It’s hard to know what to make of what seem to be awfully high rates of diagnosis of and treatment for attention-deficit/hyperactivity disorder, or ADHD, among American children. A new story in the Wall Street Journal does a yeoman’s job of trying to get to the bottom of a resulting, and particularly troubling development, that of kids, including ones in kindergarten, being prescribed ADHD medications. When those prove not to be very effective or generate side effects, the response too often is add more drugs to the mix, when even the original Rx is a gamble with developing brains, particularly given the loose definition of what constitutes ADHD and the dearth of information about effectiveness and long term effects from juvenile use.
The article notes: “Factors such as differences in sex, race and foster-care status didn’t explain the gap.”
And the raw numbers are not pretty. 7.1 million between the age of 3 (!!!) and 17 are under treatment for ADHD, which is over 10% of that group. Medicaid data (a sample of 166,000) showed that of those administered ADHD drugs in 2109, only 37% had received therapy.
Now there are no doubt instances where a child’s behavior is so pathological that some sort of intervention is necessary. And there are no doubt instances where medicating a child with ADHD drugs was beneficial in the short term and not damaging longer term. And there may be baseline conditions in society, from more pollutants and toxins (think of how the adoption of lead-free gasoline reduced crime rates) to early over-stimulation of children via electronic devices to more anxiety among children due to more precarity and higher divorce rates, all taking a toll on young people, with more ADHD a result.
But for those of us old enough to have had free range childhoods, it’s hard not to think that a big contributor is increased intolerance of childhood. Admittedly, kids were once supposed to be seen and not heard. But it seems that children are expected to comport with ever-more-stringent norms of performance and behavior.
Remember that a big purpose of public education has long been not just the formal learning, but also deep acculturation: of having to turn up every weekday at a set time, to sit quietly and accept being under the control of an adult non-family member, to comply with instructions, to achieve certain minimums of performance and see excelling as a proof of personal merit, to sometimes cooperate on group projects. This is preparation for factory and office routines.
Over the past few decades, child-unfriendly developments include:
Less recess. My elementary school effectively had three recesses: one in the morning, one in the afternoon, and a play period at the end of lunch time. I can’t fathom how most kids sit still as long as they are expected to now. Education Week reports that the CDC-funded the Physical Activity Policy Research and Evaluation Network recommends only 20 minutes a day. The article also contains a bizarrely-difficult-to view table with the results of a 2025 survey; here are some of its findings:
While this is not quite terrible, it does not seem so hot either.
Comparatively little walking to and from school. Intuitively, too little overall activity can’t be a plus for focusing. Studies have deemed the US to have “low prevalence” of children walking to and from school. If communities aren’t willing to solve that problem (say with more “safe” routes), another approach would be short in-class exercise sessions:
Children in China are required to exercise between different lessons in school pic.twitter.com/yIIFXgJ6jR
— Historic Vids (@historyinmemes) January 17, 2024
Increased performance demands. Accompanying the death of free-range childhoods, children seem to be subject to higher performance standards, and at younger ages, with “performance” meaning both “behaving adequately in class” and “doing well academically”. Some of this seems to result from much greater economic stratification, and with it, more parental anxiety about having their offspring get into a “good” college. When I was young, grades and scores started mattering only at the earliest as of seventh grade in public schools, when more promising students might be tracked into advanced language or advanced math and science programs. Putting aside intense competition in cities like New York and San Francisco, with a big contingent of affluent parents spending bigly to get their kids into elite kindergartens or other special burnishing so at to get them into advantage-conferring private schools, there seems to be too much anxiety at too young ages about accomplishments at school. No wonder children show up with what looks like ADHD.
Schools as childcare providers. In my childhood, “latchkey” children with working mothers and fathers were not very common. Now, having kids in school all day is more essential for most parents.
Consider this part from the opening anecdote, of a now 29-year-old struggling to get off psychiatric meds:
Danielle Gansky was 7 years old when an administrator at her upscale private girls’ school in suburban Philadelphia flagged problems with her academic performance. She was a bubbly and creative kid, but she was easily distracted in class and her schoolwork was sloppy.
The school told Gansky’s mother that the girl should see a psychiatrist, who diagnosed her with attention-deficit/hyperactivity disorder, or ADHD, and prescribed a stimulant. Concerned that Danielle might get kicked out if her focus didn’t improve, her mother broke into tears and agreed.
Obviously, we can’t get the full story so many years late. But this screams of a overly-controlling school and insecure parenting. What does it matter if a seemingly smart 7 year old isn’t conscientious? That is hardly a reasonable expectation at that age. I was insubordinate in first grade and had to be spanked with a belt nightly to get the message that that was not on.1 I’m not saying that was a great approach, but it did make clear I had to bend to authority. The bigger point is there is no evidence that Danielle was badly behaved, and so the school’s action seemed disproportionate. A mention to the parents and perhaps intervention if her inattentiveness was still evident in a year or two seems more fitting.
