Today, attention deficit disorder is a fact of life like the common cold. Any mom can tell us about ADD. To many, it's a bona fide affliction like diabetes and coronary artery disease. But how much do any of us really know about ADD?
Let's take a look at how this disorder got its name. It first appeared in 1980, the year psychiatrists characterized certain childish, particularly boyish behavior as pathology. Since then, ADD has spun off several new disorders. According to the American Psychiatric Association's 1994 Diagnostic and Statistical Manual of Mental Disorders, there is a new form - attention deficit-hyperactivity disorder - and four subtypes: AD/HD combined, AD/HD predominantly inattentive, AD/HD predominantly hyperactive-impulsive, and AD/HD not otherwise specified. These terms have become the fashionable talk of a thriving world: the education establishment vitally linked with the mental health and medical professions, the pharmaceutical industry, and self-help groups. The stamp of the APA, in fact, has fielded a growth industry.
Yet, there is no valid diagnosis for ADD. The term does nothing more than describe observed behavior. Clinical data have not proved scientifically that ADD is a neurological disorder. This reality, however, does not deter elementary schools from aiming the label at our children.
Here's the usual scenario: A team of education specialists, usually a reading specialist, special ed teacher, school counselor, speech pathologist, resource teacher, principal, and staff psychologist, meet with mom and dad to discuss the poor performance of their son Matt. At some point in the discussion, the topic of Matt's behavior comes up, and everyone peruses forms completed by each of Matt's teachers. These detail Matt's conduct in class and have been prepared specifically for this meeting. Talk then is all about how Matt squirms in his seat, how Matt can't concentrate, how Matt teases Kristin, how Matt can't stay on task.
At the close of the meeting, the specialists turn to mom and dad, urging them to have Matt tested for ADD. The goal of the meeting is to get the child diagnosed and medically treated because the logic follows that the treatment then proves the school was correct in suggesting that ADD is the root cause of his academic failure. The bewildered parents are no match for the institutionalized rigmarole. In the end, they give in. Matt sees a pediatrician. The outcome is a diagnosis of ADD and a prescription for Ritalin.
So, what really lies beneath the ADD boom and the manic prescribing of Ritalin? First, we've go to understand that public schools have renounced their mandate to teach the basics. Gone is requiring students to memorize the multiplication tables; gone is teaching students to read with phonics first; gone is instructing them in formal grammar and written composition. Then, as illiteracy burgeons among school children, elementary school educators resort to the meretricious argument that if children don't learn, it is because they are hindered by a disability or disorder. Of the latter, the ADD phenomenon has been hugely successful in distracting the public from recognizing the real problem plaguing elementary education: our public schools' failure to teach the fundamentals.
Let's look at the evidence mustered to support the existence of ADD as a clinical disorder. First, although the term ADD sounds impressive, the fact remains that it has no universally accepted definition. Second, there is no clinical data significant enough to prove any cause. The term is descriptive rather than causal. In other words, it describes an effect, not a cause. While speculating on probable causes, mental health professionals have demonstrated that ADD is at best a theory based on empirical observation. What's not generally known is the degree to which this theory has excited controversy. In the field, debate is vigorous. Many among the adherents view ADD as pathology and believe the best diagnosis of it is based strictly on a subjective evaluation of anecdotal evidence. Others prefer to view ADD as a personality trait characteristic of millions of Americans and fall short of calling a trait a disorder. Still others carry the notion of a trait even further, claiming that ADD is a uniquely American phenomenon emanating from our collective gene pool (a notion dismissed by geneticists). On the opposite side of the debate are physicians and psychologists who reject the ADD diagnosis altogether for lack of clinical evidence.
Despite this controversy and the absence of diagnostic validity, ADD is now the label public school officials prefer for behavior perceived to interfere with learning. Schools simply claim that if a child performing poorly also fidgets, disrupts, talks out of turn, and fails to attend, he is likely suffering from ADD. To compound the problem, a teacher may encourage the diagnosis of ADD for a misbehaving youngster because, rather than rely on inadequate disciplinary measures available to her, she can control the child more easily when he is medicated. Most often the child will bear the added moniker "learning disabled," or LD for short. In any case, the effect of labeling is immediate. Matt may have vision problems that hinder learning. These go undetected. Then his parents may be less inclined to scrutinize what's most important to his education--such factors as seating arrangements, disciplinary policy, curriculum, academic standards, the competence of his teacher, and the way that teacher teaches him to read.
