In 1987, after my son Connor’s first-grade teacher told me that he had ADHD because he stuffed his unfinished school work in his desk, I decided to wait and see how second grade in a new school went.
When school started, Connor made new friends, got along with his teachers, and seemed to be completing his work, but things rapidly declined when he stuck his foot out and tripped a classmate. I was called to the school office where I found a scared looking Connor.
“I didn’t mean to hurt him, Mom,” he told me, “and I apologized right away.” As we were leaving the building, Connor’s teacher said his classmate was fine, but she was tired of Connor’s antics, so I assured her we’d talk to Connor and he’d do better. But the principal had other ideas. He approached me as I was leaving and said, “Either you medicate that boy or I will.”
At that point, our story followed the same trajectory as many of the parents’ stories I read today. Connor’s pediatrician gave us a checklist to fill out with a home component and a school component. I didn’t have much to report on the home front, but Connor’s teacher had some concerns, so the doctor recommended we start him on Ritalin for impulse control.
We told Connor he’d be taking some pills to help him pay more attention in school, but when he asked me one night, “Will those pills make me better?” I felt a heavy anchor on my heart and decided to seek another opinion. Long story short, the psychologist with whom we consulted worked with Connor for a few weeks, and after giving him several assessments, he had this to say: “Connor doesn’t have ADHD; he’s bored. Just get him involved in some more enrichment activities and he’ll be fine. And stop giving him Ritalin.”
Connor never saw any urgency about finishing his schoolwork, and it took me much longer than it should have to realize how deep his boredom ran. Thankfully, we encouraged his musical abilities and all of his artistic and mechanical talents, and today, Connor is an accomplished musician and audio engineer, a photographer, and a skilled woodworker and carpenter.
That’s Connor’s story, and mine. (Read my previous blog post about it here.) Readers out there have their own stories and questions regarding ADHD, their own reasons to be skeptical of the advice they’re receiving about their kids’ behavior. I’m going to do my best to anticipate some of those questions and answer them in a way that, I hope, can inform parents’ decisions as they strive to do what’s best for their children—and maybe give them some hope in the process.
But haven’t things changed since the 1980s?
Even though Connor’s “diagnosis” of ADHD occurred in 1987, little has changed in the way we diagnose that cluster of behaviors we refer to as ADHD. Parents, pediatricians, and teachers still use a checklist of behaviors to determine if a child does indeed qualify as having ADHD. And in many schools and families across the United States, stimulant drugs such as Ritalin, Adderall, and Concerta are still the first line of treatment for children over six, with an additional recommendation for behavior therapy both at home and in school.
If you do a quick search on the internet, you’ll find many articles claiming that ADHD is a brain disorder and is due to a shortage of dopamine, which stimulants correct. But since most children’s dopamine levels are never checked, the idea that their brains are deficient in the neurotransmitter is simply a conjecture based on the way we know stimulants work: by increasing the amount of dopamine in the brain to give people a boost of motivation to pay attention.
But what about the checklist of symptoms to diagnose ADHD?
I found such a checklist on the ADDitude website, run by the magazine of the same name, whose tagline is “Strategies and Support for Attention Deficit and Related Conditions.” They offer an ADHD symptom checker based on the criteria found in the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association (APA). For every symptom, you have a choice of answering “very often,” “often,” “sometimes,” “rarely,” or “never.” Some of the symptoms listed include forgetting things, interrupting conversations and activities of others, fidgeting, difficulty focusing on homework, losing things, and making careless mistakes. Many would consider the list of symptoms above to be normal childhood behaviors.
“Normal”? Really? Isn’t that all pretty official, like a real medical diagnosis?
According to the APA, the DSM is “a handbook used by healthcare professionals in the United States and much of the world as an authoritative guide to the diagnosis of mental disorders. The DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders.”
Note those two words: “descriptions” and “symptoms.” That’s it. No hard science about it. No lab tests involved. The book is a handbook of labels, each one listing behavioral characteristics and other signs for practitioners to assess (and, as is often the case, disagree on).
But isn’t time of the essence? Shouldn’t I take action quickly when my child is diagnosed?
You can pause and reflect when faced with new information, especially when it involves the use of any kind of pharmaceutical.
All you really know after going through the checklist is that your child has a certain set of behaviors that are supposed to indicate a condition called ADHD. But what caused these behaviors? And if doctors can’t tell you the cause, why do they so often tell parents that the child has a chemical imbalance in the brain? And how does a doctor know, based on a checklist of behaviors, that a stimulant drug is the correct measure needed to help the child?
But what about those drugs? Where can I find some detailed information about them? And won’t they help my child in the long run?