Keep in mind that modern parents seem not at all shy about browbeating teachers and even principals when they think their student had gotten an unfairly low academic grade. So why the cowardice when they are given what might be an unfairly low behavior grade, such as underperforming or say daydreaming, as opposed to being disruptive?
Or are some parents believers in better living through chemistry? After all, in elite high schools, students are readily able to obtain Adderall and use it as a performance enhancer. But search results show multiple studies finding that stimulant use does not improve grades, contrary to urban legends.
As that extract indicates, Danielle’s mother was afraid of expulsion. The Journal indicates that is not uncommon:
The decision to treat ADHD with medication is often made by desperate parents trying to keep their kids from falling behind or being kicked out of school or daycare, parents and mental health clinicians say. For preschool-age kids, the drugs are often dispensed against pediatric guidelines, which call first for behavioral therapy, a treatment that can be hard to get. And mental health providers say the drugs are frequently prescribed to treat childhood trauma that has been misdiagnosed as ADHD.
The article explains the too-often casual approach to drug dispensing:
“We need long-term studies following young people to fully understand the effects of psychiatric medications on the developing brain,” said Dr. Mark Olfson, professor of psychiatry and epidemiology at Columbia University Irving Medical Center. Antipsychotic medications are of particular concern, he said. Some studies suggest that adults taking antipsychotics for long periods experience cognitive decline, but long-term studies haven’t been conducted on children, he said.
“The best scientific evidence suggests that it is very rare for two or more medications in kids to be helpful and there are concerns about safety, because there can be additive adverse effects of different types of medications,” said Dr. Javeed Sukhera, a child and adolescent psychiatrist and chair of psychiatry at the Institute of Living at Hartford Hospital in Connecticut.
A child on several medications at once often hasn’t had a comprehensive evaluation by a child psychiatrist, Sukhera said. Stimulants can cause side effects that can be mistaken for an additional disorder. “When a young person shows up with anxiety after starting a stimulant, that doesn’t mean that they have an anxiety disorder,” he said.
Contrast that concern with:
The Journal analysis identified nearly 5,000 providers who ordered ADHD drugs for at least 100 children each between 2019 and 2022. On average, they gave additional psychiatric drugs to 25% of their patients. A tiny number ordered the combinations at much higher rates, including 128 who did so for more than 60% of their patients…
All too often, under pressure from preschools and elementary schools, many parents seek help from pediatricians or psychiatric nurse practitioners—who frequently lack in-depth training in pediatric mental health—rather than wait months or even years for appointments with behavioral specialists or child psychiatrists.
Alexandra Perez, a clinical psychologist at Emory University School of Medicine who works with young children on Medicaid and private insurance, said she has seen children as young as 4 on multiple psychiatric medications. Many have experienced adversity or trauma and have behavioral problems as a result that get labeled as ADHD, said Perez, who practices Parent-Child Interaction Therapy (PCIT), a method that has been proven to reduce behavioral difficulties associated with ADHD.
The article continues with a long-form horror story of a disruptive 3 year old who was medicated to treat ADHD and oppositional defiant disorder, and was given more and different drugs, including antipsychotics, and an attempt to dry him out. They are experimenting with different ADHD drugs, still with no success.
The Journal notes:
The Journal’s Medicaid analysis additionally found that patients who started ADHD medications early were more likely to be prescribed additional psychiatric drugs. The youngest children—those between 4 and 6 years old in 2019—were the most likely to be on additional psychiatric medications four years later. The analysis didn’t assess the reasons.
Over 23% of the ADHD group in the Journal’s analysis—more than 39,000 children—were on at least two psychiatric medications at once by 2023. More than 4,400 were on four different drugs simultaneously, with a vast majority of them on an antipsychotic.
In a 2017 study looking at Medicaid children diagnosed with ADHD between 1999 and 2006, researchers found that for 60% of the years in which children were on multidrug regimens, they had additional mental health diagnoses like anxiety and depression that could explain the prescribing. But for nearly 40% of those years, they only had an ADHD diagnosis. Some clinicians may be reluctant to assign diagnoses to young children, according to the study.
My middle brother had behaviors that looked like a psychiatric disorder, including not speaking before the age of 3 (he wrote before he talked) and having some Tourettish behaviors. He grew out of them when adolescent hormones hit, graduated from high school along with his same-aged peers, and went to college. He was the first in the family to have a book published. I wonder what would have been done to him had he been a child now.
_____
1 I thought some of what I was being asked to do was busywork and I did it in a deliberately half-assed manner. That resulted in my getting done before the other kids. So I’d then get up and chat with the teachers.
