Role Models in a Bottle, Social Discipline in a Capsule
(Note: When this article first went live, I received 127 emails of complaint in the first 24 hours alone!!)
In every field of medicine we are seeing that increasingly psychiatric drugs are replacing the care previously afforded by human contact - especially in the area of long term elderly care who curiously are now being targeted for Ritalin prescriptions as an adjunct to SSRI's for elderly depression.
However, for the anti-Ritalin movement to blame parenting for the changes in children's behaviour that are labeled as "ADD/ADHD" is to ignore the sociological and cultural phenomena that surround the family nexus. At the point of the manifestation of the ADD/ADHD symptomology it is the responsible parent in our social nexus that takes their child to the paediatrician, not vice-versa. It is at this level that the therapist needs to begin in order to unravel the binds that the child and family are caught up in. To place sole responsibility onto the parent is to enter into the cause and effect relationship of the diagnostic protocol and is as negligent as the psychiatric terminology such as the DSM that promotes such notions as ADD and ADHD in our culture in the first place.
As might well be expected, I support no notion that ADD or ADHD exists as anything other than a sociological phenomena and I watch with interest as the psychiatric and drug industries continue their search for the alchemical Holy Grail of psychopharmacology.
The major psychiatric texts all look to the usual area of causality - i.e. genetics. We see the now standard invocation of the twin studies that attempt to show concordance as if there are enough sets of deviant twins world wide to cover every psychiatric diagnostic category of the DSM. What we don't see however is a single discussion of the conditions and standards of our current education systems nor of the role models provided by our media. Also missing from these texts is even the smallest allusion to cybernetic processes within interpersonal relationships. It seems that these concepts might possibly be considered to be too complicated for our psychiatric staff.
Listed and discussed briefly here are the neuro-psychiatric findings from research into ADD/ADHD from the biological perspective. If you are an NLPerson working in therapeutic change work with clients you can be assured that your clients will already have read up on these 'facts' - you need to know them if working with the family who has a member diagnosed with ADD.
Firstly let's look at what the initials mean.
ADD stands for Attention Deficit Disorder - this is the fidgety, socially failing child, who [contextually] lacks attention and interest and is poorly motivated. He lacks the impulsivity of the ADHD diagnosed child - Attention Deficit Hyperactivity Disorder - who has the same lack of attention but is somewhat impulsive. Broadly speaking we can consider the 'disorders' to be the same in origin. For a fuller description of these terms you may like to consider perusing that bible for the insurance companies, the DSM iv which details the behaviours commonly associated with these disorders.
Whilst food 'additives' are most commonly believed to be the causation of these behavioural changes, there exists very little evidence that this is the case. This is something that has been largely ignored by a sizable number of people who will be unaware of this and state that their children's behaviour definitely changes if they eat the 'wrong' foods. However, if such a belief permeating our cultural theology means that our children are likely to receive a better diet, then long may such a belief persist.
From a neurological perspective, the "minimal brain damage" theory has been popularised. The purported brain damage has been described as "minimal" owing to the lack of identified changes in the brains of ADD/ADHD diagnosed children by structural scanning (i.e. via MRI and CT brain scanning).
Functional scanning however did demonstrate decreased cerebral blood flow and metabolic rates in the frontal lobe areas of children diagnosed with ADD/ADHD. Kaplan suggests that one possible explanation of ADHD is that these children are not "adequately performing their inhibitory mechanism on lower structures, an effect leading to disinhibition". No one has suggested however, just how many of the neurobiological changes demonstrated by the ADD/ADHD group are in response to the process of being scanned etc.
Despite the ongoing quest for the neurobiological basis of ADD/ADHD we cannot escape one essential detail - ADD/ADHD diagnosed children show no signs or history of head/brain injury and there is no increase of ADD/ADHD signs amongst the population of children that do suffer head/brain injury. Hence the need for the 'soft signs' and 'minimal brain damage' theories.
Kaplan suggests that in families where the child has a diagnosis of ADHD co-existent with a "conduct disorder" (i.e. he doesn't like someone and he let's them know it) there is an observed increase in alcohol usage and personality disorders when compared to the general population. Naturally, it is presupposed that this has a genetic causality. It is also suggested that siblings of hyperactive children have twice the "risk" of manifesting hyperactivity and even that "one sibling may predominantly have hyperactivity symptoms, and others may predominantly have inattention symptoms[!!!]"