Inevitably, ADD has blossomed into a lucrative industry. For treatment, Ritalin and other drugs are liberally prescribed. School districts spend millions of tax dollars to meet the ballooning demand for special education, a demand internally driven and resulting in the continued hiring of special education teachers. Indeed, as parents prove that the schools have been unable to teach their children, districts have been legally obliged to pay tuition to private schools and fees to private consultants and lawyers.
Whence come the funds? For each child labeled a victim of ADD, a school can seek assistance under Public Law 94-142, the 1975 "Education for All Handicapped Children Act." This law guarantees an education to physically and emotionally handicapped children. The 1990 Individual with Disabilities Education Act (IDEA), however, in its amended version has broadly expanded the definition of disability and now justifies tax-funded programs for any child labeled with a specific learning disability, which is usually linked with ADD. To meet the new legal requirements and with funding as a powerful incentive, schools have designed elaborate procedures to identify ADD suspects. Thus, the number of girls and especially boys so labeled has grown dramatically.
But the public greets this ADD "epidemic" with mounting skepticism. As anxious parents challenge the schools to account for their children's dismal performance, the real causes surface. These are a decline in academic rigor, time wasted on non-academic activities, and the use of misguided methods for teaching reading and writing that guarantee pupil failure. What obscures the connection between these methods and their results is the absence of an absolute standard of literacy for each grade level based on criteria for high achievement set independently of the population norm. As parents seek quality control, they become increasingly dismayed. Schools rarely question their own standards and methods. Instead they focus on the child as the cause of failure.
Beyond doubt, no method causes more mischief than the current one favored for teaching reading, a method that leads inexorably to ADD labeling and the further stigmatizing of the unfortunate child. The system in vogue is whole language, a reinvention of the old look-say method. This time it showcases invented spelling by which illiterate children can demonstrate their creative writing talents. Whole language has replaced phonics, historically the best and most effective system for teaching anyone to read. Instead of learning to read by a carefully sequenced program of phonics instruction, children try to memorize the English language word by word, usually in an atmosphere of congenial pandemonium, referred to in education idiom as cooperative learning.
Underscoring this method are the beliefs held by whole language teachers. The IEA Reading Literacy Study published in 1996 by the U.S. Department of Education found that these teachers reject an emphasis on accuracy, on strong teacher direction, and on sequenced instruction where the pupil learns one skill before tackling the next in a logical progression. Instead, they embrace imprecision, welcoming wrong answers and wild guessing from children trying to read and write without benefit of instruction. In what they proudly boast of as child-centered learning, whole language teachers take a secondary role, allowing each child to decide what and how much he is to learn, and when he is to learn it.
Not surprisingly, this marriage of method and skewed teaching philosophy has produced an academic mess. Children spell poorly, fail to grasp the simplest grammatical concepts, and can't draft a well-written sentence, paragraph, or composition. They don't think, and characteristically they don't like to read because, most often, they can't. Bored and frustrated with the endless struggling, they misbehave or tune out. The problems are noted as evidence of ADD, which then becomes a convenient refuge. Thus a normal child who can't learn to read with the whole language method "suffers" from a mental disorder. The trendy ADD label makes abnormal a child's normal human response. Parents who resist the diagnosis are told gently they are in denial, a phase that passes soon into grieving and acceptance.
Once parents are hooked by the psychobabble, educators stress that no one is to blame for the disorder. The ADD child is a no-fault failure. As a remedy, he is placed in a reading group with lower expectations and meets twice a week with a reading specialist who uses the same failed methods that caused him to be illiterate in the first place. When the behavior problems persist, the school's educators press the parents to have him treated. Soon after, the child is lining up in front of the nurse's office, waiting for his drug.
