Matthew, 9, of Gages Lake was having difficulty in school. His parents described him as a pleasant, quiet child, but his teachers complained of poor performance and low self-esteem. One of them told his mother, “He won’t take his head out of the stars and pay attention.”
Matthew (not his real name) went to a therapist three times a week for several months, and the therapist concluded that the boy has attention deficit disorder. ADD is a clinical diagnosis describing people who suffer from problems with inattention.
(The second type of the disorder is attention deficit hyperactivity disorder, or ADHD, for people who have problems with hyperactivity and impulsivity. For purposes of this story, the terms ADD and ADHD are used interchangeably.)
ADD is the most commonly diagnosed and researched childhood psychological disorder in the United States, according to the U.S. Department of Education, and approximately 5 percent of the nation’s school-age children have been diagnosed with ADD, averaging one per class.
Sixty to ninety percent of those diagnosed with ADD take stimulant medication, according to the department. But the decision on whether to medicate a child is one of the most controversial topics in ADD research today, with many educators trying to alter methods of teaching to accommodate ADD children rather than simply medicating them.
Approximately 60 percent of the students in Lake County schools diagnosed with ADD are taking stimulant medication, according to school officials contacted. That is on the conservative side of the federal figures.
In Matthew’s case, he immediately started on Ritalin, the most commonly used stimulant medication (Dexadrine also is used), and it has helped his ability to concentrate and thus to learn. But amid the controversy over whether to medicate, many people, from teachers and psychologists to parents, are coming to believe that ADD is overdiagnosed and that medication is prescribed for children who don’t need it. In any case, they believe, simply altering the methods of teaching can do wonders for these children, medicated or not.
“When the public deals with issues concerning children, they don’t want to believe that ADD is a real problem that requires medication, because Ritalin and Dexadrine are controlled substances,” said Mina Dulcan, head of the Department of Child Psychiatry at Children’s Memorial Hospital in Chicago. She believes that people are worried that their children will abuse the medications or that the drugs will make their children lethargic.
The truth is that “more children sniff inhalants than abuse Ritalin,” she added.
Dulcan wrote “Practice Parameters for the Assessment and Treatment of Children, Adolescents and Adults with ADHD” for the Journal of the American Academy of Child & Adolescent Psychiatry, used by clinicians to diagnose ADHD. The diagnosis procedure is extensive, she explained. “There is no real test for ADHD, so we do things, including an extensive history of the child, have teachers and parents rate the child, physical evaluation, treatment planning and long-term support,” Dulcan said.
Though she thinks medication can be very useful in managing children with ADHD, she also believes that there are instances when it is not necessary. “Medication should not be used as a substitute for appropriate educational curricula, student-to-teacher ratios or other environmental (classroom) deficiencies. At times, the most appropriate response to a behavior problem is behavior-modification plans,” Dulcan said.
Lake County schools have developed and are implementing strategies for classroom modifications for children who opt not to use medication or as a supplement to those who do take the medication.
For example, special education teacher Tina Hickey at Oak Terrace Elementary School in Highwood has designed her own behavior-modification device, which she calls the Group Signal Sign. This sign is in the shape of a traffic signal and was created when Hickey noticed that her students did not know the appropriate time to raise their hands or give an answer. It sets necessary boundaries for her students.
These boundaries come in the form of a red light, yellow light and green light. The red light means that the class will be teacher-directed and the students should always raise their hands. The yellow light means that students need to use caution and wait their turn. They do not have to raise their hands. The green light means the kids can talk as they wish. This is normally for one-on-one interaction.
She also uses a feelings chart, which shows children that there are more feelings than just happy or sad. “We want the kids to identify their feelings so they can regulate their own behavior,” she said.
Karen Graham, a special education teacher at Woodland Middle School in Gurnee, has developed a tokenlike system that rewards but doesn’t punish. “We have a philosophy that says, `In one minute, I can change my attitude. In that one minute, I can change my entire day,’ ” Graham said.
The Caught You Being Good reward program is set up to reward kids for good attitudes and good behavior, allowing the students to do something good, be rewarded and never lose what they earn. The students can earn such things as lunch with the teacher or computer time.
Graham also implements a program that allows children to make behavior decisions for themselves. A poster hangs in her classroom outlining 12 behaviors that occur most frequently. These behaviors include being easily angered, easily misled, inconsiderate of self and aggravating others. “If they break one of these behaviors, they have a verbal or written conference with the teacher about making changes in their behavior,” Graham said. “They learn that they do have choices.”
But there are teachers who believe that medication is the only answer, or at least the quickest solution.
Sandy Brunati, director of instructional services for the Special Education District of Lake County, has jurisdiction over 37 Lake County school districts. Of the more than 85,000 students in those districts, 3,571 receive special-education services. In some cases, once teachers have established the kind of classroom environment they prefer, she said, they want any child who takes emphasis off the rest of the class, such as an ADHD child, to be removed or medicated.
