One afternoon last May, hundreds of schoolchildren in Peoria, Illinois, rallied against drug abuse at a park just outside of the city. Wearing scarlet “Dare To Say No To Drugs” T-shirts, they celebrated Drug Abuse Resistance Education day--DARE day--with volleyball, tug of war, and soda pop. Cars in the parking lot, watched over by cops on horseback, were plastered with DARE bumper stickers. In the schools during the year, each class had its own DARE police officer who regularly volunteered to teach lessons on the horrors of drugs. Yet, in this most conservative of Midwestern cities, somewhere between 5 percent and 8 percent of the schoolchildren take, with the school district’s blessing, a powerful stimulant to help them get through each day.
Eleven-year-old Brent Shipley is one of them. At the age of 5, Brent was diagnosed with attention deficit disorder. Now, every morning, after a heaping bowl of cereal, he washes down with his milk a 20-milligram time-release tablet of Ritalin to keep him calm and focused at school.
|Are we too eager to prescribe a drug for something many experts say doesn’t even exist?|
For the most part, it does the trick. Brent may throw around a ball of crumpled paper on the school bus or demonstrate a few moves from All-Star Wrestling, but such behavior is typical for a boy his age. Last year, he made the honor roll two out of four quarters at the Roosevelt School of the Arts, where he is now in the 6th grade. He performed at least satisfactorily in all his aca-demic subjects except music theory. In that class, he received a D minus despite the fact that he can play songs on the piano by ear. Sometimes he struggles at math, but his math tutor says he understands concepts easily once he takes the time to study them. Brent also plays the saxophone in the school band, sings in the school choir, and dances with a local troupe. A good-natured kid with a wide, toothy smile, he is generally well-liked, though he sometimes irritates classmates and friends with bursts of immaturity--rude noises, repetitive movements, foul language, and humor derivative of Dumb and Dumber.
But any annoyance Brent’s peers might feel is fleeting, for most are accustomed to students who take Ritalin. According to Roosevelt principal Paul Phillips, almost 10 percent of the school’s 720 students take the drug, the vast majority of them boys. Over the last few years, the use of Ritalin to treat ADD-diagnosed children has spread in Peoria and nationwide. Some 4.3 million youngsters now take the drug, more than twice the number that took it in 1990. The drug has become such a common part of schooling that the venerable New Yorker magazine listed it as one of the three R’s--"Readin Ritin Ritalin"--on its September 9 cover.
Phillips does not find the trend alarming. In fact, he thinks more kids could benefit from the drug. “Without Ritalin, some kids couldn’t focus at all,” he says matter-of-factly.
Christina Brock-Lammers, who was Brent’s 5th grade teacher and is admired within the school community for her skillful work with ADD children, takes a slightly different view. “We’re overmedicating children,” she says. “Some students need Ritalin, but others can do without it if they’re in the right environment. I don’t, for instance, have my students spend a lot of time sitting in their seats. I have an activity-centered classroom, and my students--ADD or not--find that a lot less constraining.”
Yet strictness, she says, is also important. Students need the freedom to move about, but they also need, in a kind of educational yin-yang, lots of structure. “It’s the little things,” Brock-Lammers says. “Making sure at the end of the day that each child is going home with a book.”
Still, Brock-Lammers acknowledges that for some kids like Brent classroom-management techniques do not suffice: They need Ritalin to succeed in the classroom. “If these kids miss taking their pill,” she says, “you can tell almost right away. They simply cannot do their work.”
Like Brent, virtually all Roosevelt students who take Ritalin have been diagnosed with ADD, which most experts suggest afflicts somewhere between 3 percent to 5 percent of the nation’s school-age population. Estimates vary widely, though, with some putting the number as high as 20 percent and others denying the disorder exists at all.
