Does mother know best when it comes to ADHD?

Some kids may simply be less mature than their peers, and under pressure to perform to unfair norms

Photograph by Brian Howell

“Mommy knows best” is a popular expression but it’s not a universally accepted truth. Several months ago, Jacqueline Howard refused to believe that her eight-year-old son Oliver had attention deficit hyperactivity disorder. Oliver’s teachers, however, “just wanted him medicated and to be very compliant and quiet in class. And the psychologists [wanted] to engage my son in huge amounts of counselling and programs,” recalls Howard.

But she had her own explanation for Oliver’s supposed bad behaviour in school. Born in mid-December, he was the youngest student in a split class of third and fourth graders, making some of his peers up to three years older than him. “So of course he’s noticeably immature. Of course he’s noticeably unfocused,” says Howard. “My gut instinct was that there’s not much wrong with my son. He’s just stressed out and people are setting really high expectations for him at a really young age, which he can’t fulfill.”

Howard’s view—as seemingly logical as it was maternal—was nonetheless largely dismissed, even after groundbreaking research published in the March issue of the Canadian Medical Association Journal showed that, yes, in fact, the youngest children in a class are much more likely to be diagnosed with ADHD. “It seemed that a lack of maturity was, in some cases, being misinterpreted,” explains Richard Morrow, lead author of the study and health research analyst for the PharmacoEpidemiology Group at the University of British Columbia in Vancouver. The findings “are definitely of concern,” he says. “We want to avoid medicalizing a normal range of childhood behaviour. Children mature naturally at different rates.”

Rather than acquiesce to the pressure to put Oliver on medication for a disorder that Howard was unconvinced he actually had, she opted for another, similarly drastic solution. Two months ago, Howard, a single mother, left her job of 12 years as a geophysical technologist in Calgary earning $150,000. With no work lined up, she moved with her son and 10-year-old daughter to Pender Island, B.C., population 2,500. There, they attend a small public school so accepting of “kids being kids” that there are exercise balls inside the classrooms for fidgety children to sit on during lessons. Since then, “Oliver has turned around hugely. He is doing incredibly well. And he’s happy too, which is really important,” says Howard. For her, this is vindication: “I don’t think I’m a parent in denial. I think he’s a child who needs to be given an opportunity to grow up and relax.” In his own way, and at his own pace.

Howard’s solution is extreme, no doubt, but her situation as a parent trying to chart the right course for a child suspected of having ADHD is all too common. Today, ADHD is the most prevalent mental disorder in children around the world, affecting more than five per cent. And there are no signs of the trend slowing down. “I’m afraid it will continue to increase,” says Montreal sociologist Marie-Christine Brault. “We live in a society that favours diagnosis and medication intake. I don’t know why it would stop.”

Especially given the deluge of scientific evidence published over the last few months pointing to the rising prevalence of ADHD diagnoses and the use of medication. Brault’s own work in the February issue of the Canadian Journal of Psychiatry revealed an almost twofold increase in the percentage of school-aged children diagnosed and treated for ADHD between 1994 and 2007. In the United States, a paper published in the March-April issue of Academic Pediatrics discovered a 66 per cent rise in the number of visits to the doctor for ADHD diagnosis or treatment between 2000 and 2010. “If we’re seeing this increase, there are important questions to ask,” says lead author Craig Garfield, a pediatrician and professor at Northwestern University in Chicago. First among them, “Why are we seeing this increase?”

Unfortunately, neither Garfield nor anyone else has the answer, just lots of theories: improved awareness about ADHD, effective pharmaceutical marketing of newer and apparently better drugs, a broadening of the diagnostic criteria for the disorder, higher expectations placed on children, a growing intolerance for immaturity—for “kids being kids.” Now, amid these bewildering theories and trends, a growing chorus of researchers and parents are asking out loud another important question—an unsettling one that could ultimately be life-altering for those families affected: to what extent are we over-diagnosing and overmedicating our kids?

“Everybody is so eager to say your son has ADHD,” says Howard, recalling her own experience with Oliver. “But you can’t just go, ‘Oh, how convenient, I’ll just put my kid on a pill and his school report card will get better.’ ” In her family’s case, as with many others in this situation, there was more at stake than grades, after all. “Oliver wasn’t being given the opportunity to be Oliver.”

