Is it ADHD, fetal alcohol or both?

Some children diagnosed with ADHD (Attention Deficit Hyperactivity Disorder) are “alcohol babies,” according to Ira Chasnoff, a Chicago pediatrician. Of 156 foster children referred for behavior disorders — most diagnosed with ADHD — 81 percent had fetal alcohol spectrum disorders (FASD), he found.

ADHD diagnoses have increased by 42 percent in 12 years, writes Olga Khazan in The Atlantic.

Unlike children affected by fetal alcohol syndrome, which is the most severe condition on the spectrum, those with other types of FASD may not have facial anomalies. Thus, the issue may go unnoticed by physicians for years.

“Many alcohol babies will look normal, so no one thinks of doing the toxicology,” Chasnoff said. Nationally, about 20 percent of women drink during pregnancy, but only about 3.6 percent of children have been diagnosed with FASD.

Of course, kids who’ve ended up in foster care are much more likely to have heavy-drinking mothers.

“About 74 percent of children with FASD do meet criteria for ADHD,” Chasnoff said, “but, because of all the neurochemistry changes from the alcohol, it’s a different kind of ADHD” and requires different treatment and medications.

Years ago, I visited a rehab program for drug-addicted mothers and their children. A staffer told me that “crack babies” get better. “Fetal alcohol babies” do not, she said. They suffer lifelong learning and behavioral disabilities.

Let those children move

It’s no wonder that middle schoolers fidget, slouch and daydream, writes Angela Hanscom, an occupational therapist specializing in children, on Answer Sheet. They sit too much and move too little.

She tried spending a day in a local middle school. Students were supposed to sit still and pay attention for 90 minutes at a time, with only a brief break to switch classrooms, she writes. She couldn’t do it. After 45 minutes, “I’m no longer registering anything the teacher is saying,” she writes.

“About 50 percent of the children are fidgeting and most of the remaining children are either slouched in the most unnatural positions imaginable or slumped over their desks.”

She’d planned to observe for the whole day, but it’s too exhausting.  “I decide to leave right after lunch.”

There are “too many regulations, not enough time,” says a teacher. Another blames cramming for high-stakes tests.

They go on to explain that recess has been lost due to lack of space and time as well as fear that children will get injured. “Too many children were getting hurt,” says a teacher. “Parents were calling and complaining about scrapped knees and elbows – the rest was history.”

Snack time, once a brief break, is now used for a quick vocabulary lesson. P.E. is held every sixth day.

Children march silently to the cafeteria for lunch. They’re required to remain quiet and seated throughout the lunch period.

P.E. less than once a week, no recess, no snack break, no free time at lunch . . . I can’t believe this is typical. Is it?

Many schools have switched to block scheduling, which means longer class periods and fewer breaks in between. Common Core standards may encourage more to lengthen class periods.

Inactivity can lead to improper diagnoses of Attention Deficit Hyperactivity Disorder, writes Hanscon in Why so many kids can’t sit still in school today. There are right — and surprisingly wrong — ways to get kids to sit still in class, she argues.

Hanscom is the founder of TimberNook, an outdoor play program in New England.

Do we want a cure for Walter Mitty?

“Sluggish cognitive tempo,” a new medical term for excessive daydreaming, could save lost-in-a-fog children and adults from being misdiagnosed with attention deficit disorder, writes Diana Senechal. But she worries that Walter Mitty and Fern will be cured of imagination.

If James Thurber’s Walter Mitty had been diagnosed with SCT, he’d stay “on task” and remember to buy the puppy biscuits. There’d be no “ta-pocketa-pocketa-pocketa-pocketa-pocketa.”  (The Secret Life of Walter Mitty is one of my favorite stories of all time.)

Not all wandering minds are lost, Senechal writes.

I have had students who had difficulty staying on task because they were thinking about the subject in an interesting way – as well as students who seemed “off-task” because they were actually concentrating hard (and not taking notes as the others were). I myself tended not to take notes in school; I preferred to listen and think.

If we “faulted, diagnosed and fixed” all the daydreamers, “the world would fill up with dreary essays that never departed from the rubric,” writes Senechal.

In Charlotte’s Web, Fern’s mother pays a visit to the family doctor, Dr. Dorian, in order to seek his advice about Fern, who, in her view, spends far too much time alone with the animals, just sitting and listening to them. Dr. Dorian leans back, closes his eyes, and says, “How enchanting!”

Senechal will discuss solitude on BBC’s  The Forum this weekend.

Drugged ‘for being boys’

Most boys on Attention Deficit Hyperactivity Disorder meds are “being drugged for no good reason—simply for being boys,” charges Ryan D’Agostino in Esquire.

By the time they reach high school, nearly 20 percent of all American boys will be diagnosed with ADHD. Millions of those boys will be prescribed a powerful stimulant to “normalize” them. A great many of those boys will suffer serious side effects from those drugs. The shocking truth is that many of those diagnoses are wrong . . .

“We are pathologizing boyhood,” says Ned Hallowell, a psychiatrist who has been diagnosed with ADHD himself. The co-author of two books on ADHD,  Driven to Distraction and Delivered from Distraction, Hallowell “there’s been a general girlification of elementary school, where any kind of disruptive behavior is sinful.”

Most boys are naturally more restless than most girls, and I would say that’s good. But schools want these little goody-goodies who sit still and do what they’re told—these robots—and that’s just not who boys are.”

Boys aren’t given time to outgrow immature behavior, writes D’Agostino. A huge Canadian study found that “boys who were born in December”—typically the youngest students in their class—”were 30 percent more likely to receive a diagnosis of ADHD than boys born in January,” who were nearly a full year older. And “boys were 41 percent more likely to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January.” 