Kaplan goes on to state that children in institutions are "frequently overactive" and have "poor attention spans." He tells us that: "These signs result from prolonged emotional deprivation, and they disappear when deprivational factors are removed, such as through adoption or placement in a foster home." However the experience of too many adoption and foster parents tells us otherwise. The research into the phenomena now known as "attachment disorder" affecting children such as those seen in the Romanian orphanages taken into loving foster/adoption homes, indicates that after a critical period, changing the manifest negative behaviour of children reared in emotionally deprived environments is notoriously difficult. Those wanting to know more about such occurrence's might like to read the research of Martin H. Teicher et al at McLean Hospital in Belmont Mass., USA, summarised in the Scientific American, March 2002.
Another model seeking to explain the phenomena (remember, sociological perspectives are all too often missed or ignored by mainstream psychiatry and neurology) is that of the neurotransmitter hypothesis - otherwise known as the chemical imbalance theory.
It is the area of the brain known as locus ceruleus that plays an important role in paying attention. The brain cells that make up this area are mostly noradrenergic (noradrenaline/norepinephrine) neurons. A complicated theory suggests that a feedback mechanism involving the peripheral noradrenergic nervous system affects the function of this brain region but this is no little relevance to NLPers. Phew! The major influencing factor on the biochemical hypothesis is the observation that stimulant drugs appear to calm down the behaviour of children diagnosed with ADD/ADHD. The stimulants such as Methylphenidate (Ritalin), methamphetamine (Dexedrine, 'Speed'), Pemoline (Cylert) and Gettuff Hydrochloride (Sitdownandbehavenow) are most commonly used. These drugs stimulate both dopamine (which is why recreational users take them too) and noradrenaline (norepinephrine) leading to the assertion that these neurotransmitters are involved in some way in the processes of ADD/ADHD. To suggest that these drugs "correct the chemical imbalance" is woefully naive and simplistic but tragically seems to satisfy most people's need for basic understanding of the issues.
It is often stated that ADD/ADHD diagnosed children have a polarity response to stimulant drugs - i.e. they affect people with "ADD/ADHD" in differently to the way they affect the "normal" population. This is a misconception that has not been supported by research and these drugs affect most people equally or in at least the same way as alcohol or any drug will affect people equally (according to individual characteristics, dose, set, setting etc). The diagnosis of ADD/ADHD does not necessarily predict a polarity response at all and in the therapeutic doses given (milligram per kilogram) will exert a similar effects across recipient groups. This is partly why the authorities are trying to play down or even ignore the "Kiddie Cocaine" phenomena that demonstrates children's great adaptation response to forcible medication - i.e. they have an interesting tendency to grind it into a powder and sell it to 'normals' in the playground at a dollar a pop, thus rendering everyone under the same behavioural control - some willingly, the others by attrition.
The issue of Ritalin being an addictive stimulant like "Speed" has been in the news recently, but unfortunately under the guise of the appalling Elizabeth Wurtzel's book about her addiction to the drug after she was prescribed Ritalin to compliment the Prozac she was prescribed to treat her "atypical depression" - catalogued ad nauseam in "Prozac Nation. Young and Depressed in America" - a thrilling read indeed.
Andrew T. Austin, NLP Master Practitioner
Tel: 07838 387580 for an appointment
ADD/ADHD and Ritalin Resources
National Institute on Drug Abuse. Trends in Ritalin Abuse.
Frontline. Statistics on Ritalin Abuse.
Novartis Pharmaceuticals. Ritalin.com - yes, it has it's very own webpage.
Parents Against Ritalin. An organisation that is "for" the disorder but "against" the drug.
Peter Breggin. Extensive listing of authoritive articles on ADD and Ritalin by Breggin et al and detailing how psychiatry is bad for your health.
Thom Hartmann. Thom is an NLPer who has written some interesting works on ADD - Good reading for NLPeople.
CNN. Brief interview with Elizabeth Wurtzel about her latest book and Ritalin addiction.