As a mental health nurse for 15 years near Miramichi, N.B., Ann Tozer Johnston has seen many youth struggle with ADHD. But it wasn’t until her own son was having problems at school that she began to wrestle with the issue. Last year, when Bram was nine and in Grade 4, Tozer Johnston began getting phone calls about her son’s behaviour. “The teacher would say, ‘I asked him to sit down and he took the long way around. He sharpened his pencil without permission. He was moving about the class. He wasn’t raising his hand,’ ” recalls Tozer Johnston. The offences amounted to 14 detentions. “That really started a nasty ball rolling.”

Eventually, Bram’s presence in the class was deemed so distracting that, with Tozer Johnston’s approval, he was moved to an “intervention room,” essentially an isolation area. But that didn’t help. The calls came again: Bram was opening drawers, standing on chairs. So, in March of last year, the school suggested to Tozer Johnston that her son be moved again—to a room where there would be even fewer distractions. “In their defence and in my stupidity, I did not ask more questions,” she says in hindsight. She was desperate to find a solution, anything that would help her son. “I said, ‘Well, you know, if you think that’s the best thing for him, then okay.’ ”

When, a month later, Bram was “in crisis” at home—“He was crying and saying, ‘What’s wrong with me?’ ”—Tozer Johnston visited the school unannounced. “I found him in the storage closet. On the outside of the door it said, ‘Storage.’ He was in there with a teacher’s assistant, all alone, no education materials on the walls, no teaching materials, nothing. There was a desk in the corner with a chair. And there was a big vent that went through the ceiling. My son said, ‘When that would turn on I couldn’t hear myself think,’ ” recalls Tozer Johnston. She was stunned: “I pretty much lost it. I took him home for a week, and I said, ‘He will not be returning until this gets worked out.’ ”

The ordeal was reported to the school district, says Tozer Johnston, and after a long meeting, Bram was put back into the classroom where all his problems had begun. The teachers were more tolerant of him, and Bram was understandably happier. But for Tozer Johnston, the matter was far from over. She had been inundated with requests to have Bram treated for ADHD. “They would constantly ask me, ‘Have you had him checked? What does the doctor say? Are you going to medicate him?’ That was the big question,” says Tozer Johnston. When she resisted bringing her son for testing so he could have time to recover from the trauma, she was called “medication resistant.”

Tozer Johnston saw the situation differently. For starters, Bram had long battled low self-esteem and anxiety, and she believes that was at the heart of his acting out last year. “These strategies, or whatever you want to call them that they were using, were only making it worse.” What’s more, Bram, born in mid-November, has perpetually been among the youngest students in his class. “I’ve said that for many years, ‘This child is immature,’ ” says Tozer Johnston, but that point was never taken seriously, in her view. After learning of Morrow’s study, Tozer Johnston felt affirmed. Had she known this when Bram was just starting school, “I would have held Bram back a year,” she says. “Instead he went at age four, but the expectations were the same for him as they were for every other child, even if they were born in January.”

Of course, there are many kids for whom a birthday late in the year appears to have no negative effect. And experts emphasize that in many, if not most, cases where an ADHD diagnosis is made, it is correct—and medication is warranted. “There are children in high need of help. And these medications can be effective in alleviating symptoms,” says Morrow. But it’s not always easy to make the right call, says Brault. “ADHD is a complex phenomenon. Some children are really suffering, and the consequences have a significant impact on their life,” she explains. “What’s difficult is making the distinction between normal and pathological behaviour—answering the question, is it really ADHD or not?”

Part of what makes that so hard is the wide-ranging symptoms that, when present for six months and in at least two settings such as school and home, can lead to an ADHD diagnosis: “loses objects” and “does not seem to listen” and “excessively loud” and “acts without thinking,” according to the latest Diagnostic and Statistical Manual of Mental Disorders. What’s more, the age range for diagnosing ADHD has recently been expanded by the American Academy of Pediatrics from ages six to 12 to four to 18, thereby casting a wider net for diagnoses. Next year, the new DSM will likely feature a broader diagnostic criteria as well. “The prevalence rate of ADHD increases with each new version,” says Brault. “You can diagnose more people than ever.”