An interesting aside here that probably occurred with many is the fact that marijuana was the gateway drug for me to tobacco.
Impressionsble young minds and tribal influence. I was never a heavy smoker, but did about a pack a day for 40 years.
Its been brutal trying to find a right treatment for my ADHD / autism. It’s a combination that throws your internal compass off for all things jobs, relationships, and emotions.
I went off my historic ADHD medications past college. I try them again when I realize I’m struggling as an adult. I trial them, journal, and ask myself at the end of the day if they truly help. As far as I could tell, they barely did anything for me. They don’t help with attention or prioritizing my attention. They usually increase my anxiety. So what the hell was the point of taking them?
So now I’m a little suspicious how ‘helpful’ these medications were during school. Its a disturbing thought and I’d rather not overthink it.
I still feel like I need something, and will work with a psychiatrist to try creative off label uses of medication.
At least now as a full adult, I finally can control what I take. I’ll guinie pig myself at times but won’t let some crackpot touch me. My plans, my rules.
I’d be curious as to a study that explores the role that Munchausen syndrome or Munchausen Syndrome by Proxy plays in this, in addition to big-pharma’s role in promoting ADHD diagnosis and treatment (arsonist-firefighters).
Drawing from experience here, my mother has Munchausen, and let me tell you, that made childhood a real hoot: details are not necessary or particularily relevant. Mother is easier to deal with and manage today, this thanks to a bit of knowledge and understanding, but even decades after childhood it is impossible not to carry some of the experiences with you.
I see this or something similar happening to the kids today who are being diagnosed and “treated” for ADHD. How many of these are just normal, but unlucky, kids? How many of their mothers doctor-shop until they find a doc willing to diagnose their kid so that mom can nourish herself on the pity of others? And how many docs overdiagnose ADHD for the prescription kickbacks?
Thousands of kids will grow up, self-confidence wrecked, thinking that there is something wrong with themselves when there isn’t– not good. We need them to be strong and healthy, if not for them, for ourselves.
The USA is no place to be a human, or at least a healthy one.
Sigh, I know of someone through the family that was medicated for ADHD as a kid; sadly grew up into substance abuse as an adult. It’s been a real tragic outcome; the family itself was entirely dysfunctional severely, so no doubt there are additional factors involved, but then that’s how life is. The alarm has been sounding on overmedication of kids for this for at least 10 years now, and it persists with reckless abandon.
ADHD goes alongside risk taking behaviour. Dopamine chemistry issues. More risk needed for same high that a neurotypical gets.
The rates for substance abuse disorder are far higher in those with ADHD. Like multiple times the rate of the neurotypical. There are genetic components to this. It’s entirely possible that whole family is neurodiverse.
And the problem with an entirely neurodiverse family? What happens in that family is normal to them. They don’t necessarily know they are out of the norm. Like my own family for example.
Didn’t realise all this until our kids were really not fine at all. Medication at an earlier point would have been very welcome. Rather than in the case of my eldest just six weeks before taking A level exams. And looking back at my own history of I was a teenager now with better awareness I would almost certainly be diagnosed with ADHD.
My spouse and I are on a similar journey, Hazelbee.
Our two boys have turned out to be divergently neurodivergent: one has presumed ADHD with a pinch of autism and one has sensory processing autism with a pinch of ADHD. Unfortunately ADHD boy has a compulsion to press the autism buttons of his brother, who happens to be an excellent martial artist!
Before this past twelve months, I was a big sceptic of the ADHD-autism complex but two things have happened, watching my sons grow into early adolescence and “meeting” a lot of younger generation ADHD people on reddit / Discord, who have been through an entire clinical pathway that simply didn’t exist in my childhood. The behaviours they described – indeed, they display, being online at 2am! – make me realise that (1) I probably have aspects of their conditions and (2) I am very lucky I don’t have the “competing inner voices” that many of them describe as their inner monologue.
My spouse has been on a similar journey with both #1’s dyslexia diagnosis – they realised that his problems were not normal and that their own childhood was dyslexic and now has an adult diagnosis – and the current ADHD / autism assessments – they realise that their entire family has one or the other, possibly both! But they are all high functioning (teachers, doctors, hedge fund managers, civil servants, advertising execs, with Oxbridge degrees).
My one run-in with a child psychologist, despite being frankly odd, was being taken to a clinic – I have a vivid memory if it, I drive past the house daily! – and asked to put the correct shapes in the correct holes. They ascribed my weirdness to being gifted and recommended my mother keep feeding me books. My mother never had a second child because I was too much hard work!