“When teachers find these kids do not conform, they want them out of their classroom,” Brunati said. “It is rare, but it happens.”
Diane Morrison, director of support services for the North Shore Special Education District, oversees 20 North Shore districts in Lake and Cook Counties. Of those 38,769 students, 5,726 receive special-education services. Morrison, who believes there is a tendency to overdiagnose ADD, tries to emphasize non-medicinal intervention for students and encourages medication only as a last resort.
“North Shore schools have teacher-assistance teams that meet and problem-solve. The teachers give their situations and get feedback from other educators,” Morrison said. “We try to give them ideas to manage these kids so that parents and students don’t feel they need medication. Medication does work for some students, but I think the problem with educating these kids exists with their different learning styles.”
Education therapist and author Jeffrey Freed of Evergreen, Colo., agrees and has further developed the idea in his book “Right-Brained Children in a Left-Brained World, Unlocking the Potential of Your ADD Child” (Fireside Books, $12). In the book, Freed proposes a theory that gifted and ADD children share the same basic learning style. He explains that right-brained people are highly visual learners, meaning they turn words and concepts into pictures.
“What these kids need isn’t a prescription for pills but a prescription for a different learning method,” said the 50-year-old Freed, who was diagnosed with ADHD at age 40.
Freed believes that all children can benefit from simple changes making a classroom a right-brained atmosphere. “Being a former teacher myself, I think teachers should be required to take classes to learn different learning styles,” Freed said. “I think the solution to overdiagnosing ADD and overprescribing medication lies in more informed teachers teaching these right-brained kids in their learning style so they can learn. Most of them are not even ADD; they just learn differently.”
Teachers and parents both want help in dealing with such children, said Astrid Martindale, director of Student Services for Beach Park District 3. Teachers “don’t make much money, and they have big classes. They want their kids to be well-behaved. But all kids with or without ADD are at different levels. The teachers think, `Let’s get this child on medication, and they will be better.’ That is not always the case. The kids get on the medication, and it is not managed well, and they are too lethargic.”
About 60 percent of the students with ADD in the Beach Park district are on medication, according to Martindale. But she asserted that teachers need to consider altering their teaching styles to match children’s learning styles, not the other way around.
On the medicine front, she added, some of the Lake County pediatricians she works with manage their young patients very well. The doctors send in weekly forms and monitor the child’s performance. “When a parent tells me who their child is seeing, I can just about tell you the course of treatment,” she said.
Dr. Michael Chez, a neurologist from Lake Forest, agrees that it is important to monitor children closely when on medication, and he encourages this with his patients. By the time he sees children, they already have been diagnosed with ADD and recommended for medication, so rarely does a child who comes to him not need medication for ADD. “Ninety percent of the kids who come in to see me need medication,” he said. “Medication is the least expensive treatment for ADD, at around $70 per month. Vitamins and hair analysis cost $1,000, and biofeedback costs $5,000–which is one factor making it (medication) so attractive for treating ADD.”
Chez sums up his positive approach to medications by saying, “If your child has ADD and needs meds, give it to him. If your child were running track, you wouldn’t give him Army boots; you would get him the best Nikes you could find.”
Tom Dempsey, director of special services of Grayslake District 46, said that though 65 percent of the district’s 60 students with ADD are on medication, the district strives to keep the students in a general-education environment.
“We try to direct accommodations to the entire class,” Dempsey said. “We have assignment notebooks, teach time management and homework management.”
Homework is an area in which Lake Forest High School has worked to assist its ADD students. The school formed the Homework Club, which meets after school and gives all students, including those with ADD, a chance to get help. Before students leave, they have been reassured as to what their assignments are and have begun to work on them, so they know they are on the right track. It must be working; less than 10 percent of the students in Lake Forest schools with ADD receive special-education services.
“Our teachers are trained in modification for students, including physical, behavioral and academic modifications, in our weekly support team meetings,” said Cheryl Levin, assistant director of pupil services for Lake Forest School District 67. “Our teachers discuss and implement positive ways of working with these kids. They try to use the modifications daily.”
In a similar vein, a $38,000-a-year grant to Lake County through the State Board of Education had helped provide teachers with training for mainstreaming children from special education into regular classrooms. The grant ran three years and ended last year.
Jerry Van Pelt, director of educational services for the Lake County Regional Office of Education, said the program had helped students with ADD, because teachers were taught how to manage children with different learning styles.
“The program was becoming quite good,” he said. “It covered the cost of substitutes so that teachers could attend the workshops scheduled during the schoolday. The grant was discontinued, even though the participants rated the program highly.”
As for taking these children in regular classrooms, Debbie Wuellner-Clarke of Bannockburn District 106 summed it up this way: “It is expected that we will have these kids in our classroom. We’ve grown accustomed to it. We have to keep striving to help them. They are good kids who liven up a group in a positive way.”
