REPRINTED WITH PERMISSION from Natural Awakenings, pp. 16-17 [edited with change of title from ADD: A Holistic Approach]

I’m not against pharmaceuticals. Not 100% anyway. My mother was a diabetic and I’m convinced the insulin she took daily prolonged her life. But when you’re looking at human behavior, a holistic perspective demands that you exhaust less invasive remedies before turning to medication. Such is surely the case with Attention Deficit Hyperactivity Disorder (ADHD), a problem for which there exists NO definitive diagnostic tool.

ADHD is an easy label to pin on an out-of-control child. The most precise measures we have to determine if a particular child indeed “has” ADHD are paper and pencil questionnaires which parents, teachers, and the child may fill out or take on computer. These questionnaires pinpoint aspects of the child’s behavior, and answering “yes” to a sufficient number of them yields a score which means that that child is behaving like an ADHD child. But is he in fact ADHD-or are other factors causing his disruptive, difficult, and hyper behavior? Before concluding that a given child is ADHD, parents, teachers, pediatricians, doctors, and psychologists are morally and ethically mandated to rule out other possible causes, such as the following:

1. abuse

I recently attended a conference where I was amazed to see a video of a 5 year old child totally destroying his room over a three week period. He ripped wooden frames off windows and used the wood to beat family members who entered the room. He abused the dog. He would not let his parents come near him. He was in constant motion, aggressive, and seemed to be a sociopath in training. You might think he was ADHD among other things, but no, his behavior was the product of abuse and neglect by his birth mother followed by more of the same at the hands of his adoptive parents. This unloving, belligerent child is a typical and normal product of abuse. He was not ADHD.

2. underdisciplining

At the other extreme from abusive parents are those who are afraid to discipline. These parents either were punished harshly themselves as children and have the concept of discipline confused with abuse or, they too, were overindulged. In either case, they did not teach their child limits and self control. Such a child could appear to be unable to listen, stop moving around, and concentrate when the problem is that he has merely never been required to. Parents who know how to discipline consistently combine their expectations with both external and internal consequences. Parents who want a given behavior but who don’t know how to get it may be reduced to yelling, ignoring, or giving in. The child in such a family may have ADHD behaviors but not be attention deficit.

3. depression and stress

Whether there is a divorce, death, trauma, neighborhood violence, parental substance abuse, difficult peer relations, academic problems, absentee parents or any number of other stressors in a child’s life, the resulting behavior can mimick ADD (possibly without the “H”). Children with troubles on their minds may appear spacey when, in fact, their distracted behavior is perfectly understandable. How is the child supposed to learn when his mother is in the hospital? Or when he dodged drug dealers on the way to school?

4. substance abuse

Depending on whether the drug of choice is an upper or downer, child substance abusers may behave as if they had attention deficit or hyperactivity or both. Durg use, drinking, and smoking frequently begin with children as young as 10, and depending on what is available at home, even younger. Of course, turing to substances is itself a symptom that something else has gone terribly wrong in that child’s life.

5. lifestyle

Much has been written about the relationship between food additives and behavior as well as sugar and behavior. In a particular case, if all of the above, number 1 through 4, have been ruled out, it seems only fair to children to assess the additive and sugar content of what they eat. In the same way, parents often fail to realize the importance of schedules. Children who are up too late at night may appear hyper and they will pay insufficient attention the next day. Eating dinner too late may cause difficulty sleeping. Young children exposed to gruesome shows on television have been repeatedly shown in research to exhibit trauma symptoms such as nightmares and preoccupation. And it doesn’t take much to scare a child. The tough children who say it doesn’t bother them are the ones who get the nightmares that rob them of restful sleep–and may not even remember.

The moral thing for any health provider to do when faced with a child having ADHD symptoms is to thoroughly investigate his or her context and history for any of the above before whipping out the prescription pad and writing down Ritalin, the most overprescribed drug in America. But you have to understand that not only are doctors given free samples of a smorgasbord of pharmaceuticals, mental health workers also have an incentive to recommend medication. That incentive is often the punitive effect of having insurance companies deny payment for counseling but not deny reimbursement for referral to an M.D. who can prescribe medication. Erroneously, the insurance companies believe the medication works better.

That is factually incorrect. Suppose the child were ADHD. Studies show that Ritalin works best in conjunction with therapy. Why is that? Neurologically, the brain has a tendency to work a certain way. When medicine in the system directs the brain to do otherwise, the brain resists. (It’s kind of analogous to how the body’s metabolism slows down to defeat your attempt to diet–you eat less so the body burns fuel more slowly.) This may seem annoying when you want to accomplish something, but it really makes sense. These are brilliant adaptive mechanisms that Someone figured would provide our bodies-and souls-with stability, always returning us to our previous position no matter how lopsided our lives become.

So you take medication and the brain spits out more of what the medication was working against. The solution is therapy. When you get the child to want to “go with the flow” his or her brain miraculously stops fighting the medication. I have an ADHD child, an unabused, well loved, disciplined, lovely child who is indeed ADHD. He’s on Ritalin because nothing else worked. But before we started on it and during the period he has been on it, we have talked extensively about the meaning of his problem and how he is supposed to relate to it. I have framed his Ritalin requirement as little different from my desire for a cup of coffee when I feel a bit unfocused, and I have pointed out that he is in a way luckier than some children for whom the studying and learning come easily: He has had to acquire the gifts of self discipline at great cost, making them quite precious. In addition, on weekends, when he doesn’t take medicine, he has the creativity so frequently a part of this pattern that many other children don’t have.

A holistic approach begins with ruling out all other possible explanations and ends with therapy for the spirit as well as for behavior.

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