|Psychologists, doctors, and other experts now break ADD into types and subtypes.|
The term “attention deficit disorder” is actually a broad catchall. Psychologists, doctors, and other experts now break ADD into types and subtypes. Brent’s specific diagnosis, for example, is attention deficit hyperactivity disorder, or ADHD, which has as its central features inattentiveness, impulsiveness, and hyperactivity. The last trait, hyperactivity, is the one most associated with ADD, perhaps because it’s so easy to spot. In fact, during the 1970s, “hyperactive” became the term most used to describe fidgety, overwound children who couldn’t concentrate on their schoolwork. But in the late 1970s, “hyperactive” was deemed far too limiting a word. After all, many children lumped under this heading were chronically inattentive but not the least bit restless or impulsive. So when attention deficit disorder entered the medical textbooks in the early 1980s, it was divided into two major classifications: ADD with hyperactivity and ADD without. The more prevalent ADHD is diagnosed primarily in boys, while the other--sometimes referred to in popular literature as the “spacey” or “dreamy” type--is more frequently diagnosed in girls.
|An increasingly vocal group of critics charges that both labels and the disorders they describe are nothing more than fiction.|
And yet some experts don’t buy any of it. An increasingly vocal group of critics charges that both labels and the disorders they describe are nothing more than fiction. These naysayers point out that there is no medical test that can pinpoint the supposed neurobiological disorder and that there is no obvious organic cause. They argue that if ADD is, as one best-selling book on the subject claims, “everywhere,” and if it has an almost preternatural capacity to assume new forms--there’s now a strand of ADD known as oppositional defiant disorder, or ODD--then it is so vague as to be nonexistent.
The Ritalin that Brent Shipley takes washes out of his body after eight hours, so when he arrives home from school at 4 p.m. he takes a smaller 5-milligram dose to get him through soccer practice and homework. Brent’s mother, Cindy, says life would be “rough going” without Ritalin. Sometimes, life’s rough going even with it.
Brent, for example, still cannot do his homework alone. He despises worksheets. Just can’t sit still for them. So he walks around the table iterating answers--"adjective,” “adverb,” “pronoun,” and the like--while his mother transcribes them into the blanks. Reading, on the other hand, Brent likes. But he can’t concentrate on a book for more than a few minutes at a time. Consequently, he and his mother read in tandem, like two anchors delivering the evening news on television. First he reads a page, and then she reads a page. “I’m not always sure he’s absorbing what he’s reading,” Cindy admits. “He’s good at spelling but weak at comprehension. Everything is just going too fast.”
|Cindy will sometimes stand in front of him, clasp his jaw in her hand, and ask him to think about what he’s doing.|
Cindy knows that Brent is too dependent on her, so this year she will make a special effort to get him to do homework on his own. “I realize I’m not going to be there for him forever,” she says. “It’s not as if I can go to college with him.”
Twice a week, after school, Brent practices soccer with the Peoria Kickers, one of the top youth soccer teams in the Midwest. He is a gifted athlete--tall and agile with blazing speed--yet his efforts are as sporadic on the field as they are in the classroom. Once a month or so, he’ll be exiled from practice for fooling around or refusing to obey his coach. During games, he’ll make a spectacular play and then, moments later, be so out of position that parents on the sidelines ask one another, “Where’s Brent?”
When Brent does something particularly egregious, or when he, as Cindy puts it, “is bouncing off the walls,” she’ll sometimes stand in front of him, clasp his jaw in her hand, and ask him to think about what he’s doing. Sometimes it works, and sometimes it doesn’t. He may turn around and break a window with a football he’s been told a hundred times not to throw in the house. In frustration, Cindy will ask him, “Why? Why did you do that?” even though she already knows the answer. “I don’t know,” he inevitably says, sometimes tearfully. He’s both confused and remorseful. He really doesn’t know why he does certain things. Compounding the anxiety for both mother and child is the fact that Brent does not allow himself to be physically comforted when he is distressed. He has never been a cuddler; a kiss or hug only makes him tense up.
Last year, after getting in trouble for something Cindy can no longer recall, Brent once again played out the “I don’t know why I did it” routine. But this time, Cindy continued to push. “No, tell me,” she said. “I really want to know. Explain it to me.” Brent finally answered, “It’s like a hundred people are running in my head.” This frightened Cindy; it sounded so textbook crazy. “I don’t know what he means by ‘people,’” she says, “but I do know that his head and his body are racing. His thoughts are going 100 miles an hour.”
Not too long ago, when Brent was bouncing around and making all sorts of noises, Cindy sat him down again and asked him what he was feeling. He made the same comment as before: “It feels like hundreds of people are running around in my head.”
