The realization that my kid had what's referred to in medical circles as an attention deficit disorder was greeted with mixed – and opposing – feelings. On the one hand, there was a sense of relief. I knew that my kid was smart, sincere, and wanted to succeed. He worked hard at tasks he was motivated to do and carried through on less motivating ones, too, but only if he was constantly guided back onto task. While this need was extreme and could be maddeningly frustrating, knowing that his struggles were all related to concentration gave me a framework for helping him move forward.
Accompanying and opposing that rather hopeful feeling was one of intense defensiveness. I knew that kids with attention disorders are medicated with drugs powerful enough to land healthy adults in jail – drugs known as "speed" on the street. On the other hand, I also knew that these drugs had a paradoxical effect in kids with an attention disorder; rather than speeding them up, they slowed them down and helped them concentrate. They have helped a lot of kids. Nevertheless, for me, giving my kid a daily stimulant drug was off the table.
The Promise and Problems of Stimulant Drugs for Attention Disorders
I am a person who prefers lifestyle/wellness solutions over pharmaceutical fixes whenever possible. At the same time, I fully understand that lives have been saved and improved by advances in Western medicine, and I'm happy to use pharmaceuticals when appropriate. For example, I understand the importance of the health-promoting bacteria that live naturally in our bodies and therefore shy away from knee-jerk use of antibiotics. However, I will certainly take them if I have a serious bacterial infection. Deciding when it's appropriate to use pharmaceuticals vs. alternative approaches involves balancing different factors, chief among them are the side effects of the medication and the availability and efficacy of the alternatives.
The main types of drugs prescribed for an attention disorder are stimulants that exert significant effects on sleep, growth, and other biological functions. These side effects are generally deemed mild by the psychiatric community, and the medications are considered safe; they have helped many kids with severe attention disorders get their lives back. Still, they are a dose of powerful medication to be taken every day throughout childhood, something many parents, myself included, would rather avoid if possible. (Alternative approaches, after all, have helped many children, without the side effects of stimulant pharmaceuticals. Before resorting to prescription medications, it's worth at least exploring these first!) One question I ask when it comes to the necessity of American childhood staples from tonsil removal to orthodontics is, "How do other countries deal with these issues? Are the interventions we take for granted really necessary or are there alternative approaches?"
Overdiagnosis or Underdiagnosis of Attention Disorders
An attention disorder is diagnosed – and stimulant drugs are prescribed – more often in the United States than in other countries. In fact, the diagnosis of attention disorders varies widely even within the U.S. Depending on how this variation is framed, you could argue that some kids are not getting the care they need, or you could argue that [an attention disorder] is an over diagnosed condition that allows a "quick fix" for parents and high profits for pharmaceutical companies. The truth is probably somewhere between these extremes. We are, after all, each individuals, and the lifestyle modifications that we need are different, too-- there are no cookie cutter magic pills that will fix everyone! Personally, I believe that increased awareness of attention deficit difficulties can be helpful for kids whose academic or social struggles are rooted in attention challenges but that only a small subset of kids with these difficulties need stimulant medication. For me, my first impulse upon realizing that my kid had attention challenges was to guard against him being defined by them. Instead, I would like to help him with his challenges, while defining him as a unique individual whose brain simply works differently from others.
The Gifts of Attention Disorders
Among the most helpful approaches to attention challenges is that of Dr. Lara Honos-Webb, who has framed an attention disorder as not only a set of behavioral challenges but also as a set of unique gifts and talents. For example, people with attention disorders tend to be highly creative, energetic and intuitive. These gifts are the other side of a coin that includes getting bored easily, being disruptive, and jumping to conclusions rather than listening carefully – real challenges to be sure, but still only half the picture. Dr. Honos-Webb believes that the focus on attention disorders has resulted in low self-esteem and underachievement because people with attention disorders see themselves as disordered rather than uniquely gifted. So, rather than focusing on their strengths while also working on their challenges, they only see the challenges, and therefore think of themselves as disabled or under-abled. A more holistic approach to attention difficulties is to focus on strengths while also addressing weaknesses, including by changing the person's environment to one that is better suited to someone with an attention disorder. For a child, this can mean talking to teachers about options that are better for their learning style or changing to a more appropriate school – say, one with a more projects-based focus with lots of opportunity for physical movement. For teenagers and adults, this can mean gravitating toward careers that are stimulating and that value innovation and creativity, rather than those that involve routine or that center around following rules.
