ADD (Attention Deficit Disorder) describes a child who shows an inability to pay prolonged attention and is easily distracted. ADHD (Attention Deficit Hyperactivity Disorder) describes a child who shows an inability to stay still and is always on the move. Both terms are increasingly common diagnostic labels given to restless children in consequence of their non-compliant and disruptive behavior at home and particularly at school where boys are more often so described than girls.

In addition, there are often two "deficits" at work, not one. There is the inability to pay enough attention, and the inability to get enough attention. These children take a lot of time and energy for adults to deal with, more time and energy than is often given to other children at home and at school, attention that the ADD/ADHD child sometimes seems to crave.

Parents and teachers often find ADD/ADHD children demanding and tiring to manage. As for these children themselves, being constantly corrected and frequently punished by impatient, frustrated, and angry adults, they often internalize the negative treatment they are given by defining themselves in negative terms. "I'm bad." "I'm stupid." "I'm a problem." "I'm a troublemaker." "I'm a misfit," "I'm a loser." Such name-calling only lowers self-esteem.

Unhappily, medication seems to be becoming the first resort in many of these cases and not the last, after a host of other helping and self-management strategies have been given a fair try. When it works as intended, this medication -usually psycho-stimulants - tends to slow distractibility and impulsivity down and increases the child's ability to attend to directions and remain on task. As with any medication, there are known risks of side effects, but in this case there are also unknown risks of the effects of early psychoactive medication on later learning and long-term developmental growth. On the positive side, many medicated children (as well as concerned adults) will report an improved ability to control impulse, comply with directions, and concentrate on tasks, in consequence experiencing a reduced incidence of getting in trouble with the powers that be.

But is this increased compliance at home and at school really what society should be seeking with these children? Should we be medicinally adjusting children's behavior to fit adult needs for social conformity and control?

Suppose the question is NOT whether today's child is ADD or ADHD, but rather HOW MUCH of these characteristics does he or she possess? Suppose all children possess some of these characteristics, and so the determination is only a matter of degree? Suppose that rather than these characteristics being biologically innate, they are at least partly conditioned instead? How could this be so?

Consider the world of experience and play in which today's children grow up. Given more facts about life at a younger age than they can assimilate; given more sensational information than they can easily ignore; given more consumer choices than they know how to make; given more aggressive media advertising than they can resist; given more electronic amusements than they can get to try; given more new toys and possessions than they can use; given more fad and technological change than they can keep up with; given more freedom to select entertainment to suit their inclinations, is it any wonder that today's children grow up in a state of STIMULATION OVERLOAD?

Is it any wonder that in this condition, deprived of their usual variety of diversions and escapes to depend upon, they don't know what to do with them selves, particularly at school? Is it any wonder that such over stimulated children become culturally conditioned to developing a wandering attention, a restless body, an easily dissatisfied mind, a fascination with novelty, a hunger for the new and different, a need to be multiply occupied, an intolerance for boredom, an aversion to routine, a disinterest in the old and the same, and a horror of inactivity?

We have created a disconnect between how children are conditioned by our culture and how they are expected to behave at school - to sit still, to be quiet, to follow directions, to single focus, and to spend sustained time working on unexciting instructional tasks presented by teachers who are not very entertaining. And because most parents today have jobs that deplete their energy and reduce their patience when day is done, there is often less parental tolerance for hard to manage children at home.

Suppose ADD/ADHD isn't just a biological problem with children, but is also a culturally conditioned outcome of growing up in the society we have created. Maybe as time goes on, more and more of our children will inevitably possess more ADD/ADHD traits? What are we going to do? Medicate them all?

Instead, we may want to work on another option. Rather than blaming the child when the culture is complicit, we may want to consider adjusting the delivery of educational services to fit the reality of the new breed of children that must increasingly be served. In twenty years, they may no longer be the exception. They may be the norm.

To medicate or not to medicate, that is often the question parents face? The answer is, since giving psychoactive medication means establishing some degree of dependency on a stimulant drug for self-management, parents may want to exhaust other helping options first. They don't want to unwittingly be increasing the child's susceptibility to recreational substance reliance later on if that connection ever comes to be established. More important, in addition to the risk of known, immediate adverse side effects, there is the open question about long term unknown effects on the child's physical and psychological development. Therefore, parents may want to try other non-pharmaceutical interventions before putting child at risk in this way.

One good starting point is Occupational Therapy where children are taught, through hours of practice, individual self-management skills. With this help, a child can be taught ways to focus on task and follow directions, and to manage fidgety energy and wandering attention. And parents can learn home strategies for providing consistent structure, reducing distractions, channeling restless energy, and using proximity and touch that can help the child better focus and settle down.

Finally, parents may want to ask themselves this question: "Are we giving this medication for the child's sake or for our own in order to temporarily make our parenting job easier?" If the honest answer to this question is that the child's medication is as much for the parent's sake as it is for the child's self-management sake, then drugging the child as an option of first resort may not be well advised.

A clear verdict has yet to be rendered about the payoffs and problems of reducing discipline problems at home and at school associated with a child's impulsivity and inattention with medication. In addition, there is another problem parents might want to consider. Using prescriptive medication as a disciplinary intervention with a ADD/ADHD child sometimes creates dependent parents who believe they can't effectively manage their child without keep him or her on psychoactive drugs.

© Carl Pickhardt Ph.D. 2003. For permission to use this Psychological Update, contact the author.