For parents such as Howard and Tozer Johnston, making sense of what’s best for their children—what behaviour is acceptable or “normal” and what’s not—is a personal challenge, the likes of which they’ve never encountered. For Howard, moving to a small community where Oliver can run around in the woods during recess and after school, and even bounce on a ball in the middle of class without judgment from teachers or other students, has been a risky but rewarding solution. At least so far. “My gut was that this would be better,” she says, “and it has been.”

For Tozer Johnston, getting to a better place has been complicated. Since starting Grade 5, Bram has had “a wonderful year,” she says, crediting supportive teachers as well as self-esteem building strategies. Still, earlier this year, Tozer Johnston did have Bram checked for ADHD. The results indicated that he does have the disorder, and since February, he’s taken medication every school day.

There have been side effects: Bram has lost seven pounds, and he has trouble sleeping. Tozer Johnston is conflicted about taking him off the medication. “I feel that he doesn’t need this stuff. But I do feel pressure to do it because there’s so much on the line—his education, the tolerance, being involved in school activities,” she says. “I’m afraid that if I don’t do this, will he still be treated the same way?”

For now, both she and Bram are looking forward to one thing: summer, when he will be out of school, and off the meds, says Tozer Johnston. “I can hardly wait.”

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Does mother know best when it comes to ADHD?

  1. do not always believe that our children need to be drugged up. they told my husband and myself the same thing, our son is now 23 years old running his own lawn care company. The school system did nothing for this kid, we live in BC paid our school taxes and still our kid was never allowed to be a kid and after putting our son on ritalin guess what he stopped growing, stopped eating and school still never got any better. I took him off the crap, this leads to drug additiction when these kids get older. good luck to all parents who are going thru this and who will be going thru this. stand up for your kids.

    • Lisa, untreated ADHD can lead to drug/alcohol abuse/addiction. Someone is better off to be treated with ADHD medication (there is non-stimulant medication as well) or treatment than to remain untreated. Maybe there is an over diagnosis (or misdiagnosis) of ADHD but it can cause sever issues not just in schooling but in relationships, and a variety of other daily issues.

  2. Enjoyed your article Cathy. Thanks for getting the parents experiences out there. I am now preparing an article on how parents can prepare children for kindergarten/grade1 which may help some of the mis-diagnosis of ADHD. The more we can help children the better!l Gail

  3. I have a sibling who was a grade 1 teacher. She always said they should change the cutoff date to June 30th and have children born after that date go to school the following year with the children who are younger than them but born before June 30th. That way, everyone would have that advantage of maturity that seems to be bestowed on those who are born in the beginning of the calendar year. Having had two children, one who was born early in the year and one late, I can’t help but agree. It is definitely easier to be one of the oldest in the class. Parents should never question their instinct that their child might be too immature to go to grade one or even kindergarten.

  4. Good article. Points are well made. I am
    familiar with what’s going on as I was that kid in a number of ways. For the
    mother and parents, I don’t have room here to say what I would like you to
    know. If it was only straight ADHD, it’s one thing, but you also have low
    self-esteem. That’s a big one. Google all the words as a single word: my own
    water pipe plus nestoiter. That will bring you a lot of information. Most of it
    will be unusual, but I think if you wanted to follow the crowd you would have
    put your kid on pills long ago and did whatever they told you to do. There is a
    lot of info on the site, yet the book goes deep into those issues of
    self-esteem, confidence, etc. I’m a practical man and none of my suggestions
    are based on something that is too complex. You WILL get results. Just be
    patient with your kid and with me as I tend to write a lot. In my defense, at
    least I am thorough. I will reply if you leave me a note.

  5. Also, if your kids do climb that tree on the picture, their needs are manifested by their behavior. They are craving the “State of Imbalance.” Only when they are in that state, they fully accept themselves as they are and understand the world around them. They probably feel very comfortable and content while climbing the tree or dealing with other challenging balance condition. It’s a complex thing but very common. The book goes deep into it and explains not only why it is so, but also what to do about it.

    • Hmm I am intrigued for many reasons by your comments. I looked you up on FB but it didnt have a message link to send you a message. I would love to talk to you more on this topic as I have a ADHD son. Theres too much to write here on our story but we are not going the med route as I feel “for my son” it would or could do more harm than help. We are currently looking into alternative therapies that are natural. Could you please email me? My email is countrygal03@ymail.com Thanks!:)

  6. Start children in school before they are ready, increase class size, increase pressure on teachers so they over-react when a child takes the long way around to his desk or talks out of turn. No problem – just put the child on drugs. Not a brilliant strategy in my opinion. My younger son apparently needs meds too – to control his ‘impulses’ – at least this was the opinion of his teachers. Now we are homeschooling.