Mad in America published a guide called “Psychotropic Drugs in Children and Adolescents: Stimulants, ADHD, and Other Behavioral Disorders” that gives an overview of ADHD, provides a diagram of how drugs act on the neurons in the brain, and details both the long and short-term research on using stimulants to help manage ADHD symptoms.
It would be understandable to think of stimulant drugs as a magic bullet for ADHD behaviors if you read and watch ads from the drug companies. But interestingly, after looking at studies from the previous 14 years, the 1994 edition of the APA’s Textbook of Psychiatry has this to say about long-term effectiveness: “Stimulants do not produce lasting improvements in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long-term adjustment.”
The National Institute of Mental Health (NIMH) then commissioned a study called the Multisite Multimodal Treatment Study of Children with ADHD (MTA) to provide more information on the long-term use of stimulants. People still cite the study today as proof that stimulants are effective for long-term treatment of ADHD. But let’s dig a little deeper into the results:.
- At fourteen months of treatment, researchers said that treatment with stimulants was superior to behavioral treatment in reducing symptoms and possibly improving reading scores.
- At three years of stimulant use, the results were the opposite: Children who had taken stimulants had more symptoms than those who were unmedicated and also were shorter, weighed less, and had more delinquency.
- At six years, those who were using medication showed worse hyperactivity, impulsivity, and oppositional-defiant behavior, and more symptoms of depression and anxiety.
According to MIA’s guide, other long-term studies, including results from Australia and Canada, showed that long-term use of stimulants results in “increases unhappiness, a deterioration in relationships with parents, more anxiety and depression among girls, and a deterioration in educational outcomes.”
It seems clear that the results being touted as showing stimulants’ effectiveness are limited to the results for fourteen months in results of the MTA study, not the three-and six-year results.
And besides the poor behavior outcomes associated with long-term stimulant use, some of the more serious problems with stimulants can be found on manufacturers’ package inserts. For example, the package insert for Adderall posted on Drugs.com contains this list of common adverse effects: loss of appetite, weight loss, mood changes, feeling nervous, fast heart rate, headache, dizziness, sleep problems, and dry mouth. The serious adverse effects of Adderall include seizure, muscle tics or twitches, circulation problems, aggression, hostility, paranoia, chest pain, trouble breathing, and feeling like you might pass out.
So, if the drugs don’t help much, and ADHD is not due to a chemical imbalance in the brain, how can I understand it? Where else can I look for a cause?
Dr. Thomas Armstrong, psychologist, speaker, and author, thinks we need to consider this idea: “What if ADHD children are not disordered, but we live in a disordered culture?” In this sense, we can look at our American culture with its emphasis on materialism, high achievement, and busyness as being part of the water we swim in, and then that water seeps into our skin and our bodies.
Roman Wyden, father, entrepreneur, and host of the podcast ADHD is Over, has interviewed many experts in psychology, child development, trauma, and education. I love the tagline he uses at the beginning of each podcast when he says, “The struggle is real. The label doesn’t have to be”—because Wyden’s not denying that the behaviors can be problematic. He’s just looking at them with a different lens.
He’s also put together a wonderful “ADHD Survival Guide” that you can download from his website. Based on his own experiences and what he’s learned from his guests, Wyden said this about possible causes of ADHD: “I don’t think there’s one main cause, but in general, we can look at the environment’s impacts on our lives—things like a stressful birth, heavy metals in our food and water, past and present trauma, and family dynamics can all impact a child’s nervous system so that they develop some of the behaviors we associate with ADHD.”
Just to be very clear about trauma, I want to place that word in a context that I’ve found personally helpful. Canadian family practice physician and author Gabor Mate has a special interest in childhood development and the potential lifelong impacts of trauma. Mate explains how he interprets it: “Trauma is a Greek word for wound…Trauma is not the event that inflicted the wound. So, the trauma is not the sexual abuse, the trauma is not the war. Trauma is not the abandonment. The trauma is not the inability of your parents to see you for who you were. Trauma is the wound that you sustained as a result.”
Mate goes on to talk about his own life in 1944 Hungary, when the Nazis invaded and his mother gave him to a stranger to keep, for a while, so that the Nazis couldn’t harm him—because he was Jewish.
“So, my wound wasn’t that my mother gave me [away temporarily] to a stranger [when I was a child]. My wound was that I made that mean that I wasn’t lovable and I wasn’t wanted and I was being abandoned, which is a good thing. . . [because] if the trauma wound happens inside you, the wound that you’re carrying? That can heal at any time.”
