Recommendations Regarding Possible ADD/ADHD

There is an epidemic of ADD in the US today. Or is there?

ADD/ADHD is a real disorder; however, it is one of the most overdiagnosed problems in our country today. We believe that far too many children have been diagnosed with this disorder, and as a result, far too many children are on medication for it. The usual medications prescribed are in the amphetamine family.

Why the over diagnosis? At the risk of being too simplistic, let us offer a few possible reasons. (Remember, ADD is real in some children, just not as frequent as it would appear from the over utilized medications.)

1. The American norm for child rearing has undergone a major change. So-called childrearing experts have made many parents afraid to discipline their children. Some parents are afraid to allow them to learn from consequences the child has created. They are afraid to set high expectations for their children, and then require that they meet them. And finally, they are afraid of being reported for child abuse if they discipline their children corporally.

2. Our stressed-out, frenetic way of life (both in parents and children) leaves little time for just being with each other and loving each other.

3. We require far too much of our teachers. In a class of 30 children, a teacher is expected to teach and discipline the whole class. Sometimes, frustration with a particular child can lead to the suggestion of an ADD work-up. ADD and medication can be viewed by all as an easy answer, when it is not the problem at all.

4. There is a whole industry based on ADD, and because money is to be made, it is easy to see how it could lead to excesses in diagnosis and treatment.

5. Boys make up the majority of those diagnosed with ADD. We think that sometimes, the diagnosis is made in some boys who simply demonstrate the usual characteristics of boyhood (high energy, rambunctious, distractible, etc.). Now, boys must be obedient and respectful, but boys are not girls, and vice versa. Thank God for their differences.

6. Some children are placed in academic situations which are far over their heads and they cannot ever succeed there. The answer here is not medication, but an honest appraisal of the child’s gifts and abilities.

7. Video games, computer games, and television make high-speed, hyperactive behavior seem normal to many children, and they therefore copy it. A lot less TV would be beneficial here.

Before you embark on the journey towards an ADD work-up for your child, we would recommend that you take the time to read the following books. Most children will not need any further help than what is found here. Most of you will save much time, money, and emotional energy by reading and heeding the content of these books. And, your child will really receive the help he needs with dividends coming all along the way.

A few caveats before the book recommendations:

1. Remember ADD is real, and that in a small percentage of children, medication will be extremely helpful. A diagnosis of ADD/ADHD in your child should not cause parental guilt.

2. Do not forget basic screenings, such as a neurological exam by your child’s pediatrician, as well as simple hearing and vision screens, which can be done in our office.

3. Do not forget learning disorders as possible reasons for school problems.

However, as we have said, most children will be well managed with the help of these books.

Shepherding A Child’s Heart by Ted Tripp. This is the best book I (Dr. Miller) have ever read on child rearing, and I wish it had been available when my children were young. I would have changed some things. The focus here is on a loving parent acting as a shepherd for his/her child’s heart directing the heart always to God. The emphasis is on heart change being the key. This is not mere behavior modification.

Dare To Discipline by James Dobson. This is a classic, and is out now in a new version.

Ritalin Is Not The Answer by David B. Stein. I (Dr. Miller) recommend this book with several important reservations. I disagree that there is never a patient with ADD in whom stimulant medication is useful and beneficial. Also, he is opposed to spanking, and I believe spanking used in the correct manner is both biblical and useful; I would refer you to Tripp and Dobson here. And, Dr. Stein states that one of his favorite writers is Deepak Chopra, a New Ager whom I would never recommend to my families. Finally, much of the focus in on behavior modification, where I believe heart change is the proper target. However, I do believe the author makes a good case, and that used in conjunction with the books above, this book may help keep your child off of medication.

If after reading the books above and implementing the measures discussed, you believe your child needs further evaluation, please call our office for an appointment. The usual work-up includes a thorough exam, hearing and vision screens, and questionnaires, which we will ask for you and the teacher to complete. Sometimes we will refer you on to a developmental pediatrician or a child psychologist for further testing. At other times we may recommend no treatment and no further evaluation.

Our physicians and staff are here to help you in any way we can.