FAMILY: by Lucy SullivanNews Weekly
Are we producing a generation of hyperactive zombies?
, May 6, 2000
Lucy Sullivan, from the Centre for Independent Studies, looks at possible reasons for the huge increase in prescription drugs being used to treat Attention Deficit Hyperactivity Disorder.
Attention Deficit Hyperactivity Disorder (ADHD) has assumed the character of an epidemic - an epidemic of a psychopathology - among primary school children in the course of the past decade, with rates much higher for boys than for girls.
Diagnosis depends upon medical practitioners' interpretations of individual cases brought to their attention by concerned parents and others, and treatment is by amphetamine medication. Prescriptions for the two major ADHD drugs, Dexamphetamine and Ritalin, showed a 21-fold increase between 1990 and 1997. This treatment presents the apparent paradox of a stimulant being used to control hyperactivity.
The answer to this paradox may lie in a connection between low levels of serotonin in the brain, and criminal activity, in young men.
Low levels of serotonin mean low internal arousal, and it is thought that violent and other anti-social behaviour in young men may represent strategies for self-arousal.
Higher crime and ADHD rates in males may represent a greater prevalence of naturally lower serotonin levels in males than in females.
Certainly a greater need for tangible interaction with the environment appears to exist in boys than in girls, as if they must create physical encounters and noise to assure themselves of their existence.
I remember bemusedly observing the apparent inability of my two small boys to cross a room without roughly bumping into every possible piece of furniture on their route. Small boys delight in throwing themselves at the ground and at one another in a way quite foreign to most small girls. At a later age, football fulfils this same need in a formalised way. Groups of young men entering a quiet place often seem intent on filling it with their voices.
But if the problem behaviour now called ADHD derives from a chemical brain condition, what might have happened to increase its prevalence in just a decade or so? This is too short a time for genetically-based changes of so large an incidence to have occurred.
If low serotonin levels have become more prevalent, then this is more likely to be due to environmental factors.
Alternatively, serotonin levels may not have changed; the change may be in the environmental opportunities provided for acceptable compensatory behaviour.
I can think of a number of ways in which environmental promotion of sociable self-arousal may have deteriorated in recent years.
If self-arousal for those with low resting levels of serotonin depends on physical activity, then the increased sedentary occupation induced by television, videos and computers seems an obvious culprit.
Before the age of television, children were typically sent out of the house into the backyard to play, when not required for household chores. A documentary on the childhood of the baby-boomers compiled from home movies of the 1950s was remarkable for the frenetic physical activity it revealed in the six-to-twelve year old age group.
They skipped, turned cartwheels, scaled Hills hoists, hung from bars and trees, swung, spun hula hoops and rode tricycles round and round in small spaces. And their parents obviously applauded and encouraged it.
Even when children abandon the small screen, the toys they play with today are less demanding of large-scale motor effort than they were a generation ago. In the l950s there were few of the miniaturised toys of today - the tiny people, monsters, animals and vehicles - which make imaginative play comparatively inactive.
Matchbox cars were the first arrivals in this genre. Their forerunners were pedal cars and scooters. Even clockwork trains required constant retrieval and rewinding, compared with their perpetual motion, electrical successors.
It is therefore a viable thesis that high levels of self-arousal activities in out-of-school hours were sufficient to see most children through the sedentary periods required of them in school, without undue need for self-stimulation by physical activity.
By contrast, today, the child is released from the hypnotic pacifier of the small screen into the classroom in a state of quite inadequate internal arousal, and sets about rectifying the situation in an opportunistic manner which is entirely unsuited to the requirements of a learning environment.
Changes in classroom organisation and expectations have compounded the problem. Before the era of the open classroom and self-paced learning, the teacher took responsibility for maintaining appropriate levels of arousal in her pupils in a formalised manner.
Physical activity which is disruptive in an individual was given an approved group context.
The most common everyday tactics used by the teacher were of the "sit up straight, hands behind backs, fold arms, hands on heads, stand, sit, recite together" variety, with which every school day was punctuated in response to class restlessness.
In the open classroom, the child must provide his own arousal activities and he is likely to do it by leaving his seat and disrupting the work of others.
He is also likely to prolong his periods of physical activity beyond the absolute level of need, and may shade off into naughtiness and neglect of work.
Instead of the class moving as a group from periods of mental concentration to interludes of physical activity under the teacher's control and direction, there is a constant current of disruption to which those who find concentration most difficult are most likely to succumb.
Another source of arousal that has departed from today's permissive, friendly classrooms is the titillation of marginal fear. A teacher who could gently mock, humiliate and castigate, provided an edge of excitement that was a source of arousal for all, as was the largely theatrical performance that occurred when these attentions were visited on a not-usually-hapless fellow-pupil or on oneself.
The regular practice of firing questions, calling on pupils by name, was calculated to raise the blood-pressure, whether one hoped or hoped not to be singled out to respond.
The franchise on violent arm-waving to signal the wish to answer was an accompanying release.
Time in the playground is obviously an important occasion for re-stoking the arousal system, and many schools today have shorter breaks than in the past - for example, the lunch hour is reduced to forty minutes. This reduces the length of the school day, but may be counter-productive for discipline and learning.
Before the feminist revolution, primary age boys usually had a separate playground from girls, allowing them to indulge in their concussive games.
In a space shared with girls, there is pressure for them to conform to standards that girls find more comfortable.
Children with ADHD often seem impervious to punishment, but this may be a sign of the imminence of their need for stimulation. Laboratory rats in cages lead very unstimulated lives compared with in the wild, and it has been found that they will actually learn to press a lever to give themselves electric shocks. Apparently shock, normally a punishment, is better than nothing happening.
It was recently reported that in some New South Wales schools the problem of ADHD has become so great that doctors, teachers and parents are co-operating to ensure that children get their amphetamine hit at the necessary intervals during school hours (The Australian, March 20, 2000, "Adding it together").
It might at least be worthwhile running a control group in which parents and teachers co-operate to ensure that children engage in plenty of independent physical activity at home and that group "arousal activities" offset obligations for concentration and attention, as part of the normal school day.