I’ve heard Wyden say in some of his podcast episodes that he and his wife took a hard look at their family dynamics when their older son Khai was diagnosed with ADHD. And I don’t detect any notes of blame in his approach, like blaming themselves for being bad parents.
“Well, there’s a difference between blaming yourself and taking responsibility for the way things are. My wife and I were both working a lot, I wasn’t very present in the marriage, and the kids had a nanny, so we realized that one thing we could do to help our sons was to remove as many environmental stressors as possible…The more we looked into the idea of trauma, the more we realized our son Khai likely felt traumatized when he was taken from us after his birth and then kept in the hospital for several days so he could be treated for jaundice. The separation from parents, the strange voices of the nurses and doctors, the lights and noises in the nursery—all of that is overloading the infant’s nervous system and likely felt as a traumatic event.”
The Wydens eventually decided to homeschool both of their sons—Khai and Etienne—and now the boys enjoy a hybrid education—two days at a public school that offers a homeschool program and the rest of the time learning from home. Khai passed the entrance exam for a prestigious high school and will be starting there in the fall. It looks like the road the Wydens took has been successful for their sons in many ways.
I often hear teachers and parents refer to a child who struggles with ADHD behaviors as “an ADDer” as if that label gives you a complete picture of the child. Should I be concerned about people using a label like that?
These days, all of society seems to trade in labels because they serve as a shorthand way of describing individuals , especially in the realm of any kind of emotional distress or different ability. We even refer to ourselves this way, as if our “diagnosis” is the totality of who we are: alcoholic, addict, borderline, emotionally disabled, and ADDer. And yes, it takes more words to talk about people without labels, but I believe that it also makes them more fully a person with much less focus on any kind of difference. Think about the different picture you form of a person who “self-medicates with alcohol” as opposed to the more direct label of alcoholic.
Years ago, when I worked as a special educator in a high school, I was assigned to work with the “ED” kids—emotionally disabled. Now when I think about that label, the term itself doesn’t even make sense. And when I close my eyes and see each one of the faces of my former students, I also remember their stories of abuse, abandonment, and family disarray. And I realize that what we were doing was, as researcher Vicky Plows put it, “[locating] the problem within the child, individualizing issues, and shifting the focus away from the larger context. This [kind of labeling] can make it hard to tackle problems holistically.” And labels can certainly harm children in other ways, leading to bullying, stigmatization, and marginalization in schools.
Sometimes labels and diagnoses are a necessary component of getting services for a child, such as when they are diagnosed with a learning, hearing, or vision disability. Such information can also be used by teachers to seek out the most effective forms of teaching for a given child. But we all know any child is more than the label of their particular problems.
The question I ask myself now is this: Does anyone need to know what a child is diagnosed with? We can probably all remember kids who were labeled when we were in school, and those labels seem to stick forever. Worse than that, a child who is constantly referred to by their symptoms or diagnosis can internalize the negative connotations that people ascribe to certain categories and limit themselves unnecessarily or develop a very wounded self-image.
If the labels don’t help, and the drugs aren’t the answer for my child, what can I do to help him succeed in life and in school? Despite our best efforts to be loving and positive, we constantly argue and remind him about homework and chores, and his teachers are frustrated as well.
I well remember how challenging my son was as a child, in the sense that we operated on different timetables, and both his teachers and I were perplexed and frustrated with his lack of urgency in following directions or completing school and classwork. I would have welcomed a new approach to working with him that could have eased our mutual frustration.
To give parents an overview of some holistic ways to help children learn self-management skills, I’ve also looked at two different approaches to helping children learn self-regulation skills, because many ADHD behaviors fall into three main areas that children need assistance with:
- Executive function (planning, breaking down tasks into chunks, blocking out distractions);
- Emotional and social skills (difficulty managing frustration and irritability age-appropriately, starting conversation, waiting your turn to talk, and seeking inappropriate attention); and
- Language and cognitive flexibility skills (getting confused with following directions, trouble expressing needs, seeing situations in black and white, having trouble with transitions and schedule changes, and negative self-labeling based on one experience).
What’s an extremely structured, step-by-step approach to helping kids and families deal with such behaviors?
There are two I want to share with you. The first is detailed in Avigail Gimpel’s book HyperHealing: The Empowered Parent’s Guide to Raising a Healthy Child with ADHD Symptoms (HyperHealing), with an overview of the data behind ADHD in a concise book called HyperHealing: Show Me the Science. Her program involves establishing clear family rules and punishments, a collaborative approach to developing better social-’emotional skills, and finally, addressing the importance of a healthy diet and adequate exercise for growing children.