“You know what?” Cindy responded. “That’s why you take Ritalin. To get them to walk.”
Unlike some mothers whose children have been diagnosed with attention deficit disorder, Cindy had no sense that anything was wrong with Brent during her pregnancy or the months after his birth. He was colicky, it’s true, and he required constant attention when he was awake, but this is the case for many babies.
|The first thing that struck Cindy as unusual was that at 9 months, Brent refused to ride in a stroller under any circumstances.|
The first thing that struck Cindy as unusual was that after Brent learned to walk at 9 months he refused to ride in a stroller under any circumstances. In fact, he didn’t so much walk as run. When they went to the zoo or the mall, Cindy had to strap his wrist to hers with a cord to keep him from disappearing into the crowd. To get him back in the car, she had to pick him up kicking and screaming. He moved so continually throughout the day that at night he would make the transition from wired intensity to deep sleep in an instant, having exhausted both himself and his increasingly discouraged parents.
One day, when Brent was about 3, Cindy cleaned the house in anticipation of out-of-town guests. Finishing up, she poured foot powder into a pair of shoes and left them sitting on a living room table to answer the phone. When she returned, powder was everywhere--on the furniture, the light fixtures, the carpet. Brent just looked at his stunned mother, unable to fathom what he had done wrong.
This was the first of many such incidents, no single one, as Cindy well realizes, particularly extraordinary in itself. “It’s not really that he’s doing anything that any normal kid doesn’t do,” she says. “It’s the uncontrollable impulse, the fact that when you ask him why he does certain things he always says, ‘I don’t know.’ Now a lot of kids will say that. But Brent does a lot of incredibly impulsive things.”
|As time went on, Brent’s almost complete lack of restraint wore on the Shipleys’ marriage.|
As time went on, Brent’s almost complete lack of restraint wore on the Shipleys’ marriage. Both Cindy and her husband, Bill, who declined to be interviewed for this article, were raised in what Cindy terms the “old school.” Their parents were loving but strict disciplinarians who would not abide foolishness. Although Bill eventually came to accept his son’s disability, he has much less patience with Brent than his wife does. “Bill still thinks that ‘don’t’ means don’t--period,” Cindy says. “He’s convinced that Brent has attention deficit disorder but still thinks he should be able to control himself. This causes conflict because I’m likely to stick up for Brent. But Bill will say, ‘He’s not listening; he’s ignoring me.’”
Some of Cindy’s friends share Bill’s attitude about self-control. But, to her great annoyance, these same people lecture her on the evils of Ritalin, the very thing that allows ADD children to exercise some self-control. Brent, they say, should be able to control himself without the drug. And, if for some reason he can’t, then she as his parent should take charge.
“I tell them that it’s not a control thing,” Cindy says. “If people are using Ritalin to control their kids’ behavior--and I know that in fact happens--then they’re using it for the wrong reasons. What’s going on here is the mentality that you as a parent should be able to control your child no matter what. But, if your child has a disability, say cerebral palsy, you’re not going to sit there and watch him starve to death because he cannot feed himself. You’re going to provide him with the means to help himself so that he can survive. And that’s exactly what Ritalin does.”
As Brent was about to begin kindergarten, the Shipleys took him to a pediatrician for his school physical. Over the course of a three-hour visit, Brent was running around the room and climbing over the examining table. The pediatrician told the Shipleys that he saw signs of attention deficit disorder and that they should keep a close watch on how things developed at school.
|It is no secret that the ADD diagnosis is sometimes made haphazardly.|
It is no secret that the ADD diagnosis is sometimes made haphazardly, that doctors or psychologists, succumbing to the needs of weary parents, occasionally recommend Ritalin after asking only a few cursory questions. But when the Shipleys took Brent to see psychologist Betty Hart in February of his kindergarten year, the examination was anything but casual. Hart took a detailed family history and inquired into the minutiae of Brent’s school and home life. She had Brent’s kindergarten teacher fill out a questionnaire.
And Hart observed Brent herself. She put Brent alone in a playroom stocked with toys and told him to “entertain” himself. Through a one-way mirror, she and the Shipleys watched as he quickly emptied the toys from the shelves and then abandoned them in small piles on the floor. “He couldn’t complete a single task,” Cindy says. “And that’s one of the main things that characterizes ADD.”