My spouse had raised autism concerns about son #1 in the past because of his difficulty fitting in socially with peers but I didn’t see anything wrong or the benefit of labelling a primary school child much less medicating them. Now he’s a teenager and has learned to make friends, what has become apparent is a borderline pathological issue with distraction / compulsion. He is well behaved and studious in school, has great powers of hyperfocus but is hugely careless in his work and writing and incapable of managing his time or deadlines. He will play computer games rather than do the work then have a meltdown about not having done it. He is equally incapable of letting a subject drop, despite the heaviest of instruction, e.g. with his brother.
We’ve paid for a private diagnosis and he gets the results next week. If they recommend he takes medication though, we are very unlikely to support it. The ADHD may be preventing him from performing to his full potential but he is insouciantly happy and still breezing through school – he has moved schools twice in search of more academic challenge and he’s got nowhere more demanding to try – so it is not actually pathological. We’d rather focus our efforts on behavioural and learning development coaching. If he starts to struggle in his late teens or at university academically because of his attentional issues or this inner cacophony some ADHD people report and willpower ceased to be enough, he can make his own choice.
Son #2 is a very different position. He easily suffers sensory overload (normal volume music is too loud, bright lights, background noise, smells, clothes / fabric etc) and he is paralysed by choice or competing demands on his attention. This quickly results in him being overwhelmed and becoming emotionally dysregulated. He is very unhappy because, as he is getting older (about to move to secondary schools), social expectations and demands are higher – as are his own expectations of himself because he cannot bear to make mistakes or fail at tasks. His meltdowns are now happening daily and are causing him to be socially isolated by his peers, stopping him enjoying being a chorister etc. He has developed a full-blown school anxiety and refuses to attend. Again, he’s very bright but in exam conditions he goes to pieces with anxiety when he meets unfamiliar material.
There’s no medication for autism – I wish there were – we just have to help him find coping strategies to manage his sensory issues and therefore stay regulated and remove his source of anxiety and hope we can do this as the demands of school accelerate (moving to secondary school, public exams, puberty etc).
In brief, I am no longer sceptical that these conditions exist. They are more distinct than simply “being a child” but they are a valid and valuable way of being a human. They need to be diagnosed because there’s a wide range of possible interventions. The US experience of medicating primary school children sounds crazy though because there is so much development and socialisation still to happen.
Thanks for writing such a detailed reply. Hoping you read this too.
Its definitely a journey. some phrases that stick in the mind after the last few years for me:
“the apple doesnt’ fall far from the tree”
and “birds of a feather flock together”
or while filling out the Connors test second time around (the one for ADHD) : “remember we’re doing it for X not for you” . hmmmm.
or reading so many of the relatable stories on additudemag.com
or the endless revisiting of my own history while searching for answers as to what was happening to my children.
like my school reports, unanimous, “he is capable of an A but we don’t know what version is going to turn up on the day, he’s equally capable of a fail” – this about my O Levels. I was either very interested or not interested at all. nothing in between. still like it now 4 decades on.
the journey with the family and self realization is without a doubt the hardest thing I have done. it is also the best thing I have done. so take heart. We are in a much better place – the self awareness is super important. Realising you are not like other people – it opens up options. and I don’t just mean medication. I am not medicated, some in the family are.
The insights open up different behaviours and suggestions around how to regulate. or even why regulation is needed. and you can give up the mask. small things like – if my hands aren’t moving I cant think. or how good weighted blankets are for sleep. or how noise or food impact some of us. the tumble dryer is the worst noise in the world, it literally causes me pain. I can only tolerate if fresh in the morning. tired at night? forget it. have to turn it off.
and this type of late diagnosis/realization – there is a good description. It’s like rewatching a movie for the second time, but you know the ending. Second time through the film you see the whole movie in a different light.
“divergently neurodivergent:” – great phrase :D
“grow into early adolescence ” – puberty is a point where masks drop. it is worse for females – the social changes are worse. and neurodiversity research for females is just worse (less spending, history, research)
“competing inner voices” – ? sounds normal? adhd friend of mine describes it as “the chorus of bastards” – trying to get you down.
” they realise that their entire family has one or the other, possibly both! ” – I think this might be more common than we realise. from birds of a feather flock together.
“son #1 in the past because of his difficulty fitting in socially with peers but I didn’t see anything wrong ” – of course you didnt see anything wrong. See apples and trees above .
“has learned to make friends,” – normal people dont need to learn how to make friends. I think it just sort of happens for them :D :D
” private diagnosis” – if you have the money and in the uk this is the way. CAMHS is a joke when it comes to waiting times and funding. We went private . when you find yourself living day by day, or at times even hour by hour you need to.
on son 1 – “We’d rather focus our efforts on behavioural and learning development coaching” – good approach. if you are not at a crisis point then learning to live with the constraints is the start.
son 2 – ” full-blown school anxiety and refuses to attend” – take this very seriously and get on top of understanding this now. my middle child struggled so much, missing multiple years of school, getting back to an even keel recently aged 20. and by “get on top of” I mean don’t underestimate it, do the learning yourself. and explore the EHCP process. might seem harsh to pick out but its the big red flag to me in your post. Do the learning, dont push it to your spouse, do it together. your child cant do it. its on you.
and on a meta level – none of my family are non-verbal or really severely impaired. For us its about coping mechanisms and learning what works or not. If a technique works for one of us then we can and will adopt it, if not then move on. when we get new observation or learning we talk about it and fit it into the family.
