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ADHD: Attention Deficit Hyperactivity Disorder
Childhood Mental Disorders and Illnesses

by David B. Stein
Jossey-Bass, 2002
Review by Michael Sakuma, Ph.D. on Aug 4th 2003

Ritalin is Not the Answer Action Guide

The book title Ritalin is not the answer-action guide compelled me to look it over and give it a chance.  Being a psychologist, tired of medical model dogma (the current trend in psychiatry that mental/behavioral disorders have a biological cause and treatment), I was intrigued at a drug-free plan to help children with what we call "add".  Before my review, I should comment that I have not seen the original book that I assume, outlines the program more thoroughly.  This book that I am currently reviewing is an "action guide" that I assume has participatory exercises and self tests to help parents adopt the program.  Despite not seeing the original book, I believe I have read enough to form an "informed" opinion.

The guide is divided into three parts.  The first is designed to educate parents about the "true facts" (presumably those that the psychiatrists don't want you to know) about the "real causes" of ADD/ADHD.  I have some problem with this, but we will return to this later.  The second part is a skills building segment for caregivers using classic behavioral techniques such as reward and punishment to shape behavior. The third part of the book is focused on "teaching values" to your children and "avoiding ADD."  Again, I will comment on this section later. The book contains resources for parents and references listed as appendices. 

Let me start the review by saying that I generally am wary of "magic bullets", purported cure-all treatments that are the missing link that is somehow escaping the experts.  The book starts with a checklist of behaviors for parents to rate their kids.  Is your child "tightly wound" and "difficult to control" Do they "listen to you" and "are your nerves shot"?  If the answer is "yes" to many of his questions, Stein urges you to "cheer up" because he will "teach you to make these problems disappear." While Stein's program may be effective, I find it unlikely that the program will make all of these problems vanish (like so much magic).  It is a very hopeful claim, and certainly these books are designed to give hope.  I prefer a more realistic stance.

I very much like the premise of his book, that Ritalin need not be the answer for a child with attentional problems.  Research in the field shows that behavioral treatment, as suggested in this book, is effective in managing some children with ADD/ADHD.  I believe that medicine is often prescribed as curative, when in fact it does normalize all that is wrong in ADD.  As in any other "mental" disorder drugs (probably) should not be taken without some psychological support, and in ADD, I believe that the diagnosis is broad enough that there are many children who might benefit from behavioral treatment alone.  However, the book (I believe) is incorrect in assuming that all children who suffer from ADD (what he calls IA/HM– Inability to attend/highly misbehaving) are the same and can be treated in this one-way.  Stein fails to take into consideration that any diagnosis (be it schizophrenia or ADD) may result from any of a number of etiologies… biological dysfunction certainly being one.  Therefore, while I dislike the medical model's penchant for assuming that everything is biological, I equally dislike voices on the other side that (seem to be saying) that none of it is biological.  Even if Stein agrees that IA/HM may have some biological roots but need not be treated with drugs, I would agree with the caveat that the most effective treatment in this scenario would be biological treatment AND a behavioral plan as outlined here. 

I should conclude in saying that I believe that Stein's program might very well be effective for many children and parents suffering from IA/HM.  I do not believe that it is the panacea that is advertised.  There is some truth to Stein's hypothesis that changing cultural habits and values and an eroding educational system are the sources of IA/HM, however, I tend to balk at his suggestion that one parent might want to think about giving up their job to spend more time with the child as a non-solution.  He urges parents at the end of the book to "pass the word" to politicians and friends that our eroding society is causing the problems.  Again, while I see some truth to this statement, I believe it is only one facet of a complex and multifaceted problem. The search for the magic bullet continues.


© 2003 Michael Sakuma

Michael Sakuma is Chair of the Psychology Department at Dowling College, Long Island, New York.