Experts Agree Parents’ Role Critical But Polarized On Disorder’s Cause

As the public becomes more aware of attention-deficit hyperactivity disorder, a debate continues as to whether the condition has a biological or environmental cause. Because many other problems can mimic the behaviors — being overactive, quarrelsome, impulsive or inattentive — some question whether ADHD exists at all.

Posted on the kitchen fridge is Donna Wiese’s list of behavior rules for her son, Tommy DeYoung of Niles. He earns points for keeping his room clean, finishing homework and doing something the first time he’s told. Clear expectations for behavior are part of behavior modification, an important element in helping children diagnosed with ADHD.

Tribune Photo/JIM RIDER

No one knows what causes ADHD, but the medical establishment says mounting evidence points to biological causes.

A widely held theory is that in people with ADHD, the brain areas that control attention are less active than those of a normal person. Research also shows that a mother’s use of cigarettes, alcohol or other drugs during pregnancy may cause damage that may lead to ADHD. What’s more, toxins in the environment may disrupt brain development or processes, which may cause ADHD symptoms. The disorder tends to run in families, which points to genetic influences. However, ADHD does not appear to be caused by too much TV, food allergies, excess sugar, poor home life or poor school environment, according to the National Institute of Mental Health.

One subscriber to the brain theory is Dr. Russell A. Barkley, director of psychology and professor of psychiatry and neurology at the University of Massachusetts Medical Center. He believes ADHD is caused by a developmental failure in the brain circuitry that underlies inhibition and self-control.

Genetic basis for ADHD

Faulty genetics underlie ADHD, says Barkley, author of “Taking Charge of ADHD: The Complete, Authoritative Guide for Parents.” He cites studies showing siblings of children with ADHD are between five and seven times more likely to develop the syndrome than children from unaffected families, and children of a parent who has ADHD have up to a 50 percent chance of experiencing the same difficulties.

Barkley’s books say children with ADHD can benefit from drugs such as Ritalin to boost their capacity to inhibit and regulate impulsive behaviors. He also urges parents and teachers of children with ADHD to give the child a structured environment, make consequences of a child’s actions frequent and immediate and use prompts and cues about rules. He advises parents to anticipate events for their child, break tasks down into smaller pieces and reward the child for good behavior with a point system.

But there are plenty who disagree.

One critic of medication for ADHD is Dr. Peter R. Breggin, a psychiatrist and author of “Talking Back to Ritalin, Revised: What Doctors Aren’t Telling You.”

Breggin contends the ADHD diagnosis is simply a list of the behaviors that most commonly cause disturbance at schools.

Classrooms are too large, there are too few teaching assistants and volunteers, and instructional materials are often outdated and boring compared to modern technologies that appeal to children, he says. “By diagnosing the child with ADHD, blame for the conflict is placed on the child. Instead of examining the context of the child’s life — why the child is restless or disobedient in the classroom or home — the problem is attributed to the child’s faulty brain,” he told a Congressional subcommittee in 2000.

David B. Stein, author of “Unraveling the ADD/ADHD Fiasco,” is even more critical.

Stein, a psychology professor at Longwood College, Farmville, Va., believes ADHD is a hoax perpetrated by the drug industry and the behavior problems some call ADHD symptoms are simply misbehaviors caused by poor parenting.

The currently popular treatments for ADHD “operate in the belief the child is diseased, handicapped and cannot function unless helped with a barrage of helps, reminders, warnings, on and on,” Stein said in a phone interview. “My approach operates under the belief that these are nothing more than children behaviorally out of control, who don’t think and pay attention to what they are doing, and hate schoolwork, though they don’t hate school.”

Society to blame

Stein blames society for what’s called ADHD. Parents spend little time nurturing children, kids lead chaotic lives shuttling between divorced parents’ homes and running to too many extracurricular activities, and an at-home parent is increasingly rare. “Kids don’t come home to milk and cookies and ‘How was your day?’ anymore,” he said. With no parental nurturing, kids don’t learn values, have little motivation and a poor attitude toward school.

What’s more, today it’s cool to hate school, he said, and TV often portrays role models who are rebellious toward authority figures.

Stein says it’s a travesty to give stimulant drugs to children. “Drugs do constrain behavior, and that’s because the kid is drugged. When the drug stops, all problems return. They have not learned self-control or how to study. They need real accomplishment for self-esteem.”

His book promotes a parenting technique in which the child learns to control his own behavior, think about consequences of actions, be polite and complete schoolwork without special help. The parent takes control of the child’s behavior by listing what is not acceptable — temper tantrums, opposition, dawdling, etc. — and implementing immediate timeouts to discourage those behaviors. Good behaviors are rewarded with praise, not points.

“My parenting methods are completely safe and are permanent changes. The child gains a sense of self-esteem by permanent improvement because they genuinely learned to accomplish,” he said.

Or is it allergies?

Dr. Douglas W. Elliott, a family practice doctor at Crossroads Healing Arts in Goshen, is one of those with yet another theory. He believes symptoms ascribed to ADHD are often caused by food allergies, which can cause inflammation of the bowels and allow toxins to enter the body, where they accumulate and affect hormone and enzyme function. Dairy products are the most common food allergen, he said.

After searching for both acute and delayed-onset allergies, Elliott puts the patient on a “cleaner, more wholesome” hypoallergenic diet, removing problem ingredients such as refined sugar and caffeine and adding food supplements.

“It’s been extremely successful in helping these kids do better without drugs,” he said.

What teachers say

Whatever the problem is, it goes beyond discipline and it isn’t new, some teachers say.

Phyllis Largey, a first-grade teacher at Forest G. Hay Elementary School in South Bend, said she “absolutely” discounts the theory that it is caused by poor parenting.

“It goes beyond that,” said Largey. “It is a situation where the child simply cannot control him or herself,” and it isn’t because the parent didn’t try, she said.

She also disagrees with the notion that it’s a new problem caused by today’s hectic lifestyles. There were children with symptoms of ADHD in the classroom when she started teaching 33 years ago, she noted.

Regardless of ADHD’s cause, classroom teachers have developed ways to help the child at school.

Michael Celichowski, a third-grade teacher at Marshall Elementary School in South Bend, said teachers sometimes modify assignments, such as giving the child four math problems at a time instead of 20 all at once. When a child is hyperactive, the teacher might switch him or her to another task. Seating is important; a child with ADHD might do better in a quieter part of the classroom, especially if a noisy activity is going on. Sometimes, a teacher will give a child a sticker or mark on a behavior sheet rewarding him or her for good behavior. “Positive reinforcement is a gem for keeping a child’s attention focused,” he said.

What’s important, he said, is for the family, physician, teacher and therapist to work together, he said.

To the critics who say ADHD is concocted by the pharmaceutical industry, pediatrician Dr. Michael J. Hudson of Navarre Pediatric Group in South Bend said, “There is a ton of evidence to suggest that’s not true. It’s not just parenting and discipline.”

Still, he acknowledges a chaotic home life can worsen the situation. “A third of the kids I see diagnosed with ADHD would do much better with structure and discipline in their lives,” he said.

Structure and discipline seem to be one area of common ground among observers.

An organized environment is key for Tommy DeYoung, 12, of Niles. At school, his teacher sends home daily reports on his schoolwork, attitude and cooperation. At home, he earns points toward treats such as a trip to a video arcade with a friend by keeping his room clean, finishing his homework and obeying his mom and stepfather without an argument.

Providing structure and positive discipline is a challenge parents should try to meet, Hudson said. “It takes time and effort, and most parents don’t have the time. It takes a lot of energy to change what we do.”