Michael Costigan is a 17 – year-old from Orange County, CA. He is a social entrepreneur, public speaker, and truly enjoys helping other’s better understand teen related issues. You can follow him at www.SpeakingofMichael.com
From the 1980s – 2000s there has been a tremendous amount of advancement within the psychiatric and neuroscience fields. The understanding has enabled clinicians and researchers alike to conclude that the brain enables the mind. It is now well known that
the field of cognitive neuroscience is the first and foremost cutting edge psychological science.
Recently, Dr. Aditi Shankardass, a clinical neuroscientist, gave a TED talk. The talk, entitled “A second opinion on learning disorders”, brought to my attention a fundamental misconception so many clinical studies and for that matter clinical practitioners fall victim to; developmental disorders in children are typically diagnosed by observing behavior, when really, we should be looking directly at their brains. This vital principle is wonderfully illustrated by Shankardass’ work. “She explains how a remarkable EEG device has revealed mistaken diagnoses and transformed children’s lives.” Specially, Shankardass’ work with Autism and other disorders like ADHD and
Dyslexia are also addressed.
[Aditi Shankardass] heads Harvard affiliated Bright Minds Institute’s neurophysiology department, [she] has been using this technology for past two years with startling results — almost half the 200 children who arrived at her clinic, previously diagnosed with autism, were in fact suffering from brain seizures, undetectable to the eye, causing symptoms identical to autism. See Link
This is quite a major discovery, and one that isn’t unique to just autism. All too often we see educators, parents, and even clinicians jump to quickly into assuming a child has a learning disability or disorder. Often an adequate understanding of the surrounding context, environment, and past and present performance is overlooked. What presents itself as symptoms of mild to moderate ADHD could easily be a child bored in an oversized class. This isn’t to say ADHD and other disorders don’t exist, quite the contrary, they are very real and there is a very real need to be advancing treatment for them. However, the big picture must be considered, and observation alone is not always enough to provide an accurate depiction of what is actually happening within the brain. Longitudinal studies will show that 70 percent of individuals diagnosed with ADHD during childhood still meet the criteria used to diagnose them once they have reached
adulthood. (Gazzaniga & Heatherton 2003). Likewise, these individuals are also more likely to drop out of school and reach a lower socio-economic level than expected. Treatment therefore, with someone showing legitimacy in core diagnostic criteria is
imperative at early ages. If you care about children and you have a direct say in their medical well being, please take note of the following:
1. True ADD/ADHD symptoms are dramatically noticeable, they also don’t manifest magically in the teen years.
-In accordance with the DSM-IV, “To be diagnosed with ADHD, children should have at least 6 attention symptoms or 6 activity and impulsivity symptoms — to a degree beyond what would be expected for children their age.”
-Difficulty sustaining attention in tasks or play (notable – even things typically
enjoyed are affected by true ADD/ADHD)
-Does not seem to listen when spoken to directly
-Does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace
-Difficulty organizing tasks and activities
-Often loses toys, assignments, pencils, books, or tools needed for tasks or
-Easily distracted (to the point where tasks are not accomplished)
-Often forgetful in daily activities
-Fidgets with hands or feet or squirms in seat (cannot sit still for any length of
-Leaves seat when remaining seated is expected
-Often “on the go,” acts as if “driven by a motor,” talks excessively
-Difficulty playing quietly
-Blurts out answers before questions have been completed
-Interrupts or intrudes on others (butts into conversations or games)
-Difficulty awaiting turn
Now, it should be obvious that simply having a few of these symptoms with varying degrees of consistency does not constitute for one of these disorders. Rather, 6 of either classification, with persistent and consistent presence of symptoms is grounds for the disorder. ADD and ADHD interrupt life and are blatantly difficult to deal with, they go beyond personality traits and quirks that might include an individual who just doesn’t like to listen or do their homework. Furthermore, some symptoms must be present before age 7. So the child who goes from possessing none of these symptoms to not wanting to do big projects in high school doesn’t meet the requirements.
2. The treatments for ADD and ADHD have two distinct medically accepted approaches, there are many useless treatment options not supported by the scientific community.
Recent research points towards the highest efficacy rates in regards to ADD and ADHD treatment with a combination of both medication and behavioral therapy. According to clinical studies, “The use of methylphenidate (ritalin) for children with ADHD dramatically reduces negative behaviors while only slightly increasing the amount of positive behavior” (Pelham 1990). While there is evidence to show that children taking these drugs are often more successful in school, happier, and more socially adept, there is also evidence to show these do not seem to be long term benefits, in fact the dissipation rate is often directly correlated with the length of drug use beyond a set point. The National Institute of Mental Health worked to establish the Multimodal Treatment of Attention-Deficit Hyperactivity Disorder (MTA) in 1992. “Children who received both medication and behavioral therapy showed a slight advantage over those who received only medication in areas such as social skills, academics, and parent-child relations” (Jensen 2001). Elements of behavioral therapy include goal setting, rewards and consequences, and consistent therapy for extended periods of time.
3. Criticisms run deep, and many opinions exist, these you should be aware of…
It doesn’t take an expert to tell you that medication is not a “magic bullet” for mental disorders. While a pill may help relieve the symptoms of a disorder, there must be a foundation for teaching the patient how to cope and deal with the disorder. These patients must be trained to adapt, to think in more effective patterns, and sometimes to adjust to new ways of interacting with others. Psychological, cognitive, and behavioral interventions often address these issues more directly and effectively than medication. However, ADHD drugs have been shown to offer up a plethora of side effects, including stunting growth. Additionally, the Washington Post reported in 2009 in a follow up study of MTA that the results showed drugs were not effective after 3 years and posed significant risks. “The stance the group took in the first paper was so strong that the people are embarrassed to say they were wrong and we led the whole field astray,” said Pelham, of the State University of New York at Buffalo (Washington Post 2009). Clearly this is an on going debate, and clearly an accurate conclusion might not be reached for some time. It makes sense then that a behavioral approach should be considered before drugs.