What’s Up with all this ADHD?

Can so many children really have an attention disorder, for which they need to take medication every day, indefinitely? What is going on here? What if, the problem is not with the children, but with what we are expecting them to be able to do? What if young children are not supposed to be able to sit at a desk and stay focused on an adult talking about something they’re not familiar with or interested in? Historically, children were thought of as small adults (they even look like that in paintings). They were expected to be able to get up every day and go to work.  Nowadays, though, we are enlightened, and we understand that children are not physically or emotionally prepared for this, that it is not good for them.  Now we know that they need time and opportunity to grow and learn and play before we can send them to the field or the factory or the office all day, every day.  But how enlightened are we?  Don’t we do something very similar when we send them to school, to sit in the classroom and listen and perform, every day?

Unfortunately, our educational system – its methods and policies, was not developed in conjunction with science, with a foundation in an understanding of children and their developing brains.  Of course, there are wonderful educators who have an intuitive understanding of children and how they learn, and how best to teach them – to grab their attention, engage their curiosity and motivate them to work at mastering new skills and information. But these I’m afraid are the rare exception, and the instructional programs that train our teachers and our educational policy makers have not incorporated, and do not disseminate, this wisdom.

Very young children learn through sensation and movement, via their own direct experience of their physical environment and their bodies. Because we are so focused on developing reading and other competitive, abstract, intellectual skills, we inappropriately limit their natural learning opportunities, their physical movement, their spontaneous exploration of the physical environment, which may make a mess. The scale is wrong (too small), the modality (verbal/language/talking to) is wrong, the format is wrong (abstract ideas, representations, rather than real, concrete objects and events). And, as a result, guess what?  Children have trouble staying focused, paying attention, sitting still, getting their “work” done.  And we have prescribed this list of symptoms to be a definition of a disorder, such that many, many children qualify as “having” it, and needing to be “treated” for it.  Why didn’t children have this condition twenty or thirty years ago?  Because they were allowed to play, I mean learn, the way they were meant to.

There are three “subtypes” of ADHD:  inattentive type, hyperactive/impulsive type, and combined type.  Research consistently points to the hyperactive/impulsive type as being a separate entity, and this may be, in a small number of children, a true neurologic (brain-based) disorder.  The ability to inhibit one’s impulses, a skill that is purportedly deficient in ADHD hyperactive/impulsive type, develops as the front part of the brain develops, relatively late and not complete until early adulthood. Toddlers and teenagers are notoriously impulsive (albeit in different ways), and we do not diagnose them with disorders when they are unable to resist grabbing the toy they want from another child (toddler) or going out with friends at the last minute instead of studying for a test (teen).

The ability to inhibit our impulses is something that most of us work on throughout our lives, as we try to resist having one more piece of cake (or glass of wine), or buying something shiny that we don’t need, or saying something in anger that we will later regret. But for some people, this brain circuitry and is an area of weakness and particularly difficult to develop.  I once saw child who was so impulsive that I had to clear my desk of every object, because if he saw something, he would grab it, play with it, mangling paper clips, writing on the desk with the pencil, turning the lamp on and off, etc.  For this child, the “see it, grab it” circuit in the brain that is most active in an infant, never got effectively overpowered by a higher-level, inhibitory circuit that allows us to see something new and interesting and resist the impulse to reach out, wrap our hand around it and put it in our mouth – a pre-wired circuit that has survival value for an infant, allowing them to learn to feed themselves.

But the “inattentive” type of ADHD is more likely a rationalization for our failure to engage children actively in learning in the classroom. Being distracted by things and events other than the focus of the “lesson” is much more likely when the “lesson” is either daunting or uninteresting, the content abstract and the method of instruction passive.  We all learn most effectively not through passive listening, but by direct experience, by actively interacting with the environment, sensing, perceiving, and responding to, not only the initial event or information, but the cause-and-effect linking of our own behavior, our participation.

There are some educational methods and philosophies that incorporate this wisdom. Maria Montessori had it right when she created a classroom filled with an interesting assortment of stuff for children to explore and interact with.  The Orton-Gillingham method for reading instruction, which promotes a “multi-sensory” presentation – seeing, hearing, and feeling the movement of the muscles to form the letters, touches on this experiential quality of natural learning, although in practice it falls short by providing, for many children, too little, too late.   If we introduced the letters and their sounds, and eventually the rules for spelling and constructing sentences, in large scale, whole body ways to young children, they might be both interested in (and therefore attentive to) and motivated for (and thereby attentive to) learning to crack the code of printed words on a page. As it is, we start talking at them, explaining, presenting tiny letters packed into small, two-dimensional pages, lecturing in contradictory terms about the sounds that “ae” and “ea” make, and create a generation of children with a disorder – “dyslexia,” or  “ADHD.”