Here is what we believe: We believe that this society has forgotten how to discipline children, particularly boys. We believe that there is a well-established impulse to categorize all undesirable behaviors as medical, rather than moral. We believe that boyish high spirits are out of fashion and are being pathologized by parents and schools too busy or lazy to provide steady guidance and discipline.
Recognize it? This is conventional wisdom about attention deficit hyperactivity disorder -- particularly among conservatives -- and it has a seductive plausibility. But while the popular belief that we are overmedicating an entire generation of normal kids seems to fit the historical moment, it is only partly true.
The reality, as the National Institute of Mental Health reports, is that between 3 percent and 5 percent of children under the age of 18 do have ADHD.
An article in Scientific American recently reported research into a section of the brain that is different in children with the disorder. It's the "administrative" section of the brain, the area that is believed to control organization, focus and follow-through.
Children with ADHD are not just fidgety, as many kids are, they seem instead to be "driven by a motor" nearly all the time. They run, jump, climb and spin not just on the playground but everywhere. They are constantly losing things and have difficulty following through on simple instructions. They are highly distractible and impatient, and do not seem to listen when spoken to. Any task requiring sustained mental effort and focus is difficult and painful for them, whatever their IQ.
They are often socially inept, failing to recognize social cues that other children naturally pick up on. Also hampering their sociability is great difficulty sharing and taking turns, and extreme impulsiveness. These traits show up at home and at school, and significantly impair these kids' lives. Ritalin and other stimulants can mean the difference between success and failure for millions.
Dr. Sally Satel, a psychiatrist and fellow at the American Enterprise Institute, acknowledges that ADHD is often overdiagnosed. She cites data in the Journal of the American Academy of Child and Adolescent Psychiatry showing that more than half of the children in some North Carolina communities who were receiving medication for ADHD did not have the disorder. But the same study, Satel writes, also found that
one quarter of children who did meet the diagnostic criteria were not being treated.
In the view of Satel and other psychiatrists, the trouble arises when pediatricians or general practitioners prescribe stimulants or other medications without performing a thorough diagnosis. In order to diagnose ADHD correctly, the psychiatrist should have several meetings with the child and his parents. (Usually, but not always, children with ADHD are male.) Behaviors like inattention, impulsiveness and lack of focus, Satel explains, must be seen over a long period of time and not just in response to a stressful time in the child's life such as the birth of a sibling, a divorce or a move.
Skeptics ask why ADHD appeared so suddenly. The answer is that it isn't new. Doctors have been aware of the disorder for decades and have successfully treated it with stimulants since the 1950s. But until recently, most of the children who had the disorder went untreated. Their behavior was simply labeled disruptive or incorrigible -- and it is difficult to estimate just what percentage of kids who got into trouble with the law or dropped out of school began their downward spiral at least in part due to the disorder.
And while it is widely known that too many parents are having their children labeled and medicated erroneously, the reverse phenomenon is also a problem and is arguably more serious. The anti-Ritalin backlash has discouraged many parents from seeking an evaluation of children who are clearly hurting. Parents who have witnessed the effects of stimulants on kids with ADHD come away believing that Ritalin is a wonder drug.
Certainly none of the foregoing should exempt children with ADHD from moral standards or expectations, and it does not refute critics who see laziness at work in some parents. But the caricature of inattentive parents shoving Ritalin down the throats of perfectly normal youngsters is unjust to the millions who suffer with a real disease.