by Robert Mendelsohn, M.D.
When your child reaches the toddler stage you may discover that he has more energy, is more active, and less disciplined than most other kids of comparable age. At first you'll be pleased that he is outgoing and alert, not lethargic and withdrawn. Then, after chasing him day after day from one exploratory mishap to another, you may find that your reservoir of patience and stamina has been exhausted. That's when you'll begin to wonder whether his boundless energy is a blessing, after all. You may even worry that his behavior is abnormal; that he is "hyperactive" or a victim of "attention deficit disorder"(ADD), "learning disability"(LD), or "minimal brain damage" (MBD), all of which are so often diagnosed today.
My purpose in this chapter is to warn you of the hazards of making that diagnosis yourself, and of letting anyone else doctor, teacher, or friend do it for you. Once your child is given one of these labels there is a strong probability that he may be subjected to some unacceptable risks.
Professional counseling and drug treatment for children who exhibit exaggerated but perfectly normal developmental behavior has become almost epidemic in the United States. Largely because of pressure from school authorities, many American parents have lost faith in the legitimacy of their own decisions and in the accumulated wisdom of their parents, relatives, and friends. They've been led to believe that doctors and mental health professionals have the only answers to questions that previous generations answered quite effectively themselves.
If kids were made with cookie cutters, like the gingerbread man, norms could be set for your child's developmental behavior and the level of activity that he should display. Happily, they're not, with the result that no two children are precisely alike. That's frustrating for teachers, doctors, and every other professional who believes that everything in life should go by the book. It is not uncommon today for a child who is so active and inattentive that he gives his teacher fits to be diagnosed as "hyperactive" or "brain-damaged", treated with depressive chemicals, and isolated in the "learning lab" at school.
The possibility that your exceptionally active but perfectly normal child could be branded with one of these derogatory labels – none of which has a valid scientific definition – is not remote. The number of children who have suffered this fate has risen by 500,000 in the last five years. It could happen to your child if he displays some of these behaviors, which are on the checklists that psychologists use: doesn’t always listen to directions; fidgets and won't sit still; daydreams in class; butts into situations that are none of his business; is slow getting ready for school; shows off when other children are around; or is more physically active than the other children in his class.
Your reaction to that list is probably the same as mine. I would begin to worry if a child didn’t display most of those behaviors. Then I'd devote my attention to trying to diagnose why he is behaving like a vegetable! But when he does display them, the mental health professionals are likely to give him drugs that often do turn him into something resembling a vegetable!
Avoid Drugs for Behavior Modification
If some of your child's behavior is more exaggerated and thus more annoying than that of other children you know, don't endanger him by exposing him to therapy or drugs. Instead, search for the environmental factors – at home, in school, or among his peers – that may be causing emotional problems. What pressures on your child are producing the behavior patterns that are unacceptable to his teachers and to you? Search also for dietary allergies that may be at the heart of his problems. Meanwhile, try to relieve some of the emotional pressure that his behavior is causing, provide strong emotional support at home, and let him know that he has you on his side when he encounters trouble outside your home.
In my experience, if it is carried out objectively and thoroughly, this approach usually works. Certainly, if it does, it is a desirable alternative to professional counseling that may cause your child to be labeled hyperactive, MBD, or ADD. If that happens, your child's school will probably place him in a special education program and assign him to a "learning. laboratory", which will brand him as inferior among his peers. (In some schools the learning lab is derisively labeled – by the kids who aren’t in it – as the "loony lab"!)
I don't believe any child deserves that fate simply because he is harder to manage or harder to teach than the others in his class. This should concern you, but you should be even more concerned if psychoactive drugs, such as Ritalin or Cylert, are prescribed for your child. Educators and doctors who label a child hyperactive or learning disabled, and then suggest treating him with chemicals, always defend their recommendations by asserting that it will improve the child's ability: to learn. They know that you will respond to this more positively than to their true motivation, which is to drug your child into near-somnolence so he will be more manageable and less of a nuisance in the classroom.
No one has ever been able to demonstrate that drugs such as Cylert and Ritalin improve the academic performance of the children who take them. The major effect of Ritalin and similar drugs is on the short-term manageability of hyperkinetic behavior. The pupil is drugged to make life easier for his teacher, not to make it better and more productive for the child. If your child is the victim, the potential risks of these drugs are a high price to pay to make his teacher more comfortable.