After Hart’s evaluation, just as Brent was about to turn 6, he began to take 5 milligrams of Ritalin three times a day: in the morning, at noon, and in the afternoon when he arrived home from school. A year later, he was taking 10 milligrams three times a day, which is a fairly typical dose for kids.
Ritalin allowed Brent to settle down and concentrate almost immediately, although he did experience some common side effects. He lost his appetite, so much so that he hardly ever ate lunch. And the effects of the 10-milligram dose peaked early and dramatically. A half-hour after ingesting the medication, Brent would become lethargic, going, as his mother describes it, “from hyper to staring at the TV.”
In the 4th grade, Brent switched to a time-release tablet with an all-day effect. Consequently, Cindy says, things are much improved. Brent’s appetite is still best in the morning, but he now eats lunch and dinner, as well. And the mood swings aren’t so dramatic. Brent is now on a more even keel.
|For the majority of doctors who prescribe Ritalin, ADD is as much a medical condition as diabetes or hemophilia.|
For the great majority of doctors who prescribe Ritalin, attention deficit disorder is as much a medical condition as diabetes or hemophilia. It doesn’t matter to them that researchers have been unable to find a definitive medical cause. Most would probably agree that Brent’s symptoms--his pronounced inattentiveness, impulsiveness, and hyperactivity--point to a classic case of ADD.
“It’s an inherited condition, a designer disorder,” says Peoria psychologist Eric Ward, who has perhaps diagnosed more cases of ADD than any other local clinician. “Those who say that ADD doesn’t exist or that its diagnosis is hopelessly subjective are usually those who don’t get in the trenches and do a lot of this work. People come into this office with this list of complaints so strikingly similar that when I tell them what else is involved in the cluster of symptoms they have this kind of ‘aha’ experience. ‘You really know,’ they say. ‘You’ve been to our house.’ But, of course, I haven’t. And what makes it even more remarkable is that many have other children with whom they’ve used the same parenting and discipline methods, and yet the children demonstrate behavior that’s not at all similar.”
In the 1980s, Ward trained with Russell Barkley, a professor of psychiatry and neurology at the University of Massachusetts Medical Center whose 1990 book, Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosing and Treatment, is still considered the last word among those working in the field. From Barkley, Ward learned a simple but critical lesson: You can only diagnose ADD when you can make a clear distinction between a conduct problem and the attention deficit disorder. As Ward explains it, many children chronically and willfully misbehave on account of inadequate parenting and poor discipline. What distinguishes the ADD kid, on the other hand, is an absence of willful, intentional misbehavior. According to this line of thinking, kids like Brent really don’t know why they do certain things. Much of the time, they are acting on sheer impulse.
“Parents with ADD children,” Ward explains, “will say, ‘So and so doesn’t obey me because he’s in a dream world and distractible.’ It’s not just a case of the child being defiant and angry.”
ADD, Ward adds, tends to surface very early in a child’s life, before parenting styles can have much influence. Parents are often aware of an ADD-type disorder by their child’s second birthday. Some mothers know, or claim to know, while the child is still in the womb.
|The key to an accurate diagnosis is the “cross situational” nature of the disorder.|
But diagnosis, Ward insists, must never rely solely on parental testimony. The key to an accurate diagnosis is the “cross situational” nature of the disorder: ADD symptoms must appear in a variety of settings--both at home and in school, for instance. “If it’s truly a chemical, biological disorder,” Ward says, “then it’s got to go with you from place to place.” A difficult child who becomes calmer and more attentive after a few months in a disciplined classroom setting probably does not have ADD, Ward says. “The parents will say, ‘We had a heck of a time in September and early October, but by the end of October everything was a lot better.’ ”
Although Ward has few doubts about his ability to diagnose and treat ADD, others are much less sanguine. In fact, they are deeply disturbed by the exuberant confidence of people like Boston psychiatrist Edward Hallowell, who, in the first sentence of his best-selling 1994 book, Driven to Distraction, declares, “Once you catch on to what this syndrome is all about, you’ll see it everywhere.”
