http://www.philly.com/mld/philly/living/health/7852459.htm
Posted on Mon, Feb. 02, 2004
Dan Gottlieb | Be cautious in diagnosing ADHD
By Dan Gottlieb
Many children with symptoms of attention deficit hyperactivity disorder (ADHD)
actually suffer from a more prosaic malady: lack of sleep.
A recent study, published in the October issue of Pediatrics, examined more
than 3,000 5-year-olds and found nearly 20 percent had symptoms of ADHD, while
half reported daytime sleepiness.
Agitation and distractibility are not unusual symptoms for children who have
not gotten enough sleep. It is quite possible many children medicated for ADHD
are really sleep-deprived. When I discussed this on a recent radio show, I
suggested that we should go slowly before we diagnose and medicate our
children. The evaluation should be thorough and we should look at the overall
context of the child's life, rather than simply medicate the symptoms.
In addition, I suggested that most of our children are overstimulated and that
some of these hyperactive symptoms are just the response of their minds and
bodies trying to keep up with an unhealthy environment.
One listener was distressed about what she heard. She wrote to me:
"My concern about what you were saying is that you may be encouraging children
to be held hostage (by their symptoms) while you and others advocate for
important societal changes that would probably work better than medication but
are much harder to obtain than a diagnosis and medication."
I certainly agree that depression, anxiety, hyperactivity and rigid behaviors
are illnesses that need to be treated. But they are also symptoms that need to
be respected. Because if we respect the symptoms, rather than trying to
eliminate them, they might lead us to the real problem.
Several years ago, I saw an 11-year-old girl for consultation. She had been
diagnosed with school phobia as she would cry and argue with her parents every
day before school. A behavioral therapist had treated her for her phobia but
the treatment never worked. Her family doctor put her on medication for the
phobia, but that didn't work either.
After a couple of sessions, she confided to me that she was being molested by
an older boy at school who told her that if anyone found out he would hurt her.
The phobia was the symptom, not the illness.
Family therapists have long known that a symptom in a child could also reflect
a problem in the family. I have seen many children who showed symptoms of
depression or anxiety when the real problem was parental conflict or
depression. I was recently asked to see a boy who was agitated in school and
diagnosed with ADHD. After I saw the family, it became clear that his mother
had an eating disorder and the marriage was in trouble. As the family improved,
he became less agitated.
This problem is not confined to children. Many adults go to their family doctor
for stress-related symptoms or depression and get pills. Yet the real problem
is with their lifestyle. So they get medication, which will suppress the
symptoms so they can continue living a lifestyle that is unhealthy.
Managed-care and pharmaceutical companies largely support this approach, as it
is a profitable approach - in the short run. In the long run, the anxiety,
depression or stress-related symptoms continue, resulting in lost work, medical
problems and a variety of other social ills.
The classic example of treating symptoms is using diet programs for obesity. It
is widely known that the failure rate for these programs is well over 90
percent, and any dietitian will tell you that what is required is a lifestyle
change and not just a diet change.
Our children are increasingly diagnosed with ADHD, depression and anxiety
disorders, and more children than ever are taking psychiatric medication. As a
culture, we are becoming more effective at treating symptoms and less effective
at treating the problems that cause them.
No, we cannot wait until our society changes. Society changes glacially and
children suffer daily. But this ADHD business is a label upon which
pharmaceutical companies have made millions, and parents and teachers are
controlling overstimulated children chemically.
I am not waiting for society to change, but I am asking parents and
professionals to take the time to look at the whole child and not simply to try
to manage his or her behavior.
I also understand and respect the other side of the argument. I have seen how
destructive ADHD is and what it takes away from children and families. And I
have seen how medication can be a lifesaver when used with the right child in
the right way. But to medicate a child (or anyone, for that matter) simply to
control behavior does everyone a disservice.