Dangerous Side Effects of Ritalin
What are the risks to your child if he is put on Ritalin or a similar drug? First, there is ample evidence that they are prescribed inappropriately, administered carelessly, and have side effects that are dangerous in themselves. Add to that the fact that they obviate the need and the incentive to discover what is really troubling your child, and you have a package that exemplifies contemporary medical practice and educational policy at their worst.
In the prescribing information for Ritalin that the manufacturer, Ciba-Geigy, supplied for the Physician's Desk Reference, the company acknowledges that it does not know how Ritalin works or how its effects relate to the condition of the central nervous system. It warns against the use of the drug in children under the age of six and admits that its long-term safety is unknown. It also notes that suppression of growth in those who take the drug has been noted in some cases and that there is some clinical evidence that it may provoke convulsive seizures in some patients.
The prescribing information then goes on to the potential side effects, which are so frightening that I will quote them directly from the book (the italicized phrases are mine)
Nervousness and insomnia are the most common adverse reactions but are usually controlled by reducing dosage and omitting the drug in the afternoon and the evening. Other reactions include hypersensitivity (including skin rash), urticaria [swollen, itching patches of skin], fever, arthralgia, exfoliative dermatitis [scaly patches of skin], erythema multiforme [an acute inflammatory skin disease], with histopathological findings of necrotizing vasculitis [destruction of blood vessels], and thrombocytopenic purpura [a serious blood clotting disorder], anorexia, nausea, dizziness, palpitations; headache; dyskinesia [impairment of voluntary muscle movement], drowsiness, blood pressure and pulse changes, both up and down; tachycardia [rapid heartbeat], angina [spasmodic attacks of intense heart pain], cardiac arrhythmia [irregular heartbeat,; abdominal pain, and weight loss during prolonged therapy.
There have been rare reports of Tourette's syndrome. Toxic psychosis has been reported in patients taking this drug; leukopenia [reduction in white blood cells] and/or anemia; and a few instances of scalp hair loss. In children, loss of appetite, abdominal pain, weight loss during prolonged therapy, insomnia, and tachycardia may occur more frequently; however, any of the other adverse reactions listed above may also occur.
This is the kind of information about a drug that the manufacturer is compelled by law to share with the doctors who will prescribe it. Unfortunately, there is no law requiring that the doctors who prescribe the drug share the information about its potentially damaging or fatal effects with you. That is why I have provided so much information about Ritalin, which applies, as well, to its counterparts.
If your child's teacher, school principal, counselor, or pediatrician attempts to pressure you into accepting chemical treatment for your child's behavior patterns, reject the advice out of hand. There is no benefit that justifies the risks, nor can they be justified in order to spare his teacher the annoyance of having him talk out of turn or squirm in his seat.
Look for Emotional Pressures as Cause
Don't accept a teacher's assessment of your child's behavioral shortcomings without investigating whether they may be the result of his or her interaction with him. Irreconcilable personality conflicts are not uncommon, and if one exists between your child and his teacher, the teacher may be the problem if he or she is not dealing equitably and sympathetically with your child. In that case the answer is to change teachers, not to use drugs to try to alter the behavior of the pupil.
While you are endeavoring to correct any conditions that are causing problems for your child at school, look for others that may be troubling him at home. If he is insecure because of stress among other family members, try to resolve those problems or at least avoid exposing him to the tensions that exist. If there are difficulties with his playmates or others outside your home, try to resolve those. Then turn your attention to the possibility that his hyperactive behavior may stem from allergies to food or other substances. There is substantial evidence that nutritional approaches may succeed in improving his emotional condition and behavior.
I must caution you that your pediatrician may not be sympathetic to this approach. The late Dr. Benjamin Feingold, the pioneer of dietary control of hyperactive behavior, encountered great skepticism from others in the medical profession. That's not surprising, because doctors chronically reject non-medical solutions to problems they believe belong to them. Don't let that discourage you. Nervous system symptoms related to food hypersensitivity have been described by one observer after another for at least half a century. More recently, there has been a mass of clinical evidence which demonstrates that the Feingold diet does work with many children.
