Tuesday, March 11, 2014

Thoughts on Psychiatry in General and ADHD

First of all, I want to say "thank you" for all of the kind messages I received after my last post!  Really- I have been so touched by the emails, private messages, and facebook comments.

I have also received a lot of questions and wanted to write a follow-up to address some of those, particularly as they relate to Attention Deficit Disorder, which I have done a lot of research on and is also an area with which I have some experience.

First, we need to talk about psychiatry in general.  Since it deals with the inner workings of the mind, it is different than other fields of medicine. You cannot detect bipolar disorder, ADHD, or any other "illness" with a blood test or x-ray.  As such, counselors and psychiatrists depend on other criteria, which consists primarily of observations in the form of checklists.  For example, the most recent diagnostic criteria for the inattentive portion of ADD is as follows:

Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
  • Often has trouble holding attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted
  • Is often forgetful in daily activities.

In and of themselves, lists such as these are not bad, and can provide a useful tool for categorizing behavior.  The problem comes with how we then frequently interpret that information.

In our often linear view of things, and in the medical model we are accustomed to, we often think "If I have Disorder A, then I need to pursue Treatment A to fix it."  The problem with applying this model to psychiatry is that it does not examine the causative factors.  There are any number of reasons that a child may exhibit the behaviors listed above, ranging from lack of physical exercise, too much television, disruptions in home life, improper nutrition, he is not interested in the task at hand, individual personality, lack of discipline, etc., etc.  The possibilities are really endless.  To say that every child that exhibits these behavior then has a disorder and needs the same treatment is a false notion.

My oldest son could have been diagnosed with ADHD a hundred times over.  In fact, I once had a pediatrician (who was not even trained in psychiatry) offer to prescribe ADHD medication after I filled out a questionnaire.  Needless to say, I left his practice in a hurry!  I was never comfortable with the idea of medicating him.  I am not saying that our answers are the answers everyone should choose.  I know better than that, and I know there are many factors to consider and that medication may be the best answer for some.  I am simply stating that there are other options, and it is wise to examine other factors in the child's life, and what could be causing the problem.

With Cameron, I realized that he had a great need for physical activity, and that the structure of his elementary school did not provide that.  He had PE once a week, and one recess per day at 2:30pm.  He could not concentrate without that physical outlet.  This is a problem for a lot of little boys these days (and a number of girls as well!), who are simply not wired to sit all day long.  Thus, when they fail to live up to this unreasonable expectation, they are often labeled as having a "deficit".  The problem is frequently not the child, but our own expectations and demands, combined with an environment that does not take the child's needs into account.  We started having Cameron play outside before doing his homework (and often take a break to run when he was having trouble focusing), and made sure that he got the activity at home that he wasn't getting at school.

 Cameron also has a lot of drive and ambition and is fiercely independent.  Those qualities in a young child are a lot to handle!  However, they are highly prized in adults.  Sometimes we need to be patient with the developmental process and keep the end in mind.  Be wary of short-circuiting the process as children learn to deal with the strengths and weaknesses they were born with.  After all, we want them to know how to handle all of this on their own once they leave our homes, right?

Second - there are factors that diminish a child's ability to focus and pay attention.  Television is one.  Watch any television program (even educational programs aimed at young children) and pay attention to how many seconds elapse before the camera angle changes.  If you're lucky, you may hit 6 seconds.  Frequently, it is more like 3-4 seconds.  These frequently changing images actually train the brain to pay attention for very short periods of time. 

Third, we very rarely require things of our children that require sustained focus.  Many things in our world today provide immediate gratification, and children are not brought up performing tasks that require focus and patience.  Some examples of tasks that require focus are reading longer books (whether the child reads alone or is read to), putting together puzzles, gardening, doing chores well and to completion, playing a longer board game, etc.  The skill of sustained focus that our children learn in other tasks will actually transfer to the classroom.

Fourth, many children today grow up with the expectation that everything should be fun.  Thus, when something is boring, or long, or unpleasant, they check out.  It is beneficial to learn from a young age that not everything is fun, but it still needs to be done.  I really don't like doing housework or helping kids with homework, but it is part of my job, and there are times I need to put a hard hat on and just do it.  Having responsibilities - even ones they do not enjoy -  helps them learn to persevere when things get tough.