I am glad I managed to convince our daughters not to allow ADHD drugs for their offspring. My argument was, children should be allowed to be kids. Parents bear the burden of responsibility for the well-being of their children. Childhood is for the children, not the parents. Thus, parents must be made aware of the need for sacrifice on their part in the best interests of their children. The main inference I can make from all of this heavy and unnecessary medication of the young of America is that the parents are not mature enough to face their responsibilities inherent in parenthood and are looking for an easy way out.
I too remember my “free range” childhood. I walked to school all through High School. I biked tens of miles on the weekends. With friends I bowled, went to the beach, played football, (both kinds,) explored, and generally stayed physically active.
I have recounted before my disastrous experience with Prozac. Needless to say, it firmly set me on my present path of cynical distrust of Big Pharma and Big Medicine. In my case, one can say that my cynicism and paranoia are survival strategies. In our moderne over medicated society, cynicism and paranoia are to be touted as positive tools for navigating the reefs and shoals of societal pressures to conform. Remember, most of these rules are for the benefit of elites and top predators, not you and me.
Fight hard to stay safe.
In addition to the points made by Yves, I’d add that anxiety can lead to a presentation dominated by distraction and poor concentration. One of my favorite examples is a report by Rhoda Frenkel from 1993 in which a girl of 7 was troubled/excited by anxiety and sexual fantasies that got going in the midst of her parents’ divorce. Her ADHDish symptoms, which she thought of as the “heebie-jeebies” and had an element of an exciting somatic escape from a relational mess, subsided as she was helped to navigate feelings of anger and loss associated with the divorce.
These days the availability of an adequate evaluation that would identify the source of her symptoms is very unlikely. Most therapists are clueless when it comes to thinking about simple defensive transformations of emotions. Even if they could spot a correlation between symptom onset and family problems, daring to consider sexualization as part of the response would be hard for them to do and so the patient would be left in confused muddle. The same tends to apply to other “wrong” feelings and emotions, particularly anger and rage.
Not a psychologist but from my understanding, part of their assessment should include ruling out alternative diagnosis. I know for adults that things like Borderline Personality Disorder and Bipolar Disorder are tested as part of the psychological ADHD assessment, since they are common mimickers.
Sexualization in children is also not exactly congrous with an ADHD diagnosis either. At least at my Uni, it would make most psychiatry residents think about sexual abuse and things like PTSD which could both explain sexualization out of keeping with age-appropriate exploration/awareness as well as cognitive impairment like with attention.
I do agree in the sense that a lot of psychiatry trainees I talk to have to be constantly reminded that mood disorders, etc., need to be considered in someone presenting with concentration issues, not to mention that they’re commonly comorbid with ADHD too. That said, I don’t believe that connecting sexualization with a social issue at the level of the patient’s family/environment would be a stretch for anybody I know in either psychiatry/psychology.
Agreed about the importance of considering alternative diagnoses, but worth noting that a bipolar diagnosis has tended to be overdone in ways similar to the above case. N of 1 from my experience, but I had a patient who’d actually been diagnosed as manic-depressive because she would try to obsessively throw herself into activities, like gardening, to try to break out of gloom. Her “cycling” was based more on finding that projects that embodied hope would never quite get the payoff she hoped for, she’d crash, and then try to rally again in a way that was quite plucky. The underlying story was wrapped up in family dynamics I won’t get into, but what she needed was not a mood stabilizer but a straightforward psychotherapy.
My son had a hard time learning to read, and never liked sitting for extended periods of time in a classroom. When ADHD medication was suggested, it was he, rather than we as parents, who adamantly refused their use. Thus his own intuition at a very young age, that nothing was wrong with him that needed pharmaceutical intervention, set our course. At about that time I read Thom Hartmann’s take on the issue delineating the attentional differences between hunter-gatherer mind and farmer mind, and became convinced that following my son’s own intuitive grasp of what was best for himself was the way to go. He had no interest in going to college, and cursed with a love of working with his hands, entered the building trades, has a family of his own, and is doing as well as can be expected given our systemic givens.
I took a drugs and behavior course in college, taught by one of the leading drug research experts on the campus and she would go on rants about how ADHD medications in children were only being used to “control” their behaviors chemically instead of addressing the root causes of their issues.
