ADHD and me

Jennifer Roback Morse
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Posted: Oct 10, 2005 12:05 AM

A recent report from the Centers for Disease Control reveals some interesting patterns about the prevalence of hyperactivity. Kids from lower income families are more likely to be diagnosed with ADHD.  Almost 15% of boys from families below the poverty line have a history of the diagnosis, while only 10% of boys in families at twice the poverty line do. I have some theories about this, both as a policy wonk and as a mom.

What are my credentials to speak on this topic?  I don’t have a medical degree, or a degree in psychology.  My Ph.D. is in economics. So I do know something about how to interpret data. But my real expertise on this particular topic is my M.O.M. degree.

I’ve been working on my M.O.M. degree since 1991,when I had two children in six months, (a record of sorts, even for a Catholic.)  We adopted a little 2 year old boy from Romania, and gave birth to a little girl, six months later.
Because our son had some special developmental issues, we accumulated a lot of information about a whole variety of disabilities, most of which he turned out not to have.

We decided all that knowledge about childhood trauma and unusual disorders was too valuable to waste on only one child: (economies of scale and all that.) So in 2003, we became foster parents for San Diego county. We’ve had 7 foster kids in our home, and seen lots of others come and go, if you count all their siblings in different foster homes, and then all the foster siblings of our foster kids’ siblings. (Did you follow that? There is nothing simple about the simple demographics for foster families. Even the simple question, “how many children do you have?” takes more than a sound-bite to answer.) 

Anyhow, the point is: I have seen more than the usual number of kids that moms see. And most of “my” kids have no genetic relationship to one another.  So although I have only seen a small sample of children “up close and personal,” it is probably a larger sample, and more statistically meaningful sample than most families get to see.  I have some definite opinions about “Attention Deficit Hyperactivity Disorder.

I have to tell you: I am not an Anti- Medication Absolutist.  I have seen kids who do really well with medication with almost miraculous improvement.  On the other hand, I am not a Pro-Medication True Believer. I have seen kids who were positively harmed by medication. And by harmed, I mean a child who became more irritable, more unmanageable and even violent.

 How could that be? The ADHD diagnosis is sometimes assigned too casually. People think it is a simple explanation for what they see. But the treatment for ADHD can actually aggravate other problems, such as bipolar disorder.
 
According to Dr. Demitri Papolos and Janice Papolos, children with bipolar disorder can sometimes react very badly to stimulants or anti-depressants. In their book, The Bipolar Child: the definitive and reassuring guide to childhood’s most misunderstood disorder, they report instances of bipolar children, who were wrongly diagnosed, or wrongly medicated.

“Antidepressants and in many cases stimulants given without the benefit of a mood stabilizer (possibly even with the protection of a mood stabilizer) can cause havoc in a child suffering from a bipolar condition, increasing anxiety states, potentially inducing mania, more frequent (mood) cycling, and increases in aggressive outbursts and temper tantrums.”  

Parents may believe that ADHD is a relatively benign diagnosis, with a potentially manageable outcome.  But if you overlook something more serious, and medicate the wrong disorder, you can make your child much worse. If your child is not responding to the medicine prescribed for ADHD, or if his behavior is becoming worse in some areas, consider getting a more thorough diagnostic work-up.

These brings me to my theory about why the children of the poor are more likely to be medicated for ADHD.  Better off parents may be more persistent about getting an accurate diagnosis.  Children of the poor may simply accept the opinion of the first authority figure who tells them their child needs medication.

It is also possible that there truly is more attention deficit disorder among the poor. Some researchers believe there is a genetic component to the disorder. If that is the case, then untreated and undiagnosed ADHD could account for some of the problems in living that plague the parents, problems that lead to them having lower incomes, or to their kids landing in foster care. I am at least willing to consider this as a hypothesis.

One other possible explanation: better off parents may be able to come up with non-medication strategies for managing their kids’ behavior. We have found it helpful to simplify the child’s life as much as possible. We have often stripped an easily distracted child’s room of all toys and unnecessary decor.

We keep the toys anywhere but in his room. He can dress himself in the morning, without being drawn off-task by all the stuff in his room. We also limit the use of anything with a screen. We don’t even own a TV; we seriously limit video games. Often, the birth parents think we’re being mean. They have a tough time understanding why we’re doing these things. But eventually they get the point that it can be in their child’s interest to have fewer things and less screen time.

These strategies are not panaceas. They won’t cure every hyperactive kid. But these strategies will improve the quality of life for almost any kid. The fact that the children of the poor are more likely to have an ADHD diagnosis may just mean that their parents need more and better information.