“Sluggish cognitive tempo” — day dreaming — is the latest candidate for diagnosis and medication, reports the New York Times.

“We’re seeing a fad in evolution: Just as A.D.H.D. has been the diagnosis du jour for 15 years or so, this is the beginning of another,” said Dr. Allen Frances, an emeritus professor of psychiatry at Duke University. “This is a public health experiment on millions of kids.”

‘Smart pill’ doesn’t improve schoolwork

The “smart pill” isn’t so smartreports Nature. ADHD (Attention Deficit Hyperactivity Disorder) meds improve classroom behavior for the first year or so, but do little for academic achievement, according to “a growing body of evidence.”  

In the early 1990s, the MTA study began following four groups of elementary children with ADHD. They received medication, behavior therapy, medication and therapy or whatever care they had already been receiving.

After 14 months, the medicated groups showed better control of ADHD.  The drugs/therapy group had higher grades, but the regular care group was second best. And the gains didn’t last.

By three years in, the four groups had become indistinguishable on every measure. Treatment conferred no lasting benefit in terms of grades, test scores or social adjustment. Eight years later, it was the same story. 

. . . A 2013 review of randomized controlled trials longer than 12 months similarly concluded that there is scant evidence for improvements in ADHD symptoms or academic performance lasting much beyond a year.

A few studies show long-term gains in academic performance, but the boost is small and fades over time.

Attention Deficit drug ‘disaster’

“After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder,” Dr. Keith Conners calls the rising rates of diagnosis “a national disaster of dangerous proportions,” reports the New York Times in The Selling of Attention Deficit Disorder.

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

Fifteen percent of high school-aged Americans now are diagnosed with ADHD, reports the Times. Classic ADHD, “historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life.” Drugs can help, though they have side effects.

But . . . drug company marketing has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.

Now,  adult diagnoses are soaring, reports the Times. “In this six-question test, anyone but the highly organized” could be deemed “ADHD possible.”

From idealist to ‘bad teacher’

John Owens quit a successful publishing career, studied education for a year in graduate school and became a writing teacher at a South Bronx high school that “considered itself a model of school reform.” It didn’t go well, Owens writes in Confessions of a Bad Teacher.
bad teacher
Owens talks to Ed Week Teacher‘s Hana Maruyama about his “heartbreaking” year as a teacher.

His principal was obsessed with data, says Owens, but the numbers were meaningless. “I had to put in 2,000 points of data a week for my kids. Everything from attendance to homework. But I also had to put in things like self-determination. I mean, what is self-determination?”

He was told he was a “bad teacher,” he complains. “If I were a good teacher, the kids who had attention deficit hyperactivity disorder would sit still and learn. If I were a good teacher, the kids who didn’t speak English would speak English. If I were a good teacher, all the problems that these kids faced would be solved in my 46 minutes a day with them.”

ADHD diagnoses surge overseas

Attention Deficit Hyperactivity Disorder (ADHD) diagnoses are surging overseas, as well as in the U.S. Children may be taking powerful drugs needlessly, warn researchers in the British Medical Journal (BMJ).

In Australia, prescriptions for the stimulant Ritalin and other ADHD drugs rose by 72 percent between 2000 and 2011, while in Britain and the Netherlands prescriptions roughly doubled between 2003 and 2008, said the paper.

According to the US National Institute of Mental Health (NIMH), nearly one in 11 American children aged 13-18 and one in 25 adults are affected by ADHD.

Ritalin and other drugs are appropriate only for “severe” ADHD symptoms, which occur among about 14 percent of children with the condition, the study noted. Yet 87 percent of U.S. children diagnosed with ADHD in 2010 received medications.

Carnival of Homeschooling

The Carnival of Homeschooling is up at The Homeschool Post. Reaping what you sow is the theme.

Coming to Grips with My Homeschool Reality (The Holistic Homeschooler) and 10 Reasons to Homeschool an ADHD Child (Harrington Harmonies) deal with homeschooling children with dyslexia, mood disorders and/or hyperactivity.

Test-based funding linked to ADHD rise

The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic is test-based accountability argues Maggie Koerth-Baker in the New York Times Magazine. Diagnoses are skyrocketing, she writes. “Before the early 1990s, fewer than 5 percent of school-age kids were thought to have A.D.H.D.”  This year, the Centers for Disease Control and Prevention estimated that 11 percent of children ages 4 to 17 had received the diagnosis.  When test scores count, schools have an incentive to diagnose more children as disabled, she believes.

The No Child Left Behind Act, signed into law by President George W. Bush, was the first federal effort to link school financing to standardized-test performance. But various states had been slowly rolling out similar policies for the last three decades. North Carolina was one of the first to adopt such a program; California was one of the last. The correlations between the implementation of these laws and the rates of A.D.H.D. diagnosis matched on a regional scale as well. When (Berkeley Psychology Professor Stephen) Hinshaw compared the rollout of these school policies with incidences of A.D.H.D., he found that when a state passed laws punishing or rewarding schools for their standardized-test scores, A.D.H.D. diagnoses in that state would increase not long afterward. Nationwide, the rates of A.D.H.D. diagnosis increased by 22 percent in the first four years after No Child Left Behind was implemented.

To be clear: Those are correlations, not causal links. But A.D.H.D., education policies, disability protections and advertising freedoms all appear to wink suggestively at one another. From parents’ and teachers’ perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.)

Rates of A.D.H.D. diagnosis vary widely from country to country, Koerth-Baker observes. In 2003, nearly 8 percent of U.S. children — but only 2 percent of British kids — had been given a diagnosis of A.D.H.D.