CALLING FOR A SKILL-ORIENTED, NON-DRUG TREATMENT
The Over-Diagnosis Problem
More children are diagnosed daily for ADD
or ADHD, to the tune of two millions plus
in the US. But what exactly is ADD or ADHD?
The actual definition is vague, because there
are no objective and logical ways to define
the deficits and symptoms. When we look at
the real description of the population considered,
we see that the two terms of ADD and ADHD
are often used interchangeably used and increasingly
mixed with the old ‘Hyperactivity’, Low Achievers,
and even Oppositonal/Defiance Disorder (ODD).
The reason for this over-diagnosis is the
vague definition of attention and loose measurement
criteria. For example, what type of attention
is crucial in ADD? Is it attention to all
school tasks? or to math only? or to writing?
Is there attention deficits while playing
video games? And in what setting does the
deficit occur? In the classroom? Only in
a specific class? Or everywhere? And how
‘hyper’ should a child be before he is hyperactive?
I used to have images of a boy who literally
couldn't control himself and bounced up and
down in the chair every minute. Rarely have
we seen such a case.
ADD/ADHD As a Social Phenomenon
The prevalence of ADD/ADHD is to a large
extent the result of cultural, social and
Just think back 25 years ago, there were
much less in-seat activities. We used to
be more physically involved - playing in
the filed, catching birds, climbing trees,
driving a tractor or a lawn mower, etc. A
kid used to be happy spending half a day
jumping rope, climbing tress, or trying to
catch fish in a stream.
Even the old one-room, non-graded country
school had more physical activities and less
seat work than our school. Indeed, many of
the so called ADD/ADHD kids would have had
no problems learning and fitting in before.
If there were seated, quiet times (I don’t
mean lounging on the couch watching TV, which
contributes significantly to the ‘inability’
to sit up straight in class), they used to
entice more attention and stamina from the
child. Remember not too long ago many kids
used to collect and appreciate rare stamps,
or practice (not dabble) on the piano? We
used to have to concentrate in order to ‘hear’
the ball game on the radio, and visualize
the scenes at the same time. Persisting and
focusing on activities were a must in the
But the same kids nowadays wouldn’t touch
a piano or look at tiny stamps. They collect
instead the quick changing Pokemon or baseball
cards. They also have computer games, videogames,
Internet, TV, telephone....., a whole host
of technological gadgets which instantaneously
entertain and replace thoughtful, quiet activities.
The modern child can watch remote-control
TV and flip channels the second he doesn’t
like (in the new lingual, ‘bored’ by) a program.
He can go through videogames in a flash.
So who has the patience to read books or
collect stamps or practice the piano or climb
Furthermore, the need to imagine and focus
is eroding rapidly. We watch ball games on
TV now, and if we missed (i.e., did not pay
attention to) some actions, there are always
instant replays. The same go for videogames.
If a kid loses a game, he can always try
it again, and again, without much planning
or forethought, until he hits it right. In
techno movies for teens, images are getting
faster and faster and sound bytes louder
and louder. Anything less won’t keep up the
What I am saying is: Children can now afford
to be, and often times train themselves to
be, careless, impatient and non-focused.
Yet the industrial world is going the other
direction - requiring more sustained seat-work
and focused attention, from designing computer
programs, analyzing stocks, to flying airplanes.
Schools re-emphasize the 3 R’s in an attempt
to prepare our youngsters for the global
tech world. There are more daily details
to be remembered.....
The outcome? Many children who would have
functioned fine before are now ADD or ADHD.
Some children, especially girls, will ‘naturally’
adjust to the demands more easily. Others
will suddenly find keeping up hard.
It’s like many of us who are tone-deaf or
musically dis-inclined go though life with
no problem. But if playing music were suddenly
to become essential for success, then tone-deafness
and musical disinterest would be viewed as
Should We Medicate?
When we recognize many ADD/ADHD symptoms
are the by-product of technological comfort
and life style, and/or resulted from the
increasing demands of intellectual seat-work,
the question then becomes: Should we help
ADD/ADHD children to cope by medication?
Or by teaching them the skills and by realigning
The answer is obvious: Just like nobody would
even think of using drugs to increase a child’s
musical interests and stamina to practice,
we should improve in intellectual pursuit
and academic achievement through training
and realignment of life structure.
First, one has to perform a label-free, skill-based
evaluation of factors affecting the poor
school grades, ‘forgetfulness’ (especially
of homework, test dates), the losing of things,
or the poor frustration tolerance, the lack
of independent study/work habit, etc., keeping
in mind that motivation, discipline, life
style and previous learning history have
a lot to do with the problems associated
Once the factors are isolated and defined,
there is only one kind of treatment worth
undertaking - that it work on the deficits
and produce measurable improvement. In treatment,
the key is to have a thorough, logical analysis
of the problem, the settings and the consequences
and to develop personalized, child-specific
training on motivation, study habit, time
management, as well as training on processing
and focusing skills.
Often times though, drugs give a false sense
of relief of the symptoms. For example, the
child is ‘calmer’ and thus ‘appears less
absent minded’. Under medication, he can
sit longer for a task. However, the drug
merely serves to ‘tone down’ the overall
motility level rather than improve cognitive
focusing and learning. The true test of drug
effectiveness should be measured by actual
improvement on things ADHD is supposed to
ruin - school grades, memory and focusing
of relevant details. I have yet to see such
effects on many children under medication.
In addition to effectiveness, a second argument
against psychotropic medication is its tremendous
expenses and the sense of despair and stigma
about the ‘disease’ under the medical model.
The problem is exacerbated by the negative
side effects - loss of appetite, insomnia,
or even a general slow down in thinking.
Thus, until the day a drug is invented that
can actually improve focusing and learning
of academic concepts, the most appropriate
treatment for ADD/ADHD remains to be behavioral