She was firmly against medicating children unless absolutely necessary, preferring our non pharma interventions (like making sure kids had proper outlets for their energy)
“Kids are not wired to sit still and listen for 8 hours a day, why do we act like when they fail at this task there is something inherently wrong, they are just kids”
In the realm of long term effects, there is reason to believe that stimulant drugs are riskier in prepubescent and early adolescent kids than older children.
Stimulants can potentially lead to early fusing of growth plates, ie, preventing long bones from growing in length as they normally would, with children potentially being shorter than they would have been. This is something that still needs more research to confirm but it’s not exactly something that should be ignored.
Other potential side effects include insomnia, which children absolutely do not need, appetite supression, the list goes on.
Not that there isn’t a role for stimulants/other psychiatric drugs in young children but the decision should always follow a thorough risk-benefit analysis involving the parents, the child if possible, the psychiatrist and anyone else involved in their care. It’s similar to why colon cancer screening isn’t recommended after, I believe, age 70. Even if you do find something suspicious, the disadvantages of investigating things that could easily be benign outweigh the benefits at that age.
I have to agree that, in the grand scheme of things, having trouble focusing in 3rd grade is hardly the end of the world, while also being woefully insufficient evidence of ADHD. Again, a decision regarding the timing of any pharmacological intervention isn’t cut and dry. However, as another commenter described, regarding Munchausen’s (now Factitious Disorder) by Proxy, it would absolutely be prudent to explore reasons any parents insisting on stimulant meds give.
Otherwise, outside of policy changes, I think making as many people aware of the problems with medications in childhood is the only other way to avoid this. At the same time, it would be just as bad for more parents to staunchly refuse meds that do have evidence for being a net benefit depending on the situation. I think that, at the end of the day, having a proper explanation from the doctor about what the indication for the treatment is and why they feel like it’s better than any other option generally, is necessary (in all fairness, this should always take place with any recommendation).
I believe the instances where psych meds are a “net benefit” on a developing brain are vanishingly small.
Wow, you were smart enough to realize that your teachers were assigning worthless impractical busywork and not actually waste your own time doing it? I was so naive that I diligently did whatever assigned homework, however worthless, every night. It resulted in stellar grades, yet I am still furious at school and my parents for not telling me how unimportant good grades are, furious for ruining my childhood, furious for the school induced post-traumatic stress disorder (PTSD).
My own experience is different than the subject of this post—ADHD, its over-diagnosis and over-prescription of methylphenidate, and how school is dreadfully acting as the first line of ADHD diagnosis. The students who can’t sit still and pay attention to awful and impractical subject materials will be drugged up or reprimanded. I, on the other hand, became an automaton. School did an awful job preparing me for life, but later in my adult life, holy cow, was I good at filing TPS (totally pointless stuff) reports! I was so good that I learned how to program computers to parse through spreadsheets and text documents to automatically generate a TPS report. (This is a big topic for another day. When I used Perl 25 years ago to parse through documents and generate a special document with a special format, isn’t that almost the same as not-so-Artificial not-so-Intelligence?)
Whether we are talking about children being drugged upped unnecessarily with psychostimulants or intellectually inflexible and docile children from the rigidity of the educational system, money still flows to those who already have money. Did the pharmaceuticals encourage schools, parents, and doctors to over-diagnosis ADHD and over-prescribe respective drugs? They don’t call ’em addicts, but being dependent on a cocktail of drugs to counteract the original harm of the first drug is pretty lucrative. Or alternatively, one can be molded into an office drone, feebly accepting whatever repugnant directives the HR department is imposing.
To be more specific:
We were told to copy sentences from the blackboard and draw pictures illustrating them.
Admittedly, I did hate art projects :-)
However, I thought perhaps the point was for us to prove to the teacher that we could read the sentence. I could read it. So WTF re the picture? Why this silly way to establish that?
I did copy all the sentences. For about half, I designed my drawing so grass would cover the sentence.
For the other half, I didn’t draw any picture and went up to chat with the teachers since I got done before the other kids.
adults tried to force psychiatric meds on me from a very young age. i refused all psych medications. (i did not have any bad experiences with specific medications, i just hated the idea of drugs messing with my head after reading too many books as a 7 year old.) then refusal did not work so i pretended to take medications when i was like 11. then i was caught. eventually at 12 i landed in a psych ward where they sedated me and shoved an ng tube up my nose to force feed me medications. i ended up taking them “voluntarily” for about a year after; quitting cold turkey the minute i thought i could get away with it.
my point in this is that you cannot refuse medication. cps will go “oh no parents you are refusing to give your children drugs that help them, we are taking your kids away” or kids will get labeled as “noncompliant” which allows as much force as doctors feel like to be used against them.
especially for children. i have actual tourettes and while i haven’t grown out of it, it has gotten better. a lot of people grow out of tourettes. your brain just needs to build to regulate itself. as a kid i also had a lot of issues with sensory overstimulation, but have since learned to tolerate things that used to bother me. most people will either train their brains to work different, or find ways to make the world accommodate them. 7 year olds can learn how to regulate their behaviors and change how their brain works. they say people with tourettes have abnormally large prefrontal cortexes from the workout they get from repressing tics. im sure other people develop brain structures to compensate for “disorders” as well.