Hallowell may see it everywhere, but other doctors and psychologists looking at the very same kids have a hard time spotting it at all. One of them is pediatrician Sharon Collins of Cedar Rapids, Iowa, where, according to a recent study, some 8 percent of children in elementary and middle school take Ritalin.
“I’m frustrated; I’m crying out,” Collins says. “When our children are born, we’re so pleased to have this wonderful child--a child who no one else is like. Then they enter preschool, and they’re all supposed to be the same, and so we label those who are not, ADD.”
Collins says she is under great pressure to prescribe Ritalin. And in fact she occasionally does. “I have people who come to me on Ritalin, and I can’t always change their minds,” she says. “So I prescribe it, though it’s not in my heart. And I’ve had people for whom I won’t prescribe it leave my practice.”
|Doctors are pressured by parents, who are pressured by teachers, who are pressured by administrators.|
Based on what she has observed, Collins believes that the impetus to prescribe Ritalin is hierarchical in nature. Doctors are pressured by parents, who are pressured by teachers, who are pressured by administrators who have completely bought into the traditional structure of schooling. In Cedar Rapids, Collins says, this structure still involves kids sitting in seats listening to their teachers talk--something many kids just can’t do.
“You have this pressure to have very compliant, well-ordered children,” she says. “So when you have a classroom of 25 children, one or two children getting up and walking around can be extremely disturbing for a lot of teachers. They’ll say to parents, ‘Your child may fail if he doesn’t concentrate on this given thing.’ The assumption is that success means completing everything your teacher tells you to do.”
Thomas Armstrong, one of the fiercest critics of the ADD diagnosis and author of the controversial book The Myth of the ADD Child, shares Collins’ view. The problem, he believes, lies less with the children diagnosed than with the society and schools that have done such pre-emptive labeling. He scoffs at what he sardonically terms the “holy trinity” of ADD symptoms--inattentiveness, impulsiveness, hyperactivity--saying such traits are apparent in all normal children.
|Armstrong’s view that ADD is actually a myth emerged from his own experiences as a special education teacher.|
Armstrong’s view that ADD is actually a myth emerged from his own experiences as a special education teacher in Northern California. He describes how one supervisor told him that his classroom was too unruly and that he needed to study exemplary classrooms where strong behavioral-modification systems were in place. So, in an attempt to “shape up,” Armstrong visited “superior” classrooms, gathering ideas. Under one scheme he adopted, students gained and lost points for specific positive or negative behaviors. But the plan failed miserably. Already frustrated, his kids grew more so when they had points taken away. He scrapped the behavior-modification strategy for a more collaborative model in which students had a say in formulating and enforcing classroom rules. Armstrong found this approach much more productive, though it did not, he admits, make his classroom any tidier.
As far as Armstrong is concerned, stories like this demonstrate that schools are fixated on controlling behavior that could in a more open, supportive environment actually be expressed in constructive ways. Youngsters diagnosed with ADD, he says, often have an abundance of creative energy. He points out that many accomplished individuals--Robert Frost, Albert Einstein, and Winston Churchill--struggled in school. Today, Armstrong laments, such brilliant people would probably be labeled ADD.
“What really hit me,” Armstrong says, “is the deficit orientation of special education, the propensity to look at kids in terms of negatives, what they can’t do. Look, for example, how kids labeled with ADD are described in terms of a wayward machine--crossed wires, an airplane with no one in the cockpit. But there is no ADD brain, no ADD deficiency. In fact, there are a lot of positive traits associated with ADD-labeled people.”
Armstrong cites longitudinal studies suggesting that many such people eventually become self-employed, which he sees as a highly adaptive trait in an era when corporations dismiss hundreds of employees in a single stroke. Although this sounds like a bit of a stretch-- self-employment, after all, can be a euphemism for out of work--Armstrong isn’t the only one to put a positive spin on symptoms associated with ADD.
Bonnie Cramond, an educational psychologist at the University of Georgia, was studying creativity when she happened across an article about students diagnosed with ADD. It struck her that these students demonstrated characteristics closely associated with creativity; in fact, it sometimes seemed to her that ADD and creativity were the very same things.