Dr. Feingold, who was chief of the allergy clinics of the Kaiser Foundation in California, zeroed in on chemical food additives – colorings, flavorings, preservatives, stabilizers, and others – as the principal contributors to hyperactive behavior. He recommended eliminating these chemicals from the diet by substituting natural foods for the highly-processed items found in most American pantries and refrigerators. There is overwhelming clinical evidence that this approach is often successful.
Dr. Feingold's results have been duplicated by many others. Dr. William G. Crook, a pediatrician and allergist at the Children's Clinic in Jackson, Tennessee, reported on another study at a food allergy symposium. He said that hyperactivity was related to food allergy in about three-fourths of the cases in a study of more than 100 children who were overactive.
Dr. Crook observed precisely what Dr. Feingold and many parents have experienced: children can be helped by using elimination diets to identify offending foods. He identified milk and refined cane sugar as the leading culprits in a list that also included corn, wheat, eggs, soy, citrus, and other items.
If you have an overactive child with behavior problems, don’t turn to drugs prescribed by your doctor until you have determined what success you have with food you can buy from your grocer!
Question Diagnosis of Brain Damage
You should also be extremely wary of any suggestion that your child's behavior patterns stem from some form of brain damage or disorder. These conditions do exist in some children, of course, but the number is far fewer than the number of such cases that are diagnosed. Psychiatry is such an imprecise science, if it can be called a science, that its practitioners rarely agree on a diagnosis. Experiments have been conducted which show that psychologists and psychiatrists can be expected to agree with each other on a diagnosis only about 54 percent of the time. That's so close to the law of averages that you could consult a cabdriver and a carpenter and get the same result.
Nevertheless, on the basis of questionable diagnosis, your child may be recommended for psychotherapy if his behavior varies from what the mental health practitioner chooses to consider the "norm". Children who are correctly diagnosed as having brain or neurological damage or actual psychoses may benefit from treatment, of course. But short of that, there is little evidence that psychological counseling helps, and considerable evidence that it may actually aggravate a child’s psychological/emotional problems.
The inadequacies of psychotherapy have been revealed repeatedly in follow-up studies of populations that exposed to psychiatric treatment. One well-known study points out that the spontaneous remission rate in patients with psychiatric conditions is 70 percent for both adults and children. Another study, reporting on a 20-year follow-up of patients at the University of Wisconsin, compared patients who were counseled with those who applied for but never received counseling. The most positive conclusion the study could reach was that counseling seemed to do no harm!
Another study of youths in Cambridge and Somerville, Massachusetts, was even less reassuring. It compared a group that had been counseled for five years, on a one-to-one basis with a personal counselor, to another group that received no therapy at all. Almost without exception, psychological therapy appeared to have a negative effect on these youngsters in later life. Begun in 1939, this 30-year follow-up found a solid correlation between therapy and criminal behavior. More of the men who had received psychotherapy as youths were convicted of serious crimes and multiple crimes than those who had no treatment at all. Those who had the longest and most frequent contact with counselors had the highest incidence of antisocial and criminal behavior.
Finally, a 1980 review of 120 studies of psychotherapy for juvenile delinquents found that those who received counseling fared worse, in terms of subsequent behavior, than those who didn't. A report on this research in the Toronto Globe & Mail summed it up in this paragraph: If you want to stop a juvenile delinquent from robbing, raping, and clubbing people, don't send him to a social worker, a psychiatrist, a psychologist, a group home, or a therapeutic community, and don’t make any efforts to counsel his family either. They all fail and some may even make him more violent than when he began.
There are, to be sure, some specific childhood mental and neurological disorders that stem from brain and neurological damage. Many of them are the consequence of medical interventions that I have discussed earlier in this book, e.g, cerebral-palsy, Down's syndrome, Tourette's syndrome, autism, etc.
If your child is the victim of one of these conditions, professional help is appropriate, if for no other reason than to explore innovative treatment that may appear – such as the nutritional supplementation methods in the management of mongolism and other causes of mental retardation pioneered by Detroit's Henry Turkel, M.D., and Ruth Harrell, M.D., of Old Dominion University. However, if your child is suffering from this kind of condition – rather than behavioral manifestations that simply make him more difficult to manage than other children – you'll know the difference. Your best course is to seek professional help when it is clearly needed, but to avoid it if you are told that your child is suffering from a "learning disability", an "attention deficit disorder", or some other vaguely defined condition. The mental health professionals have yet to prove that any of these alleged disorders even exists!
PROCESSING, PLEASE WAIT...