Someone has the right idea...
Parents push the new abnormal
Lawrence Diller has been treating children with behavioral problems for 28 years, and he has noticed a disturbing trend: the kids brought in for possible psychiatric medication are "far less abnormal" than they used to be. Parents are less willing to tolerate minor weaknesses, says Diller, a behavioral pediatrician in Walnut Creek, California. He sometimes prescribes drugs but laments their overuse. Diller's new book, The Last Normal Child (Praeger Publishers, $39.99), explores the rood causes of the surge in psychiatric drug treatment for children and suggests different approaches. USA Today's Marilyn Elias spoke to Diller:
Q: Why did you call your book The Last Normal Child?
A: Because I had this fantasy, as more and more normal kids get psychiatric medication, that eventually the last normal child in the world finally would be brought to me for a prescription.
Q: What are some of the key reasons that more parents are bringing in normal kids to see if they have ADHD or another disorder and should be medicated?
A: For one thing, academic standards are getting increasingly rigorous and ridiculous--at ever-younger ages. Teachers start to complain about the children, especially boys, who can't get with the program.
I used to think parents worried only about their kids being good students, getting good jobs and making money. But now there's also this tremendous worry about children's self-image, their self-esteem. And the kids do feel bad, because they know they're disappointing their parents and teacher.
Sometimes children have undiagnosed learning disabilities, not ADHD. Or, they might not be motivated to do academic work. Not every kid is academic, and that can be hard for high-achieving parents. There may be problems at home, or parents may not be disciplining properly, so kids are acting out.
Q: Aren't you blaming parents a lot here?
A: No. Parents love their children and want the best for them. They bring kids in for evaluations out of love and great worry. Often it's the teacher who suggests it.
Q: What do you advise parents when a teacher or school psychologist says a child may have ADHD?
A: The child first should be evaluated for learning disabilities. If he's acting out in class, the teacher should try a behavior management program that offers incentives for good behavior. If a kid is inattentive but not hyperactive--and that's the fastest-growing percentage of kids being diagnosed with ADHD--90% of the time he has some kind of learning or processing disorder and may need a special educational program.
Q: How does a child's motivation matter when there are school problems?
A: Most commonly, you see kids struggling academically, but they have wonderful hearts, they're good socially. They're going to do well in something like sales. They're just not interested in academics. Others may be very creative, talented. They just don't fit into a school mold. Parents are worried and wonder if these kids should be on an ADHD drug so they'll get "on track." Being unmotivated can look similar to ADHD; they don't follow through, they're disorganized, they have trouble concentrating. But there are all different kinds of people in the world, and sometimes parents just have to accept that their kid is eccentric or different than they expected. These parents may need reassurance that their kids can do well by being themselves.
Q: Aren't you persuaded by some of the new brain scan studies that ADHD is a biological disorder?
A: I concede that there's a neurological component here, and it is genetic. But we know the environment can change kids' brains too. There's a core group that would greatly benefit from medication no matter what--perhaps an eight or a tenth of the kids getting it. But most of those with mild to moderate problems--which is most of what you see in a community sample--could manage without medication if they had better discipline and behavior management. The environment can amplify or decrease problems.
Q: What about defiant children? Some children are getting diagnosed with mental disorders if they're too difficult to control.
A: I'm not saying that these children are easy or that they never should get medication. But especially among the high-achieving professional parents I see, there's often too much talking, talking about the kids' feelings, and ambivalence about giving immediate consequences for bad behaviors--timeouts and withdrawing privelages that are important to a child. I work with the parents, helping them to give kids incentives for sitting still and doing homework, and following through with consistent discipline.
If, after a few months, a behavior management program at school and home doesn't have any effect, then we can consider medication.
Thank you, Mr. Diller. This all makes so much sense... maybe this will help to refine the line between illness and a different way of thinking.