For Cramond, as well as for Armstrong and Collins, how behavior is interpreted--"dreamy” vs. “imaginative,” say--has everything to do with the orientation of the interpreter. Unfortunately, Cramond asserts, many teachers are trained and conditioned to look for disabilities rather than abilities, for problems instead of possibilities. For example, many creative children are solitary, preferring to play alone. Yet teachers trained to look for ADD--"once you know what this disorder is all about, you see it everywhere"--are likely to label a loner who has difficulty making friends as an ADD suspect.
|Inattention may in fact be imaginative preoccupation. Hyperactivity may be overflowing energy.|
In a recent paper titled “The Coincidence of Attention Deficit Hyperactivity Disorder and Creativity,” Cramond equates specific ADD symptoms with creative traits. Inattention, she writes, may in fact be imaginative preoccupation. Hyperactivity may be overflowing energy. “The various behaviors that may induce a diagnosis of ADHD,” Cramond concludes, “have also been shown to have correlates in the literature on creative behavior.”
Creative work, however, demands sustained concentration, something ADD-diagnosed children tend to find impossible. But Cramond insists that many ADD youngsters can focus extremely well when they’re interested in a project. “These kids are understimulated, not overstimulated,” Cramond says. “Yet schools want to break information into small units, make it all routine, which is the very worst thing you can do.”
Cramond lives in Atlanta, where, she says, a high percentage of children are on Ritalin. Yet very few children at her local Montessori school, she notes, take the drug. She attributes this to a classroom environment that, while highly structured, permits children to choose from a wide variety of activities that are bound to engage their interests.
But if what Cramond and others say is true, if ADD symptoms aren’t really that bad and may in fact be a sign of creativity, then why do we continue to treat children who display such symptoms with Ritalin? “It’s this deep-rooted thing in the American consciousness about the need for more rigorous this and that,” Armstrong says. “This drives the [ADD] movement more than anything else. I do workshops around the country and see all kinds of sociological spinoffs. I actually see parents pushing to get their kids labeled ADD so they can stay competitive. They want their kids to take Ritalin to be allowed more time to take a test. Ritalin has become a kind of cognitive steroid. ‘We’re going to pump up your mind.’”
Critics can carp all they want about the myth of the ADD child and the drugging of children, but Cindy Shipley is unmoved. It’s not that she hasn’t considered their views or that she doesn’t agree with them on some issues. She believes that ADD may well be “the disease of the ‘90s,” spreading everywhere. And she worries, along with Thomas Armstrong, that ADD may be induced in part by our entertainment-crazed culture. “It’s the whole Sesame Street mentality telling us that our kids have to be constantly entertained with this ever-changing format,” Cindy says. “We parents feel we constantly have to entertain our kids, and as a result they’ve lost the ability to entertain themselves. When I was a kid, I’d be content to lie under a tree and read a book for two or three hours at a time. Now, Brent will visit my mom and call me each day, saying, ‘I’m bored.’ He just doesn’t know how to entertain himself.”
“I often wonder how Brent would have done with something like the Montessori concept.”
Cindy also thinks that the nature of schooling is part of the problem. “I don’t think school has changed much since we were in school, but the kids have changed,” she explains. “Teachers still have this set program, but more and more of the kids don’t fit into it. I often wonder how Brent would have done with something like the Montessori concept.” Cindy praises Brock-Lammers, the Roosevelt 5th grade teacher, for regularly taking her students on outdoor adventures to collect leaves or water samples for science projects and the like. “Brent thought he was just having fun, but in fact he was learning a lot,” Cindy says. “It’s too bad other teachers don’t do more of these things.”
Despite these broad concerns, Cindy has absolutely no doubt that ADD exists and that her son Brent has a classic case. ADD may be overdiagnosed, and Ritalin may be overprescribed, she says, but those who say the disorder is a myth or a social invention or a conspiracy of rigid educators have never met anyone like her son. Skeptics do not know what it’s like to live with a youngster who never sits still, a youngster who turns on the television and then runs outside, who, even at the age of 12, can’t bear to be alone.
“To this very day, Brent has to be in a room with somebody,” Cindy says. “If I were to say, ‘Take care of yourself for a while,’ he’d get frustrated, probably cry. I walk to the doorway, and it’s, ‘Mom, Mom, Mom.’ It’s a terrible demand on me.”