  7. Children are being greatly over diagnosed and it is largely a result of Big Pharma’s desire for even greater profits and the broad labelling permitted by the DSM. Psychiatrist D Allen Frances who was the chair of DSM IV has come out of retirement to campaign against the stigmatization and over medication of both children and adults with the new DSM V . He recently gave a one hour lecture on the subject at U of T that is well worth watching.

    http://ww3.tvo.org/video/177352/allen-j-frances-overdiagnosis-mental-illness

  8. As a writer and a mother with a child with severe ADHD, I’m incredibly disappointed at how one-sided your article is. Your personal interviews are with parents who either chose not to medicate or who felt pressured into it and now wish they hadn’t. What about the parents who chose to go the medication route and whose children are now able to participate fully in their own lives? Who can now function in class and are able to enjoy learning? Who now have friends instead of being ostracized because of their unpredictable (and often scary) behaviour? What about the fact that treatment for ADHD often requires both behaviour therapy and medication? What about the fact that many kids can’t participate fully (or at all) in behaviour therapry without first being medicated? What about the fact that imaging studies (MRIs, etc.) have shown beyond a shadow of a doubt that ADHD is a condition caused by the frontal lobe of the brain not functioning properly? The frontal lobe is the area of the brain that regulates emotions, impulse, and memory, which explains why people with ADHD struggle in certain areas of their lives.
    Are there children who are misdiagnosed? Absolutely. Are there parents who feel pressured to medicate their children. Absolutely. But there are also those of us who have had our children properly diagnosed by psychiatrists and behavioural specialists to ensure that this is not the case. There are those of us who work incredibly closely with amazing public schools who go out of their way to ensure that our children receive the education they need in a way that works for them. There are those of us who work with our local children’s mental heatlh agencies to ensure that our children learn skills to help them deal with the problems caused by their brain not functioning properly.
    ADHD and it’s accompanying conditions (ADHD is rarely seen on it’s own, but often goes hand-in-hand with ODD, anxiety, mood disorders, and autism) are incredibly complex to diagnose and treat. Hyperactivity in children is just one outward manifestation of a serious condition that affects every aspect of their lives, and to present it as the key factor is to trivialize it. Articles such as this one, that present only one part of the story (and a small part, at that), add to the judgment already felt by parents who make the decision to medicate their children.
    How about a new article, one that presents all the facts, and helps to alleviate the stigma instead of adding to it? I even know a writer.
    Laura Wright, blogger at The ODD Mom: Loving, laughing and living with an ADHD/ODD child

  9. I believe that parents have the right to choose and to question which course of intervention they decided to pursue with their children when it comes to addressing learning, behavior and/or mental health concerns. Most alternative courses of action are costly, time consuming requiring a lot of patience, perseverance and commitment, but they are out there! I have seen them work, but they are not a quick fix. Parents need to know all of their alternatives and need to research far and wide to find the solutions that are a good fit relative to their belief systems, values and lifestyle. While parents may opt to medicate and choose to do so, I think if they had the time and the interest to do the research, many medical doctors, psychiatrists have researched and documented on the risks associate with highly powerful psychotropic medications. If parents want to take the risk, they have the right. No different than a person choosing to smoke, knowing well there are associated health risks. I guess the question that begs to be asks – do the benefits out way the costs? I believe that short term gain does not translate into long term benefits, relative to individual health and well being. An ounce of prevention is a pound of cure and I think if we really took the time to understand the root cause of the behaviors, emotional, and mental functioning of these children/adults manifesting symptoms associated with ADHD, what we would uncover is a multiple of causal factors, a number of which are based in diet, nutrients, toxins, genetics and social factors (i.e. pace of society, technology, access to nature) etc.that are impacting everyone’s health, but more specifically those in society who’s neurological systems are not fully developed or have been compromised in some way; namely our children, the elderly and those with serious developmental (physical, mental) challenges. It appears to me that the most vulnerable in our society are being preyed upon and it is our job as guardians to protect them

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