It is no secret that millions of American school children are receiving medications and numerous classroom accommodations to improve their ability to attend to lessons and to help control classroom behavior. The popular medical diagnosis of Attention Deficit/Hyperactivity Disorder (ADD or AD/HD) is the primary reason for this trend. According to the National Institutes of Health (NIH) there are no reliable, medical tests to confirm the diagnosis of AD/HD (2, 7, 20). With this information in mind, there is a very real possibility that there are extrinsic factors causing hyperactivity and inattention. Drs. Hallowell and Ratey, both experts in child psychiatry, remind parents and educators:

Most children are distractible, impulsive, and restless some of the time. The vast majority of children do not have ADD, and one must be very careful not to make the diagnosis so easily that it loses meaning or becomes a fad (43).

There is no scientific debate regarding the fact that some children do indeed have learning disabilities and others may have genuine neurological problems. There is controversy, however, regarding both the lack of scientific proof that AD/HD is a physiological disorder (NIH 7), and its subsequent treatment with psychotropic medications (LeFever, Dawson, and Morrow 1359, 1361, 1363). Those who completely accept the medical model of ADHD often fail to consider how children's individuality, family dynamics, and today's culture affect the learning and behavior of children.

Attention Deficit Hyperactivity Disorder is not a new concept. One of the first to document the attention and behavior problems now called AD/HD was Sir George Frederic Still at the beginning of the 20th century (Armstrong 6); today this is known as Temperament Theory. In the New York Longitudinal Study, Thomas and Chess acknowledged nine categories of temperament describing how children behave in daily life situations. Activity level, regularity of biological functions, reaction to new situations, adaptability, responsiveness to stimuli, intensity of reaction, quality of mood, distractibility, and persistence are the specific characteristics these researchers identified (qtd. in Hales, Yudofsky, and Talbot 125). In his 1998 book "Please Understand Me II: Temperament, Character Intelligence", David Keirsey extended Myers' and Briggs' theory of four basic temperaments to include aspects of character and intelligence; he identified sixteen different human temperaments (11). Thom Hartmann places temperament in a more cultural and historical perspective when he describes children identified as AD/HD as "hunters living in a farmer's world" (35). Before labeling a child as biologically disordered, it is critical to consider his/her level of activity and attention span in the context of his/her individual temperament (LeFever, Dawson, and Morrow 1363).

Another factor to consider is the theory of Multiple Intelligences. Howard Gardner identified seven different intelligences that should be evaluated and nurtured in children: linguistic intelligence; logical-mathematical intelligence; spatial intelligence; musical intelligence; bodily-kinesthetic ability; interpersonal intelligence; and intrapersonal intelligence (1993).  Gardner believes that every individual possesses each of these intelligences to some degree, but each person has particular strengths in one or more of these areas (1993). Psychologist and professional special educator Thomas Armstrong suggests, "...if our nation's classrooms taught more often in this multiple-intelligences way, we'd have fewer students identified as ADD" (95). Multiple Intelligence Theory is widely accepted in the educational field and by psychologists who regularly assess learning abilities and disabilities in school children.

In conjunction with Multiple Intelligence Theory, experts insist that behavioral symptoms identified as AD/HD are not indicative of a disorder at all, but may be signs of a child's creativity and potential giftedness. Gifted and/or creative children are frequently overactive, sloppy and disorganized, forgetful, and often daydream.  They may be demanding and assertive, argumentative and cynical, temperamental and moody, and occasionally emotional and/or withdrawn.  These behaviors can easily be misunderstood and result in the inappropriate labeling of the child and subsequent placement in a special education program (Cramond 6-10).  School situations and classroom environments also may have an impact on the behavior of the gifted and creative child.  If the educational environment is not challenging enough and is insensitive to learning styles and temperament, the gifted or creative child may respond by displaying negative behaviors (Cramond 15-16).

Modern day family dynamics and structure may also contribute to inattention and hyperactivity. Consider the following facts from the Children's Defense Fund:

· In 1998, 5.4 million children lived in households headed by a relative other than a parent.

· Thirty-nine percent of the above lived in households with no parent present.

· An estimated 547,000 children were in foster care as of March 31, 1999.

· Today in America 10.8 million children are uninsured and are more than four times likely than insured children to have an unmet medical need.

· Just 23 percent of all families with children younger than six have one parent working and one parent who stays at home.

· In 1997, close to one million children were confirmed as victims of abuse and neglect.

Because the primary institution of socialization is the family unit, stable home environments are critical for the healthy growth and development of children.