Gimpel’s book HyperHealing is nearly 400 pages long, very well-researched, and written in a conversational style that makes you feel as if you’re talking with a wise friend who seems to have found a good solution to a difficult challenge. She goes into extensive detail in each chapter, providing supporting research and detailed examples of problem behaviors, possible explanations, and solutions that have worked for her personally and in her professional life. I’m providing a brief summary of her work, and if you feel that her approach resonates with your parenting style, I’d recommend her books so that you have a complete picture of her program.
Gimpel first asks you as a parent to look at the “habit loops” you are in as far as your child’s behavior and how you respond. We often find ourselves in patterns of behavior that we don’t know how to get out of, and she spends a good deal of ink on helping you figure out your situation. As long as we remain in the loop and respond vigorously to the outburst, we are actually rewarding the tantrum—in the sense of giving energy and attention to the behavior. “The way we communicate either reinforces negative behavior (like giving in to a tantrum or nagging request from a child) or builds positive momentum.”
Understanding your family’s habit loops and triggers opens the gateway to the rest of the program: Compliment positive actions, establish clear ground rules, and punish when rules are broken. Gimpel thoroughly explores the most effective ways to compliment people that will reinforce positive behaviors. “Let’s raise our voices with joy when she does something right and be bland when responding to negative behavior.” She recommends that compliments are specific (You made my day when you came in the house with a big smile. . . ); that you give them right away when the event happens, and don’t add a “but” (. . . but you forgot to take off your wet shoes); and reinforce the compliment with touch—a high five, a shoulder squeeze, or a hug—as long as the child is open to that.
From compliments, Gimpel goes on to talk about punishment and family rules. She recommends three rules to explain to children: respect parents, respect siblings, and no putting yourself or others in danger. Each rule has several specifics that you could discuss as a family. What I take away from her presentation is that the compliments show your child how to behave in the world and get along with others, the rules are there as guardrails for everyone, and the punishments are for the times when the child makes a bad decision and breaks one of the guardrails.
Punishments should be respectful, and one way to accomplish that is to let the child do something to correct the situation. If a child speaks disrespectfully to his sibling, you can tell him calmly and respectfully that he broke a rule and now he needs to go and water the plants on the porch, or fold a few items of laundry. If the child refuses to comply, Gimpel recommends either taking away an item or a privilege—offer half a treat or none at all or read a shorter story at bedtime.
Gimpel spends a considerable amount of time giving real-life examples of how to implement her ideas as far as discipline and compliments go. The rest of the book is devoted to helping the child develop better self-management, social, and cognitive skills. I found her approach highly structured, warm, and caring, and I can see how many families would resonate with what she offers.
What’s another way to help challenging kids?
If you’re looking for another modality, consider Howard Glasser’s Nurtured Heart Approach. His books Notching Up the Nurtured Heart Approach and Transforming the Difficult Child Workbook: An Interactive Guide to the Nurtured Heart Approach offer more streamlined guidance on working with challenging kids in both the school and at home. As I read the book for educators, I could immediately see that Glasser’s three-step approach to working with kids in schools could also work at home, and I found the workbook for parents to be written in a comprehensive, step-by-step manner that presents all the ideas for parents in small steps with wide-ranging examples.
Glasser breaks down his approach into what he calls three “stands”:
- I will purposefully create successes for my child.
- I refuse to be drawn into accidentally energizing and rewarding negativity.
- I will provide a true consequence when a rule is broken.
Before leading us through the stands with detailed examples, he presents an interesting concept that he calls “Video Game Therapy.” Glasser says kids weather the challenges and setbacks of video games because “the rules are clear and specific, the game provides perfect structure and clear, consistent consequences at every level of play, the child knows what to do to score…and becomes expert at NOT breaking the rules, and the game is ALWAYS in the NOW.”
Glasser, like Gimpel, discusses the need for family rules to be clear and consistent, and to have the kids know what the rules are. He also suggests framing them in the negative—no lying, no disrespecting parents, siblings, and peers—because doing so removes ambiguity. Whereas saying “be respectful” can open you up for debate and create an unclear situation. Posting the rules is not necessary, and unfailing application, without issuing warnings, is the key to his approach.
Here’s how Glasser might approach a sibling argument: Suppose your two children have been teasing each other all morning, and they finally come to you and ask for help resolving the situation. You notice that your daughter has managed not to hit her younger brother even though she’s clearly angry. Glasser suggests you say something like: “Thanks for not taking your anger out on anyone. That’s really good self-control. I also notice that you decided to solve the problem in a safe way. I’m proud of you for asking for help and managing such intense feelings.”
