ADHD – The Young Male’s Dilemma

Methylphenidate (Ritalin) 10mg Pill (Ciba/Nova...

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“Last year, more than two million prescriptions for Ritalin and other ADHD drugs were written specifically for children under 17, and at least 75 per cent of them were for young males.”

This past summer the Globe & Mail published a series of articles focussing on ADHD, younger children, especially boys, and the school system. Every parent, teacher and pediatrician in Canada should be aware of current research and statistics. To start off here are some salient quotes and excerpts with my highlighting of key points.
Prof. Jon Bradley, who taught elementary school before joining McGill to teach prospective teachers some 40 years ago, believes that schools have removed “the time to be male.” Shorter recesses, and lunch and gym periods, and the decline of metal and woodworking classes all contribute, he says, to boys’ restlessness in the classroom and the likelihood of being picked out for acting up.
Prof. Bradley asks – “What are we drugging for … female teachers who don’t understand that boys like to run and jump and shout? That’s what boys do.”
“What if we were drugging girls at the same rate?” asks Bradley. “What if [the majority] of these prescriptions were being written for girls? There’d be a march.”
To some extent, the medical gender gap simply exposes the biological bias of Mother Nature: Boys’ brains, perhaps due to chromosomes and hormones, are more vulnerable than girls to several neurological disorders. Boys are four times more likely to develop autism, three times more likely to suffer dyslexia, and two to three times more likely to be diagnosed with ADHD.

But some see a system of harried parents, school officials and general practitioners too ready to label rambunctious young males. While boys might be three times more likely than girls to develop ADHD, research suggests they are nine times more likely to be sent for a clinical assessment and five times more likely to be medicated for it.

The youngest children in their kindergarten classes are heavily overrepresented among those diagnosed with ADHD. This results in the heavy over-prescribing of psychiatric drugs such as Ritalin (more than two million prescriptions were filled at Canadian drugstores in 2007), with potentially harmful long-term effects, including high blood pressure and stunted growth – not to mention wasting time and money on a useless intervention, instead of doing something that might help a child.

Drugs to treat ADHD, with common side effects that include insomnia and headaches, have been better studied than most psychiatric medications used in children. But questions linger about their long term safety.

A U.S. study last year suggested that Ritalin, or methylphenidate, could have unknown consequences on crucial brain systems. As well, Health Canada, and later, the U.S. Food and Drug Administration, warned a few years ago that the stimulant drugs may be dangerous for those with underlying heart problems – and those who do not actually have ADHD

“It certainly suggests that drugs are being abused,” says Gordon Floyd, President and CEO, Children’s Mental Health Ontario. Mr. Floyd feels counselling stands a better chance of getting to the root of problem with children, rather than using drugs for years to dull symptoms. Research shows, he says, that talk therapy can be very successful for kids with ADHD. But with wait times of six months or more in Ontario for behavioural therapies for children, many don’t wait.

“There’s a desire for quick fix….the idea that “oh, we’ll fix this with a pill’ – rather than spend a few months in counselling is pretty appealing.”

There is no test for ADHD. It is based on observation, by its nature subjective. Most children, especially young ones, have times when they can’t sit still. Those who truly have the condition may show poor judgment, lack social skills or face rejection from their peers.

Parents, teachers, and the children themselves need training to deal with these deficits. The scope for error and the human tendency to look for a quick fix suggest extreme care is needed before doctors diagnose attention deficit disorders.

And researchers believe many of the characteristics flagged as signs of ADHD by kindergarten teachers – inattention, hyperactivity and impulsivity – might simply be due to immaturity relative to members of the cohort who are 11 months or more older.

“A five-year-old might not be more poorly behaved than the average five-year-old,” said Todd Elder, an economist and the lead author of a University of Michigan study. “But he’s much more poorly behaved than the average six-year-old. “When you have a large number of female teachers looking at this, they may have a tendency to see boys’ behaviour as problematic…[Zach’s teacher] saw his active participation as a disorder.”

Because a finding of ADHD involves teacher questionnaires, it may be useful to look at teachers’ role in starting the trajectory toward a diagnosis, he said.

“It may mean teachers need more education about what is developmentally normal and what is not,” he said. “Maybe these kindergarten teachers have a lower tolerance for so-called misbehaviour in younger kids.”

Future posts will discuss major elements of this dilemma.

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