As a latchkey kid from 6th grade on, I don’t see what the big deal is, if you live in a safe neighborhood, which I would bet most kids still do (in reality, maybe not in the fantasies of today’s parents though). I would either walk the 2½ miles home or take a bus halfway and hoof it from there. Then: free time to read lots of comic books, drink soda, and eat snack food. Yeah, not ideal but far from some kind of tragic circumstances when compared to the lives kids in many parts of the world were stuck with back then. I would think any normal kid from 4th grade on could handle it. In a crime-ridden urban neighborhood or out so far in the country that there’s no easy way to get from school to within a mile or two to your home, yes, there would be a problem there. The Jonathan Haidt book that’s been talked about here before details how extreme the overprotectiveness has gotten now vs. then. Any type of open-ended chronic drug use by kids should be strongly discouraged unless the symptoms are drastic, especially things like anti-anxiety and anti-depressant drugs, which often seem to get added on once they’ve gotten you on any other “psych” prescription. Especially if we are talking about kids who have not hit puberty yet, never mind adolescents.
Meds are more prevalent because teachers are not allowed to discipline kids in school any longer without risking their careers due to overprotective parents. I don’t think beating kids is a good solution, but there are other ways.
In 4th grade a couple friends and I were misbehaving, being spazzy little boys and pulling a girl’s hair on the playground. Our teacher was informed of this, and when we came in from recess, she called us up to the front of the class, told us she heard we were pulling hair outside, and then gave all of ours a good hard yank and asked us if we liked it. We did not. Lesson learned. That teacher was chosen as Teacher of the Year for the entire state, something I doubt that would happen today.
Yves, thank you for this necessary, disturbing, thoughtful and sensitive post. It’s so true that most kids I know of today don’t have nearly enough unstructured time to just run around being kids. Like yours, my elementary school had morning and afternoon recess, plus we made two full round-trips to school each day, walking, because we went home for lunch. It had to be pouring rain for one of our moms to drive my friends and me to school. Most of us were one-car families and the dads usually took the vehicle to work.
I would also like to point out another problem. Even if medication of some sort is called for, and I believe that occasionally that might be the case, it is highly unlikely that most children will have access to the type of medical care that would make the use of that medication both appropriate and monitored adequately.
I realize I am coming at this as an adult that avoids doctors if at all possible (and this included the periods of my life when I have adequate insurance), but I have also battled depression most of my life, including during preadolescence (luckily my parents were clueless as to what was going on). I have been prescribed Prozac repeatedly. This would not be so problematic except that my thyroid goes nuts and starts acting like it has a tumor. Because so often I am seeing a doctor for the first and probably only time. AND because even as early as two decades ago many HMO practices meant no one spent adequate time talking to the patient or listening to the patient I would be handed a Prozac prescription even after pointing out the side effects I suffer using it because it was the standard prescription for anyone claiming or describing depression.
There is no doubt in my mind, that most children would have the same lack of real knowledge or oversight from the medical community when being ‘diagnosed’ as ADHD. Because time and continuity of physician access have just gotten worse since the last time I discussed my depression with anyone in the medical profession.
A few book recommendations for anyone interested in exploring the topic in greater depth:
1. Anatomy of an Epidemic by Robert Whitaker
2. A Profession Without Reason by Bruce E. Levine
3. Anything by Thomas Szaz
Drugging your children is silly on its face. When kids are struggling, we ought first to ask whether the institutions and structures to which they’re having difficulty adapting are themselves well adapted to the natural inclinations of human children. For example, and relevant to the ADHD question, if an 8 year old child is tapping his or her foot in class, perhaps we should ask if 8 year old children are well adapted to sitting for long periods of time, passively intaking instruction, before declaring the child defective. I recall bringing this up on this website and getting opprobrious pushback from a parent who assumed that, by calling into question some of the assumptions underlying the ideological guardrails which lead people to send their kids to ‘experts’ who drug them and affect their life chances, I was impugning their own choices as parents. Perhaps I was, and perhaps we should.
On the other hand, if we decide we can do nothing about these broader structures, then there exists a pragmatic question, namely whether or not the ‘expert’-sanctioned interventions actually help our kids succeed, however we define success.
Psychiatry certainly has plenty of problems, the greatest being over prescribing psychotropics. However, I would expect GPs, internists and pediatricians prescribe the bulk of psychotropics and ADHD drugs.