In addition to changes in family structure, families today face a multitude of financial challenges. With the increase in the number of single parent and dual income families there is also a rise in the number of children who are placed in day care. Very young children may spend the entire day in the care of non-family members. Older children may be placed in daycare facilities before and after school. The absence of a stay-at-home-parent has also led to an increase in the number of children leaving and arriving home from school without adult supervision (latch-key children). With so many working parents, divorced parents, and single parent situations, it is plain to see that today's parents are unable to spend as much quality time with their children as did the parents of previous generations. In the absence of a responsible adult, children are left to care for themselves and to make decisions for their own immediate safety and health. Without adult supervision, young children are not capable of making wise and appropriate choices, may act impulsively without rational thought, and may not learn the acceptable social skills necessary for success in school.

The third critical contribution to the behavior of a child is the means of discipline and punishment favored by the parents. "Research shows...that parents of kids labeled ADD...tend to use more commanding and negative statements and fewer neutral and positive communications..." (Armstrong 225). Rather than resort to authoritarian discipline and harsh punishment, parents should take time to identify exactly why the child is misbehaving. Discipline expert Rudolf Dreikers defined four primary reasons for children's misbehavior: to gain attention, to achieve power, to seek revenge, and/or to demonstrate inadequacy (qtd. in Armstrong 234-235). Perhaps Johann Arnold sums up the intent of effective discipline and punishment best as he insists that the goal should be "...to help them [children] toward the confidence that enables them to explore life and yet know their limits. That is the best preparation for adulthood" (57). Appropriate child discipline should be a more gentle teaching of self-restraint, moderation, and tolerance. In addition, punishing a child for misbehavior should not inflict pain or harm, but should serve only to reinforce established limits and boundaries. When children feel a sense of belonging and significance it is likely that they will no longer feel the need to misbehave in order to gain the attention they so crave.

The entertainment media -- including television, movies, video recordings, and the internet -- have also had an immense impact on the learning and behavior of children. An online report on media use by the National Institute on Media and the Family (NIMF) quoted prominent researchers regarding the following interesting facts (1-3):

· The average time spent in front of electronic screens (televisions, computers, video games) is nearly four and one half hours per day among two to 17 year olds (Annenberg Public Policy Center, 1999).

· The average American child grows up in a home with two TVs, three tape players, two VCRs, two CD players, one video game player, and one computer (Kaiser Family Foundation, 1999).

· 31% of children surveyed (ages 10-17) report having seen a pornographic site on the Internet (National Public Radio, 2000).

· The average child and adolescent spends between 21 and 28 hours per week watching television (Bryant, 1994).

· Studies show that children who watch cartoons or other purely entertainment television shows during their pre-school years, do poorer on pre-reading skills at age 5 (MacBeth, 1996).

· Children who are heavy television viewers (over 3 to 4 hours per day) had the poorest reading skills (Searls, 1985).

In addition to the amount of time children spend watching movies and television, interact with video games and browse the internet, the subject matter to which they are being exposed also has an impact on their behavior. Extended exposure to violence, sexual promiscuity, and profanity teaches children to be insensitive to the needs of others and to accept inappropriate behavior as normal (NIMF 1).

Additional consideration should be given to the impact the current cultural environment has on the attention span and behavior of children.  In today's culture, children are used to being constantly stimulated and entertained.  Instant results, fast food, loud music, real-time international communication, and 10-second news stories define current lifestyle. DeGrandpre states that children today are suffering from what he calls sensory addiction; they have a "need for speed" (34).  As a result, more and more children may be identified as hyperactive and impulsive simply because they need excitement and novelty.  If his/her immediate environment lacks the necessary stimulation, the child may create some excitement on his/her own by engaging in sensation-seeking behaviors simply because he/she is bored. Slowly paced and quiet environments are becoming almost intolerable for children who are accustomed to living in a fast-paced culture.  As a result, this inability to cope with slowness can have a devastating effect in the classroom where a child is expected to sit quietly for extended periods of time and engage in learning activities that require listening quietly, thinking, and problem solving.

The final component that may contribute to children's inattention and hyperactivity during the school day may indeed be the school systems themselves. Fast paced culture, media influences, and unstable family environments all over-stimulate children, yet they are still expected to be able to sit quietly for extended periods of time in classrooms filled with children. Despite differences in learning styles, abilities, temperament, and interests, children are being forced to conform to rules and curricula designed decades ago. Additionally, inappropriate behaviors and lack of attention are treated as symptoms of brain disorder rather than addressed and corrected for the symptoms of the disordered lives they truly represent (LeFever, Dawson, and Morrow 1363). Many individuals implement numerous accommodations and interventions in order to assist children. Reminders such as lists, schedules, alarm clocks, incentive plans, offering frequent feedback, and token-reward systems are the most frequently recommended interventions. Adjusting the child's classroom environment and activities, reducing distractions in the classroom, adjusting the type and amount of assignments given, giving only one assignment at a time, breaking up assignments into smaller tasks, and altering or reducing the written workload are popular accommodations and interventions (Hallowell and Ratey 222-223). Unfortunately, constant reminders, coaching appropriate behaviors, and administering medications are not treatments that will transform children into independent adults. Psychology professor David Stein says, "These techniques may be viewed as reinforcing a child's dependency on constant help from external sources" (63). Stein goes on to comment that classroom and parenting accommodations "...produce unsatisfactory results because they fail to improve children's 'thinking' and 'awareness' and actually reinforce the 'not thinking' and lack of awareness..." typical of children who are labeled AD/HD (64).