Fifth - many children simply lack the underlying cognitive skills they need.  When Garrett was struggling in school a few years ago, I had a skills analysis done at the local LearningRx center.  What we found was that his short-term memory was lacking.  How was he supposed to finish a word problem in math when he couldn't remember what it was about by the time he finished reading it? There are things you can do to strengthen those skills.  For Garrett, we bought a subscription to brainskills.com, where he played games that strengthened his memory, in addition to other skills such as focus and attention, processing speed, language skills, visual memory, etc.  We saw huge gains in his ability to succeed and focus in school.  In his case, what looked like an attention problem was actually a memory problem.  I recommend reading "Unlock the Einstein Inside" by Dr. Ken Gibson for information on this topic and ideas for training exercises.  I believe you can also find the Gibson Test online, which tests these various skills.  With Joseph, we recently found and have been using a less expensive cognitive skills training program at Lumosity.com.

Sixth - examine the child's diet.  The typical American diet is often low on nutrients necessary for optimal functioning, and high on empty sugars and starches, which can contribute to focus and behavior issues.  My kids benefit most from eating food that remembers where it came from.  We try to really limit (although I do not outlaw it completely) processed or sugary foods.  I also know others that are using the Empower Plus supplement from truehope.com that we are using for Garrett with great success for attention issues.

We have seen amazing progress in our boys, and they are now all doing fantastic in school.  They work hard at everything they do, and I am REALLY proud of them for that!  It took some patience, and it took a lot of work.  It took lifestyle changes (remind me to tell you about our tv policy sometime), and it involved enduring the judgment of others who thought there was something wrong with them and that they should be medicated.  I had to work hard to ignore that and focus on what was best for them in the long run.  I had to trust that I was doing the right thing, and that was really difficult sometimes, because I couldn't see the future and how this was all going to turn out!

I thought a lot about the messages they would receive from different solutions.  For example, I had concern about telling them that the solution  to their struggle with attention was to take a pill.  I wanted to send the message that they were capable and that the solution was to work hard and figure out the problem and solve it.

Again, I am NOT condemning anyone that chooses to treat ADHD with medication - not by a longshot!  I simply knew my children and how they would interpret that message, and I took that into consideration.  I knew they would feel different and broken and out-of-control, and I wanted to try other options first.

So - recommended reading!

My favorite is "The ADD Answer" by Dr. Frank Lawlis.  He explores lots of different reasons why a child may be struggling and has LOTS of solutions to try.  This is definitely the book I recommend first and most often.

I also like "The Diseasing of America's Children" by John Rosemond and Dr. Bose Ravenel.  Understand before you read this one that it is a hardcore argument against medicating children.  The thing I like about this book is that it questions the way we categorize our kids, and provides concrete solutions we can try first.

Last, I recommend "The Explosive Child" by Dr. Ross W. Greene.  This one deals with negative behavior in children, without regard for any diagnosis that may have been placed on the child.  His theory is that frequently kids are missing skills, such as the ability to deal with disappointment, the ability to sustain focus, the ability to manage anger, etc, and that these can be taught!  Many children can avoid psychiatric diagnoses and treatment simply by learning some missing skills, and parents can learn to predict and avoid explosive situations with their children once they understand the triggers and how to teach their children to solve them. 

Again, I am not a doctor, nor am I telling you what is best for your child, nor to abandon any course of action you may be on.  I am simply sharing what has worked for us.  When we were at the beginning of this journey, I would have LOVED to have someone share these things with me!  But we so often suffer alone when our kids are struggling.  We don't want them to be labeled or looked at differently, we don't want to appear to be a bad parent, and so we stay silent.  The result is that we miss out on a lot of support and we individually reinvent the wheel.

If there is one thing I have learned from the response to my post about Garrett, it is that A LOT of us are struggling alone.  Please accept my observations and comments, not as a prescription for all, but an exploring of the options available so that you can find the solution best for your child. My love and prayers are with you!


  1. Thank you Brigette. I appreciate all your advice and am glad someone has walked this path before me! I have also researched a lot about the right brained child. When right brained children are taught in a left brain way (the way schools do) they appear to have attention problems. We have been teaching Dallin to read using a right brain method and it is really working! Keep the great advice coming!

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