So who is right? Do youngsters like Brent have a real disorder, or is it just a myth? Between the true believers who see ADD everywhere and the critics who see it nowhere are the moderate majority who would almost certainly acknowledge that Brent has a real problem. Yet even these moderates acknowledge that ADD is overdiagnosed and Ritalin overprescribed.
|Now parents are quick to accept an ADD diagnosis and ask for Ritalin.|
Mark Stein, director of the Hyperactivity, Attention, and Learning Problems Clinic at the University of Chicago, suggests that it’s pointless to question the existence of ADD. In fact, he believes it is one of the best-researched childhood conditions. He estimates that 5 percent of the school-age population has a mild form of ADD and that 1 percent is severely beset. Yet in his view, people are going far beyond the data to find ADD where it clearly doesn’t exist. “Twelve years ago, the main problem was underdiagnosis,” Stein says. “Now it’s overdiagnosed so that I see normal 3- and 4-year-olds diagnosed with it. The problem is that when people hear the symptoms everyone thinks their child has it.”
At one time, Stein continues, ADD was diagnosed only after other possibilities were absolutely ruled out. Now parents are quick to accept an ADD diagnosis and ask for Ritalin. “But, if you give kids Ritalin who in fact don’t have ADD, what are you missing?” he asks.
“This was the first disability I had ever seen where people would get together and get excited when they learned someone had it.”
Wade Horn, former executive director, CHADD
Even some extremely unlikely candidates are disgruntled by the ADD-bandwagon phenomenon. Wade Horn, former executive director of the powerful advocacy organization Children and Adults With Attention Deficit Disorders, was so disturbed by what he saw that he resigned his post in 1993, just one year after he had taken it. “This was the first disability I had ever seen where people would get together and get excited when they learned someone had it,” Horn says. “There was almost a revivalist quality. You could hear them squealing with delight. Can you imagine someone saying that about schizophrenia? I was trying to moderate that attitude at CHADD by reminding the membership, ‘Hey, having this disorder is not great news.’ ”
Horn believes that 2 percent to 3 percent of the population suffers from ADD. CHADD uses a 3 percent to 5 percent figure, which Horn believes is at least within the realm of possibility. But he’s incredulous when he hears, as he sometimes does, people talking about 15 percent to 20 percent. “At that point, it’s no longer a disorder but a natural variation,” he says. “A kid could be anxious, or he could even have lousy parents, but instead they say it’s ADD.”
Horn, who believes that Ritalin is drastically overprescribed, remembers with a sense of outrage hearing someone in CHADD remark that the American teenager caned in Singapore a few years ago for spray-painting cars was no more responsible for his actions than if he had had epilepsy and accidentally scratched the cars’ paint. The presumption was that the teenager had ADD, which made it impossible for him to control his behavior. “You could see that ADD was becoming a catchall for bad behavior,” Ward says. “It was like, ‘I have ADD, so you’re just going to have to deal with it.’ ”
Over this past summer, Cindy Shipley fretted about how Brent would fare in the 6th grade. Brock-Lammers, his 5th grade teacher, had been strict but not rigid, providing a delicate line for Brent to walk. He could not get away with forgetting his pencils or disrupting class with clowning. Yet, at the same time, the self-contained classroom had the atmosphere of an extended family. Brent felt at ease.
But 6th grade would be different. Brent would have three teachers, each of whom would teach two subjects. Cindy worried that the absence of a single teacher-mentor and the movement from class to class would cause Brent to forget books and run around in the halls.
A month after the start of school, though, Cindy reports that Brent is having a remarkably good year. He likes his teachers, has several new friends, and is getting good grades. Still, he remains heavily dependent on his mother. As always, Cindy has to help him do his homework.
During the summer, Brent hardly took any Ritalin, only a few times before soccer games and practices; Cindy doesn’t believe in using the drug for ordinary playtime. But now that Brent is back in school, he’s back on his standard regimen. Cindy hopes the day will come when Brent no longer needs the Ritalin, but she can’t imagine when that might be.
“School and the demands it places on Brent are only going to get tougher and tougher down the road,” she says. “They say some kids no longer need Ritalin after puberty, but I think Brent will need it at least through high school and maybe even into college. But I really just don’t know.”
A version of this article appeared in the November 01, 1996 edition of Teacher as ADDicted