September 17, 2009


Overcoming ADHD: Helping Your Child Become Calm, Engaged, and Focused—Without a Pill. By Stanley I. Greenspan, M.D., with Jacob Greenspan. Da Capo. $25.

Making Friends: What You Need to Know about Your Child’s Friendships. By Elizabeth Hartley-Brewer. Da Capo. $13.

     If you have experienced the heartbreak of a child with attention deficit-hyperactivity disorder – or experience the condition, or the closely related attention-deficit disorder, yourself – you knows that the primary current treatment is pharmacological: Ritalin and other drugs are the first-line approach of medical professionals from pediatricians to psychiatrists. Ritalin is in fact the most commonly prescribed of all psychostimulant drugs; others that are often used are Adderall and Concerta. These medicines can sometimes be remarkably effective – but not all the time. They can have side effects, especially in long-term use, that can include psychosis, drug addiction, withdrawal symptoms and more. And many parents are understandably wary of using a psychoactive drug on their children unless there is no alternative. Stanley Greenspan says there is one: a form of behavior modification that gets at the root causes of a particular child’s ADD or ADHD and works to eliminate the problems that cause the condition to express itself. Overcoming ADHD is a bold book, willing to look past the apparent simplicity of using a pill to counter a life-altering condition toward a more difficult and time-consuming approach that has the potential to improve patients’ long-term living conditions. Greenspan thinks of attention as “a dynamic, active process involving many parts of the nervous system at the same time,” which means that if any part (or several parts) of that system malfunction, ADD or ADHD can result. If this analysis is correct, it follows that finding the malfunctioning area of the nervous system and correcting whatever is making it misfire can lead to mitigation, if not outright cure, of ADD or ADHD. Greenspan breaks his “comprehensive intervention approach” down into seven areas: strengthening motor function (balance, coordination, etc.); helping plan and sequence action thoughts (verbal sequencing, response to visual cues and more); modulating response to sensations; reflective thinking (helping a child know his or her own strengths and weaknesses and adapt to them); building self-confidence; improving family dynamics; and creating a healthful physical environment. Even this brief overview should indicate just how difficult Greenspan’s program is to implement in real-world (as opposed to clinical or inpatient) circumstances. The single element of modifying sensation response, for example, first requires figuring out whether a child is “sensory craving” or “sensory overreactive,” then determining in what ways the out-of-kilter sensory response manifests itself, then modifying the child’s environment to help the child adapt. Try doing that while raising other children, holding down a job (or two in a two-career household), and taking care of one’s own health. And this is but a small part of the time-intensive complexity required to implement Greenspan’s ideas. Thus, if Overcoming ADHD has a significant flaw, it is in minimizing the importance of having Ritalin and similar medicines available not only for the benefit of a child with ADD or ADHD but also for the benefit of siblings and parents. For parents determined not to give psychoactive medicines to children with attention-related disorders, Greenspan points the way toward a potentially excellent alternative approach to treatment, and provides the basics of how to go about implementing it. But there is an underlying naïveté to some of what Greenspan says – for example, on top of all the other things going on in their lives and their ADD/ADHD child’s, parents should have “regular time with each other in the evening not just to discuss the child but also to nurture one another.” Greenspan’s ideas are excellent, but they are also very time-consuming and very, very difficult for already stressed families to put into practice – a fact of life to which Greenspan pays far too little attention in formulating what is otherwise a thoughtful approach to a serious health problem.

     Any family dealing with ADD/ADHD would agree that the problem is a serious one, worthy of at least a book-length discussion. But what is the justification for a book about kids making friends with other kids – something that seems to come naturally to almost all children? Elizabeth Hartley-Brewer believes parents must direct and monitor their children’s friendships when the kids are young, with an eye toward helping them be socially successful as teenagers and in adulthood. This is at best an arguable proposition, although Hartley-Brewer seems to consider it almost self-evident. It seems more reasonable to suggest that parents be aware of difficulties their children have in forming and sustaining friendships – and in fact, Making Friends is in large part about how to handle friendship-related troubles, such as shyness, bullying (both real-world and online), cliques, imaginary friends and more. Hartley-Brewer deserves credit for including so many “tips” (set aside in the book in boxes, with the tips themselves separated by bullet points) that can help parents who choose to follow her lead as regards various aspects of friendship. For example, tips “to help a child become less clingy” include keeping important family relationships regular and secure; frequently telling him or her how lovable he/she is and how important he/she is to you; showing in small ways that you think about him/her even when you are apart; and more. Tips “if your child becomes the butt of gossip and rumor” include taking his/her feelings seriously, boosting his/her self-esteem, listening and empathizing without trying to fix the problem, monitoring any offensive text messages, and so on. Making Friends starts before elementary school and runs until middle school – a friendship minefield of a different sort – with Hartley-Brewer suggesting stages of friendship that mesh with a child’s age and grade level. This is a bit too facile, as is her underlying belief in parental direction of friendship in general. But given the fact that many children have friendship-related problems at various times, Hartley-Brewer’s book can be a useful resource for parents who encounter bumps along the social-relationship road and want to help their children find ways to get past those obstacles safely and with their ability to make and maintain friendships intact – or, even better, improved.

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