The medical diagnosis of Attention Deficit Hyperactivity Disorder is based upon subjective observations of the child's behavior in the home, the classroom, and in the community. These observations are documented and compared to the list of criteria for diagnosis that appears in the Diagnostic and Statistical Manual 4th edition (DSM-IV) of the American Psychiatric Association (APA). This criteria specifies, "There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning..." (83). Many highly respected medical professionals like William B. Carey, M.D., director of Behavioral Pediatrics at the Children's Hospital of Philadelphia, disagree with the adequacy of the DSM-IV criteria. "The DSM-IV still falls short, however, by perpetuating unclear standards for defining the behaviors". Dr. Carey adds, "...anyone could qualify if he were above average in activity or below average in attentiveness" (154). Experts who gathered at the National Institutes of Health in 1998 to discuss ADHD reached a similar conclusion in the published report of that consensus conference. "In fact, it is unclear whether the signs of ADHD represent a bimodal distribution in the population or one end of a continuum of characteristics" (7). Children are much more than a collection of neurochemicals. All children of a similar age group are not alike in temperament, ability, demeanor, or family relations, and they should not be expected to behave in the same manner and attend equally at home, in school, and in the community. To label a child disordered and to medicate him or her into classroom compliance may suppress diversity, creativity, and individuality. In addition, subjective observation alone, or in combination with testing for learning disabilities, does not addresses other possible intrinsic and/or extrinsic factors that may be contributing to the child's behavior and level of attention. Failure to closely examine the child's entire hereditary, social, family, and educational environments in an attempt to determine causation of behavior and inattention may lead to inappropriate diagnosing, labeling, and accommodating. It is critical, therefore, to place inattention and inappropriate behavior in the proper context of the whole child.

 Works Cited

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC, 1994.

Armstrong, Thomas. The Myth of the Hyperactive Child: 50 Ways to Improve Your Child's Behavior without Drugs, Labels, or Coercion. New York: Penguin Books, 1995.

Arnold, Johann. Endangered: Your Child in a Hostile World. Farmington, PA: Plough Publishing, 2000.

Carey, William B. Understanding Your Child's Temperament. New York: Macmillan, 1997.

Children's Defense Fund. Key Facts about America's Children. Online. Available: http://www.cdfactioncouncil.org/key_facts.htm

Cramond, Bonnie. The Coincidence of Attention Deficit Hyperactivity and Creativity.  Published by The National Research Center on the Gifted and Talented: Univ of  Connecticut, 1995.

DeGrandpre, Richard. Ritalin Nation. New York: W. W. Norton & Company, 1999.

Gardner, Howard. Multiple Intelligences: The Theory in Practice. New York: Basic Books, 1993.

Hales, Robert E., Stuart C. Yudofsky, and John A. Talbott. Textbook of Psychiatry 2nd Edition. Washington, DC: American Psychiatric Press, 1994.

Hallowell, Edward M., and John J. Ratey. Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood through Adulthood. New York:  Simon and Shuster,1994.

Hartmann, Thomas. Attention Deficit Disorder: A Different Perception. Green Valley, CA: Underwood Books, 1997.

Keirsey, David. Please Understand Me II: Temperament, Character, Intelligence. Del Mar, California: Prometheus Nemesis Book Company, 1998.

LeFever, Gretchen B., Keila V. Dawson, and Ardythe L. Morrow. "The Extent of Drug Therapy for Attention Deficit-Hyperactivity Disorder Among Children in Public Schools". American Journal of Public Health 89 (1999): 1359-1364.

National Institutes of Health (NIH). Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). Bethesda, MD: Nov 16-18, 1998.

National Institute on Media and the Family. Television's Effect on Reading and Academic Achievement. Online. Available:
http://www.mediaandthefamily.com/research/fact/tveffect.shtml

Stein, David B. "A Medication-Free Parent Management Program for Children Diagnosed as ADHD". Ethical Human Sciences and Services 1.1 (1999): 61-79.

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