How many times have you been asked by the parent of a child with attention-deficit/hyperactivity disorder when he will outgrow it? Or even, if he will ever outgrow it? My answer has always been, “I suspect that your son will always have whatever the brain structure or chemistry is contributing to the behaviors you are seeing now. But, we can hope that as an adult he will have found a job and an environment that better suits his talents and vulnerabilities.”
It turns out that like many of my responses to parents, my answer was only half right. In a long essay in the New York Times ( “A Natural Fix for ADHD,” Nov 2, 2014 ), Dr. Richard A. Friedman, professor of clinical psychiatry at Cornell University, New York, writes that there is some evidence that adults who were diagnosed with ADHD as children will outgrow the condition. And, that they will have MRIs that no longer demonstrate the asynchrony that was present when they had symptoms. However, the adults whose ADHD symptoms and behaviors have persisted continue to have abnormal scans.
This sounds like a typical chicken-and-egg situation. Did the brains of the lucky children who stumbled onto a path that better suited their strengths and vulnerabilities “normalize” in response to the more compatible environment? Or, did some maturational process occur in their neural connections that now allows them to thrive in an environment that they would have found so challenging as children?
Dr. Friedman doesn’t offer us an answer, but his conclusion echoes the advice that I had been peddling. He recommends that “we should be doing everything we can to help young people with ADHD select situations – whether school now or professions later – that are a better fit for their novelty-seeking behavior.” Behaviors that may have helped us survive as we wandered the environment as nomads now get those of us prone to distraction into trouble within the confines of our modern “civilized” societies.
Education should not just involve teaching students about the world they inhabit. It also must strive to help them learn more about themselves, both their strengths and their weaknesses. With this information, the well-educated student will be more likely to find a path on which he feels successful.
Unfortunately, our one-size-doesn’t-fit-all educational system is failing when it comes to helping students find careers in which they can thrive and be rewarded. Although industries across the country are crying out for skilled workers, the students who chose the “vocational” path continue to face the stigma of not having a 4-year college education. Unreasonable concerns about workplace safety and memories about the horrors of child labor make it difficult for young people to experience a variety of work environments and role models that open the door to a career in which they would thrive.
There is always the risk of channeling young people into an educational path based on their apparent aptitudes. However, as it stands today, we are guilty of not offering students a chance to experience a broad variety of options. At present, we are trying to fit square pegs into round holes. Although education has focused on rounding off some of those sharp edges, it also must help students find niches into which they can more comfortably fit.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” E-mail him at pdnews@frontlinemedcom.com .
