kids with ADHD need us to broaden our focus, however. In other words, it’s time we devoted some attention to demanding more-comprehensive solutions from school districts, doctors and parents.

The most recent estimate of the total number of U.S. children diagnosed with ADHD is 5.4 million, as of 2007, according to the Centers for Disease Control and Prevention. Consider what it means to have that many children now classified as distracted to the point of disability. As the numbers of diagnosed children have skyrocketed, we’ve labeled the kids but not the place where they’re getting into the most trouble: the classroom.

I write as a mom whose son, in seventh grade, got detentions for chewing gum, for forgetting his homework and, on one memorable occasion, for dancing the Macarena in his chair in Spanish class. His ADHD diagnosis made him eligible for more time on tests. But with a few treasured exceptions, it didn’t increase his teachers’ understanding or tolerance.

A hallmark of ADHD is a strikingly low threshold for boredom — which is not, by the way, a moral defect but a painful restlessness that a child often struggles in vain to manage.

Harold Meyer, founder of the A.D.D. Resource Center in New York City, says there is “universal frustration among parents who feel that teachers don’t understand ADHD unless their own kids have it.”

Something many parents of children with ADHD understand all too well, however, is the danger of ignoring the disorder. The psychologist Russell Barkley, at the Medical University of South Carolina, is the principal investigator in one of a handful of studies demonstrating the significantly elevated risks among people with ADHD of drug and alcohol abuse, car accidents, teen pregnancy, academic failure, unemployment, divorce and time in jail.

From what I’ve found in interviews with other parents and children, I suspect that many of the personal disasters Barkley chronicles — in addition to the high rates of anxiety and difficult behavior among kids with ADHD — may stem from those children having been punished repeatedly for behaviors beyond their control.

Children with faulty short-term memory, for instance, may work hard to complete an assignment and then forget to bring it to school. Restless kids are held in detention during recess, which predictably makes them more restless. One mom I interviewed said her daughter, who was failing at math, was prevented from going to classes in which she was excelling until she caught up in math.

Failing grades and visits to the principal’s office are the most common reasons exasperated parents haul their offspring to the doctor to find out whether they have ADHD. But doctors, too, often have too little attention to spare.

Pediatricians make the majority of ADHD diagnoses. But many of them are limited by typical appointments of less than 15 minutes, in which they’re supposed to diagnose, counsel and treat. That’s why my son’s doctor and his partners decided, years ago, that they would not treat ADHD but instead would refer cases to psychologists and psychiatrists. The problem, as my son’s doctor ruefully acknowledges, is that most of these specialists have long waiting lists, particularly if they take insurance.

“Most pediatricians are well aware of the danger of over-medication, but they face the need to take action, with a limited range of options,” says Oregon Health and Science University psychiatry professor Joel Nigg, the author of “What Causes ADHD?”

Nigg suggests that at the very least, doctors use an “attention-hygiene checklist” — a brief set of questions to ask before deciding whether to prescribe drugs. Is the child getting eight to 10 hours of sleep a night? Regular outdoor play? Is his or her home life frenetic?

The home, of course, is another key habitat suffering from deficits of attention. Modern parents, as most of us know too well, are struggling with unprecedented demands on our time. Even if we suddenly had the world’s most generous health-care system, paying for comprehensive therapies and after-school programs, how many people would have the time to get their kids to them?

But assuming, for a moment, that we had all the focus we needed, what measures might help most to soften the clash between our distracted kids and their environments?

Certainly, schools that effectively engage students would help — and throughout the country, several innovative recent experiments have boosted motivation among all kinds of kids. One of my favorite examples is the San Diego-based High Tech High charter school network, whose charismatic director, Larry Rosenstock, has been making good on his pledge to transform classroom relationships, with teachers becoming more like guides as students pursue their passions.

In the short term, for all schools, a few simple changes would go a long way. One would be to provide more training for teachers in smarter ways to deal with children with learning problems. Another: limit the scads of often rote and unnecessary homework that places disproportional stress on children with ADHD and their parents. Finally, schools could let students e-mail their homework to teachers, eliminating chances of loss.

A change that would particularly benefit children who are impulsive by nature would be to implement more “restorative justice” discipline programs, in which kids who break rules make amends to those they have harmed, instead of being isolated from the school community through detention, suspension or being kicked off campus. These programs can help the most challenging students change their behavior and, ultimately, avoid dropping out of school.

These ideas would demand a lot more of our focus, to be sure, not to mention our money. But consider what we’re already spending to maintain the status quo. A conservative study in 2007 estimated the annual U.S. costs of ADHD treatment and other related expenses, including parental work loss and juvenile justice, to be as high as $52.4 billion.

More than 5 million kids. A cost of $52.4 billion. Isn’t it time these numbers got our attention?

kathyellison@comcast.net

Katherine Ellison is the author, most recently, of “Buzz: A Year of Paying Attention,” a memoir about raising a son with ADHD while sharing the diagnosis.

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