Education Update – Childhood Mental Health Disorders: ADHD and Dyslexia
By Sybil Maimin – Almost 50 percent of youngsters with ADHD (Attention Deficit Hyperactivity Disorder) are never diagnosed and, therefore, never treated. Many people assume ADHD is bad behavior stemming from bad parenting and not a medical condition. Seeking to address the knowledge gap, The Adam Jeffrey Katz Memorial Lecture, established by the parents of a young man with mental health challenges who died too soon, educates the public about the latest thinking and research in the field of childhood mental health disorders. The 2012 lecture featured psychology professor Dr. Stephen P. speaking about current controversies surrounding ADHD, including use of medication. Also on the program, Academy Award-winning writer and producer Brian Grazer explored the challenges and successes of living with dyslexia in a lively conversation with psychiatrist and Child Mind Institute president, Dr. Harold S. Koplewicz.
Explaining that ADHD is “an equal opportunity condition” that crosses all social and economic strata but seen more in boys than in girls, Hinshaw noted the number of diagnosed cases is increasing. Recent studies show the disorder, long thought to be one of motivation or immaturity, may have some biological basis. While “bad” parenting does not cause ADHD, some parent-child relationships can exacerbate the problem; Hinshaw recommends “authoritative parenting” that is warm and loving, but sets clear limits. Girls with ADHD, while fewer, have higher risk factors and are more likely to hurt themselves or attempt suicide. The stigma suffered is mostly psychological, resulting from stereotyping, which can lead to prejudice and discrimination.
There is also some stigma associated with the use of medication. “We know more about mental illness than fifty years ago,” advised Hinshaw, “but attitudes have not improved.” Introducing a controversial subject, Hinshaw discussed the National Institute of Mental Health-funded MTA, the largest and most comprehensive treatment study of ADHD, which strongly supports the use of medication. Children in the study were given behavior modification therapy or medicine therapy alone, or in combination, under close supervision, or were given these therapies in a more casual community setting without close follow-up. (In the supervised studies, behavior therapy included parental training.) Hinshaw reports “dramatic improvement,” including no disruptions in class and better discipline at home, when a combination of carefully administered medication, better parenting, and teacher feedback are employed; results show “close to normal” behavior.
Hinshaw cited positive results with behavior therapy alone (including good parenting) in less severe cases, and noted that pre-school children should only receive behavior therapy. The study showed more difficult cases need a combination of medicine and behavior modification. The importance of continued monitoring was confirmed by the return of problem behavior after close supervision ended. Hinshaw explained the controversy over medication includes questions of over-medication, under-medication, continued effectiveness, and possible future complications. There is even a suggestion that medication may be good for the brain, or “neuro-protective.” While only long-term studies will give answers to many questions, Hinshaw believes current proven benefits mean use of medication is the “right thing to do.”
Brian Grazer, in conversation with Dr. Koplewicz about his life with dyslexia, set a delightful, almost irreverent tone. He explained that his bad early experiences in school in California — not being able to read, getting failing grades, constant reprimands — were trumped by the satisfaction he felt upon receiving the Academy Award. Early on, he learned how to maximize his strengths, be resourceful, and game the system. Tough and a good athlete, he found success in the playground and used his skills there to build his identity and gain acceptance. In high school, he joined the swim team (to avoid class time) and won awards, further strengthening his identity and confidence. “Somewhat part of a group,” he still felt like an outsider, a state of mind that eventually helped him as a writer where one “needs to be on the outside to write about the inside.” He gradually learned to read and “figured out” how to study and take tests by recognizing and concentrating on “the big idea.” In a job at Warner Bros. Studios, he surreptitiously devoted his time to furthering his own interests, the “Brian Grazer business,” making contacts, gathering useful information, and learning how to create and use leverage. He observed that, “Speaking out is less about what you say and how smart you are than about touching the emotions.” Now a father of four, this very successful man believes his dyslexia makes him a better parent by giving him “a heightened sense of empathy, and a better sense of what it feels like to be humiliated.”
Still working on coping mechanisms, he tries to meet and gain knowledge directly from people — “learning from interaction rather than from a 500 page book.” He spends time with those he trusts and puts enormous importance on male friendships. To deal with a disability, he advises, “All you need is one real champion.” In his case it was his grandmother, “who convinced me I was special even though the empirical evidence showed I was not.” As a writer and producer, Grazer has been personally nominated for four Academy Awards. In 2002, he won the Best Picture Oscar for A Beautiful Mind.