Thinking about attention deficit
Aquestion is once again being raised about using medication in young children to address behavioral issues. In the past, the issue was most often raised by teachers as a response to a child’s activity level and seeming attentional difficulties in a classroom setting. Essentially, it was being prescribed and taken for school attendance.
Statistics have shown an increase in the frequency of a diagnosis of attention deficit hyperactivity disorder reflected in the frequency with which this question is raised both by teachers and by parents. Now more than a year has passed without in-class school attendance for children, yet questions about hyperactivity and/or attention focusing come to mind when it is a parent who is concerned about a child’s behavior.
Has there really been an increase in these disorders or are there other factors leading to an increase in the diagnosis being made? Actually, in large measure this diagnosis is made based on the perceptions and reports of parents and in the past, teachers.
There is a large subjective element in this diagnosis. When does active become hyperactive? When does restlessness become an attention deficit? What is the tolerance level of a particular parent? What are the expectations for behavior of the children about whom there is concern?
In thinking about these questions one can acknowledge that there are children who are clearly having a hard time managing their bodies or their behavior and do not seem able to meet age appropriate expectations. Often, it is not only the adults around them who are distressed by this but the children themselves. Whether the use of medications is indicated in such situations is another question to be best answered with medical consultation.
Unfortunately, numerous factors have blurred the answer to the questions raised above. One factor in the past, was the pressure on teachers to meet designated requirements in their classrooms for achievement standards that ultimately relate to funding for schools. Large classes make individual attention difficult and this leads to a greater demand for compliance and conformity.
This past year, it is parents who have found themselves in the role of teachers, supervising the scheduling and often the content of their children’s remote learning. While functioning in a group requires skills that children are still in the process of developing, like impulse control, frustration tolerance and turn taking, the group setting and teacher provide both modeling and a structure for developing these skills.
Parents, who are concerned about their children’s educational development have tried to maintain expectations for their children’s learning without the supports provided by a classroom setting. At the same time, children have experienced the loss of social interaction with their peers and the motor activity so important in gaining mastery of their bodies and their environment. Sitting at attention at a table or desk can be very challenging for some children.
Particularly when it comes to activity level there is great variation in young children. The development of needed skills is a process that takes place over time and proceeds at a different pace for different children. Not all children of the same chronological age are at the same place in their development. It is here that a mother’s or teacher’s ability to allow for such variation plays an important role.
If a child seems to be having difficulty, parents need to think about what is being required of him or her, and what they know about their own child. There are ways to understand and to help children overcome the developmental bumps caused by the pandemic without labeling them “disorders.”
Elaine Heffner, LCSW, Ed.D., has written for Parents Magazine, Fox.com, Redbook, Disney online and PBS Parents, as well as other publications. She has appeared on PBS, ABC, Fox TV and other networks. Dr. Heffner is the author of “Goodenoughmothering: The Best of the Blog,” as well as “Mothering: The Emotional Experience of Motherhood after Freud and Feminism.” She is a psychotherapist and parent educator in private practice, as well as a senior lecturer of education in psychiatry at Weill Cornell Medical College. Dr. Heffner was a co-founder and served as director of the Nursery School Treatment Center at Payne Whitney Clinic, New York Hospital. And she blogs at goodenoughmothering.com.