The example outlined above exemplifies stands one and two: choosing to energize success and refusing to energize negativity. The third stand, providing a true consequence, is where I got a little hung up—because it seems to be the antithesis of the way so many of us parent. Most of us, myself included, would opt for punishment. Instead, in the example above of the two siblings, if the older sister had ripped up her brother’s painting or tossed his half-finished puzzle on the floor, Glasser recommends saying to her—so long as she stops her negative behavior—“Sherrie, thanks for putting yourself back in the game.” That can be followed with a sincere compliment—“Right now you are helping your brother and being kind.”
Glasser talks about the need to “get out of the way” and let the child be successful. He maintains that ALL kids can behave appropriately if you put the bar in the right place. He reminds us that Shamu the whale learned to leap into the air only after he was rewarded for swimming over a rope on the bottom of the pool. In essence, we can make it impossible for our kids to fail using that same approach.
Glasser emphasizes that success is due to “consistently giving consequences when a rule is broken and never looking the other way, delivering the consequence in a neutral way and keeping it very short and simple, avoiding warnings, and then recognizing success as soon as the child serves the consequence.”
What else should I know?
In conclusion, I would encourage every parent or teacher who may be reading this article to consider the research presented, question any assumptions they may have had about a given child, and explore the resources I’ve gathered to help you find your own solution. We all want to help our kids or our students, and sometimes finding the right key to unlock a child’s gifts is a matter of time, patience, trial, and error. I encourage you to trust yourself, hold your child in a positive light, and know that you will find the right answer.
American Psychiatric Association. (2023). Psychiatry Online, DSM Library. https://dsm.psychiatryonline.org
Bracken, A. (2022, March). Parenting Changed My Perspective on “ADHD”. Retrieved from Mad in America website: https://www.madinamerica.com/2022/03/parenting-changed-my-perspective-on-adhd/
Centers for Disease Control and Prevention. (2022, August). My Child Has Been Diagnosed with ADHD—Now What? Retrieved from: https://www.cdc.gov/ncbddd/adhd/treatment.html
Childs, J. H. (2022, August). The Relationship Between Dopamine and ADHD.
Retrieved from Very Well Mind website: https://www.verywellmind.com/the-relationship-between-dopamine-and-adhd-5267960
Drugs.com (website).Adderall.[2022, Nov. 8]. 2023 May 30, 2023. . https://www.drugs.com/adderall.html#side-effects.
Gimpel, A. (2021). HyperHealing: The Empowered Parent’s Guide to Raising a Healthy Child with ADHD Symptoms. Columbus, OH. Gatekeeper Press.
Gimpel, A. (2021). HyperHealing: Show Me the Science: Making Sense of Your Child’s ADHD Diagnosis. Columbus, OH. Gatekeeper Press.
Glasser, H., Block, M. (2011). Notching Up the Nurtured Heart Approach: The New Inner Wealth Initiative for Educators. Tuscon, AZ. Nurtured Heart Publications.
Mad in America. (2019). Psychotropic Drugs in Children and Adolescents: Stimulants, ADHD, and other behavioral disorders. https://www.madinamerica.com/adhd-info/
Plows, V. (2014, October). Labelling kids: the good, the bad and the ADHD. Retrieved from The Conversation. https://theconversation.com/labelling-kids-the-good-the-bad-and-the-adhd-31778
Rogers, S, (2022). CBC Radio, The Next Chapter (radio). “Are we mislabeling our trauma? Why Dr. Gabor Mate believes we need to change the way we think about pain.” https://www.cbc.ca/radio/thenextchapter/are-we-mislabeling-our-trauma-why-dr-gabor-maté-believes-we-need-to-change-the-way-we-think-about-pain-1.6661540
Saline, S.(2023, April). Does My Child Have ADHD? Symptom Test for Kids. Retrieved from Additude website: https://www.additudemag.com/adhd-symptoms-test-children/?src=embed_link
Wyden, R. (2023, May 26). Personal Communication. (personal interview).
Resources for Parents and Teachers
Armstrong, T. “American Institute for Learning and Human Development.” https://www.institute4learning.com/thomas-armstrong/
Chris Rowan Pediatric OT “Reconnect Webinars—Balance Between Teaching and Moving to Learn”, Zone-in Workshops. https://www.zoneinworkshops.com/index.html
“17 Ways to Help Students With ADHD Concentrate,” by Youki Terada. August 17, 2015; Updated June 28, 2018. Teacher-tested ideas to help students with fidgeting. HTTPS://WWW.EDUTOPIA.ORG/DISCUSSION/17-WAYS-HELP-STUDENTS-ADHD-FIDGET
Jeanine Mouchawar, certified life coach for parents of teenagers. https://www.jeaninemouchawar.com
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.