Lifestyle-Based Approaches Honor the Whole Child
The biggest advantages of lifestyle-based approaches in the treatment of an attention disorder is that they are not simply focused on a child's weaknesses. Instead, approaches based on cognitive health and mindfulness, along with physical wellness approaches like nutrition, advance the whole child – strengths and weaknesses alike. That's why I took these approaches as my first steps to addressing attention challenges. I am hoping that these interventions, which are fundamentally about how to lead a healthy, fulfilled life regardless of diagnosis status, will be all we need. So far, so good, although I do think it involves more effort on the part of parents and teachers than an approach based on medication.
Of course, medical solutions are also supposed to incorporate lifestyle changes. However, the parents I know whose kids are on prescription attention disorder medication have received little if any guidance on lifestyle approaches, and their children's attention disorder is firmly treated as a medical disorder, a disease, rather than a difference that is challenging but also provides its own strengths. Personally, I am not convinced that an attention disorder is truly a disease-- it could be thought of more as simply a genetic characteristic-- and I'm suspicious of an approach that characterizes a challenging difference as a disease in large part because a drug can make life easier. (By that same logic, since amphetamines in adults can keep them awake for days at a time, does this mean that sleeping is a disease? Certainly not. It is a challenge to need to spend ~1/3 of our lives sleeping when we could really use that time to get things done, but that challenge is simply a part of who we are as human beings. We can address our time limits through different means.)
Now, to be sure, some kids need more help than others, and certainly stimulant drugs have been helpful to a lot of kids. There are plenty of alternatives to consider, though, including homeopathic approaches, before you get to that point. The first step after receiving a diagnosis needs to be to open your mind and evaluate all your options, talking with other parents as well as doctors. A lifestyle-based approach without stimulant drugs can be a challenging path to follow – a rougher road, but perhaps a more rewarding one. At the very least, though, we owe it to our children to start by trying non-pharmaceutical approaches. If after trying lifestyle-based approaches, we feel our child still needs medication, we can always move forward from there. Another advantage to this approach is that the lifestyle approaches will convey some degree of benefit, so that perhaps a lower dose of prescription drugs are needed.
Above all, as you choose the best path forward, remember that your child is not flawed but is a unique individual with gifts to be nurtured and harnessed, not suppressed. Yes, it's challenging, but remember that while attention disorders may be officially designated as a disorder, others view attention disorders as a superpower – one shared by entrepreneurs such as Ikea founder Ingvar Kamprad, Virgin founder Sir Richard Branson, and JetBlue founder David Neeleman, who has said that "if someone told me you could be normal or you could continue to have your [attention disorder], I would take [attention disorder]." Never lose sight of your child's fundamental nature as a unique little superbeing who can change the world with their gifts, given the support and guidance to let those gifts blossom. Brillia’s five-pillar approach is a gentle way to do this. With an approach based on optimizing a child's health and gently assisting with the challenge of attention disorder symptoms, Brillia may be just what you need to let your child bloom.
References: ADHD: The Entrepreneur's Superpower Archer D. Forbes, May 2014. Effect of Stimulants on Height and Weight: a Review of the Literature Faraone SV, Biederman J, Morley CP, Spencer TJ. Journal of the American Academy of Child and Adolescent Psychiatry, 2008 Sep;47(9):994-1009. Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008 McDonald DC, Jalbert SK. Psychiatric Services, 2013 Nov 1;64(11):1079-86. The Gift of ADHD Controversy Honos-Webb L. Psychology Today, March 2013. A Healthy State of Mind Copeland CS. Healthcare Journal of New Orleans, 2015 May-June, 28-32. Risk of Serious Cardiovascular Problems with Medications for Attention-Deficit Hyperactivity Disorder Martinez-Raga J, Knecht C, Szerman N, Martinez MI. CNS Drugs, 2013 Jan;27(1):15-30. The Role of Sleep Quality and Quantity in Moderating the Effectiveness of Medication in the Treatment of Children with ADHD
Morash-Conway J, Gendron M, Corkum P. Attention Deficit and Hyperactivity Disorders, 2017 Mar;9(1):31-38. Trends and Regional Variations in the Administrative Prevalence of Attention-Deficit/Hyperactivity Disorder Among Children and Adolescents in Germany Akmatov MK, Steffen A, Holstiege J, Hering R, Schulz M, Bätzing J. Scientific Reports, 2018 Nov 19;8(1):17029. The World Within Us Copeland CS. Healthcare Journal of New Orleans, 2017 Sep-Oct, 21-26.
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