Having a son with schizophrenia, our family has had contact with all sorts of psychiatrists. There is plenty of quackery out there on the extreme ends of no-meds and over-medication.. Unfortunately, antipsychotics are the ONLY way my son can live a semi-normal life.
I am unfamiliar with Levine. Whitaker was a journalist and does not have medical training. His books are filled with hopeful anecdotes and cherry picked data. Szaz is the ultimate psychiatric quack. His “facts” that there is no physical test for schizophrenia implies there is no such disorder is harmful. We had experience with on of his students, Peter Breggin MD, who was simply incompetent and evil. Those people shouldn’t be allowed to practice, full stop.
Psychotropics are over prescribed. But they are necessary for some.
I was a disruptive, well under performing kid throughout my school years who was “diagnosed” – a word which implies a disease model – with ADHD by an “expert” at age 17. Whatever issues I had focusing in school had much more to do with the institution of the family having failed me, as well as some of the issues raised above like the BS, busy work nature of much school work. I knew this at the time, though lacked confidence, knowledge, and power to say as much. I recall asking the NP who prescribed me to provide any information on the long term efficacy and side effects of the drugs. The NP was dismissive of me, even slightly mocking, which I suppose isn’t a bad strategy if your expertise/knowledge on a matter is dubious. The kind of person simulating the “adult in the room” as described from the blog post KLG linked to the awhile back. Irritating, but I still took medication through college, then stopped afterwards and haven’t looked back since.
It’s a shame psychoanalysis fell out of fashion as a treatment modality, as that has been far more effective in helping me than any medication. That, alongside readings in philosophy and religion, have provided me better ways to interpret reality, focus my attention, and meet my needs than offloading the responsibility for those tasks onto a pill.
An appropriate musical interlude: Rolling Stones: “Mother’s Little Helper.”
See: https://www.youtube.com/watch?v=B4hjL3lY5GM
I was going to use an AI generated animated version with lyrics, but I noticed several egregious misspellings in the ‘sing along’ lyrics feed. AI Slop at its best!
It struck me that the present state of AI is Crapification Deluxe. Then I wondered, if this is merely annoying, imagine how “annoyed” you would be when this quality of AI running a drone swarm is given Termination Authority?
Sta saf.
Thank you Yves for this intelligent and rational appraisal of ADHD treatment. Sadly this story dates back many years.
When my children were very young (late 1990s) I discussed this topic with my mother (now long departed). She was a neuro Psychologist who, among her many skills, was highly regarded in the field of psychological testing. She was adamant that many, young boys in particular, were misdiagnosed with ADHD. At that time in Australia if you refused the medication for your child who had been diagnosed with ADHD they could legally take your child away from you. My wife and I were equally adamant should such occur we would migrate away from here. Fortunately that never happened.
Thank you also for reminding me of how lucky I am to have had a wise and humane advisor through my younger years.
One aspect of living in an authoritarian society is that authorities assume the system is good and the people who don’t like it have something wrong with them. This article makes it clear with one example – an energetic, creative 7-year-old girl didn’t like being trained for office and factory jobs from a young age. She didn’t want to do boring and meaningless work in childhood so that she could do boring and meaningless work in adulthood. Who can blame her?
And who thinks she’s the unhealthy one?
Forcing children to do meaningless work day after day is a form of child abuse that few recognize because it’s common and often state-mandated, and because doing personally meaningless work is common for most people in adulthood. Doing meaningless jobs is how most people make money needed to survive, so it’s a kind of conditioning that seems necessary. But stories from non-authoritarian nations are really clear – children are only given meaningful work, and actually a lot of parental and other adult consideration goes into how to motivate the children properly, building their curiosity and excitement with clever mentoring, storytelling, modeling, and other ways.
This became clear to me when I found stories of Indian boarding schools. Many people know the kids were subject to all kinds of physical and sexual abuse and shame, causing huge troubles later in life. However, these schools were also the first time children from these societies were given meaningless work. As one man wrote, “I hardly think I was ever tired in my life until those first days of boarding-school.” He described being given meaningless work, “until not a semblance of our native dignity and self-respect was left.” Source: From Deep Woods to Civilization.
Getting children to give up their dignity and tolerate boredom or meaninglessness is a key part of training them to accept living in an authoritarian society, to feel helpless even while so much corrupt behavior happens all around. It’s because their dignity wasn’t welcome in school, and was actively suppressed. Of course there are exceptions, but they are so rare they prove the rule. And often hurtful training starts much earlier in life, with abusive or deprived early childhoods which can cause anxiety, stress, and other difficult feelings, making everything else in life more difficult than needed.
Ultimately we need a different way of life without this authoritarianism, where mutual respect is normal — including treating children with respect so they will have dignity in adulthood. Luckily there are many nations that can show what this is like, if people are willing to look.