From all the fuss, one should expect the treated child to excel at reading, writing, and grammar. But he doesn't, and neither do his peers. In fact, standardized achievement test scores have demonstrated that literacy in schools nationwide is declining still, a downward trend that has affected all students, not only those labeled ADD. The National Assessment Governing Board reports in 1995 that the results of the National Assessment of Educational Progress Writing Portfolio Study ranged from mediocre to dismal. The NAEP tested a national representative sampling of 1800 fourth and 1800 eighth graders. The low scores clearly reflect the consequences of essential skills taught poorly or not at all. In 1994, moreover, the NAEP reported that the average reading proficiency of 12th -grade students had declined significantly since 1992. In 1998, the reading proficiency of 12th graders declined even further.
The implications of these reports have resonated as well within international comparisons. The OECD's first International Adult Literacy Survey comparing literacy proficiencies between seven North American and European nations published its results in 1995. The IALS used a scale ranking difficulty of literacy tasks from Level 1 to Level 5, with Level 1 at the low end of the scale, Level 3 at the central or average position, and Level 5 at the high end. In one study, adults from Canada, Germany, Netherlands, Sweden, and Switzerland (speaking French and German) who had completed a secondary education outperformed the U.S. in the percentage of those achieving average prose proficiency at Level 3. In the same study, 50.6% of U.S. adults with a high school education could not get beyond the two lowest levels. With the results of the NAEP and the IALS providing evidence to the contrary, how then can schools claim that the child treated for ADD is learning satisfactorily? The drug can get any kid to focus better on what he's doing. It doesn't teach him to read and write.
So what to do? Until literacy's downward spiral reverses and the United States ranks at the top among industrialized nations, parents must be vigilant. They should begin by reading Rudolf Flesch's Why Johnny Can't Read, a bestseller in 1955, Martin L. Gross's 1999 The Conspiracy of Ignorance: The Failure of American Public Schools, and Diane McGuinness's Why Our Children Can't Read and What We Can Do About It, published in 1997. Then they should question instruction methods. Certainly, they should examine the whole language movement's preemptive strike against systematic phonics instruction. How does the movement persist when test scores are falling? Rather than recognize their error and promote reading instruction methods proven to work, educators instead attack achievement tests that use independently set objectives for identifying high achievement levels. Indeed, parents should be aware that a campaign to discredit standardized achievement tests has been well under way. The education establishment calls it the "assessment reform movement."
Secondly, parents should consider notifying their congressmen about the perverse incentives created by the IDEA and demand that it be repealed. This law encourages school districts to staff education specialists and budget money for programs to meet needs that the schools must justify to request funding. There is little incentive for the schools to change destructive education practices and wrong teaching methods since they perpetuate a cash flow. Clearly, parents must start talking to one another. Informed and organized, they can better persuade a school board to revamp a failing education system.
Further, all of us need to challenge the educator's glib use of terms like minimal brain damage, aphasia, dyslexia, dysgraphia, and neurological disorder. Analogies to explain the brain similarly should raise red flags. Input, hard-wiring, crossing wires, and output relate to electric circuitry and personal computers, not to Matt's head. If one truly suspects Matt of having brain damage, a cranial investigation, supported by a clinical history and physical examination, may likely detect an organic lesion. Even so, such evidence may not directly establish a link to Matt's performance and behavior in class. On the other hand, with no physical evidence of damage, it is even more difficult to establish causality.
Finally, parents must insist that schools forgo the education fads, hire teachers with superior academic qualifications -- that is, teachers who are well educated and properly trained -- and let them return to teaching the time-honored basics. Drill in phonics is essential to reading, drill in grammar to writing. Additionally, the structure in words revealed through the study of phonics better prepares a child to grasp word inflections and syntax in the English language revealed through the study of grammar. Schooled in these literacy fundamentals, pupils can be taught prose techniques, the sine qua non to writing clear English. As teachers perform these academic duties, the schools must support their endeavors by setting high academic standards. Pupils who fall behind must be expected to work harder and longer to meet those standards.
As to Matt, a strong dose of academic rigor is his best medicine for overcoming obstacles to learning. Simply put, a child flourishes where expectations remain high. A child needs direct instruction and guidance. In this environment, Matt excels by studying and doing his homework. Rather than accepting mediocrity, he discovers the joy of self-reliance that comes with learning. Carrying the ADD label can only bolster his expectation of failure while hindering any real progress toward achievement.
Cheryl Hargis is the founder of Avid Readers, Inc.