Sign of the times

Why are so many children today seen as having ADHD (Attention Deficit and Hyperactivity Disorder)? There are some deeply disturbed children who need medical and psychological help, but thousands of others are also being diagnosed with ADHD and many have drug treatment for it. Yet in the past, they would not have been considered sick.

ADHD is about behaviour, not illness. Some children might have biochemical or brain disorders, but no definite medical signs have yet been found that would prove that a child has ADHD. Reading tests are used to assess ADHD in six- to 16-year-olds. Yet many children find reading hard and boring, so this is bound to shoot up ADHD rates. Diagnosis of ADHD is an opinion, rather than proof.

ADHD is measured against an assumed 'normal' level of activity and attention. However, the same level of 'overactivity' in small, crowded early years centres in Western countries could look like 'underactivity' if you have to herd up the family's goats, as many young children around the world do.

ADHD is not simply about qualities in a child. It involves children's reactions to their context too. Restless, bored inattention during a large group story time can change to intense, absorbed interest in the sand pit.

Beliefs about children

There have been great social changes that are relevant to the ADHD issue.

Today we treat four-year-olds as if they are babies rather than children.

In 1902, Albert, aged four, in Norway would buy a ticket, go by train to the harbour, look round the museum and fire station, haggle for fish in the market, and return home by himself1. Margaret, aged five, collected her younger sister from hospital and took her home across the city of Derby. In the 1930s, a five-year-old sold daily newspapers in London's Covent Garden.

In Finland today, eight-year-olds look after themselves at home all day or out playing with friends, while their parents are at work. And in Africa and Asia, orphaned children as young as eight years organise their households and small businesses.

The difference today is not simply more road traffic. Many of the above examples were set in dangerous streets. The difference is in our beliefs, especially in Britain and North America, about how limited we assume young children to be, and force them to be.

The point here is not to say that young children should have hard, heavy responsibilities. It is that, if they have to, they do have the energy and good sense to be responsible. So 'overactivity' could be a protest by many energetic, able children against being treated as helpless and stupid.

Unfortunately, adults then often try to control them even more firmly.

Children usually say they like being at home because there they are most free to organise their own time and activities2. For example, Amy aged two years, a sociable, confident child, spends hours playing by herself. She can wander in and outside, break for a snack, and then go back to her game without having to stop and clear up by a set time.

Today's restrictions

Children clearly enjoy playing and learning in early years centres and schools, but there are growing restrictions in 21st century Britain for many of them. These include:

* long hours of having to conform in highly organised groups

* pressures on the staff to make children meet demanding learning and behaviour targets

* limited space and resources, with tight restrictions imposed on vigorous, 'messy', free, adventurous and outdoor activities

* the rigid curriculum, maths and literacy hours and homework, even for four-year-olds, whereas children in most other countries do not begin formal school until aged six or seven

* being constantly observed and controlled by adults instead of having the freedom, privacy and dignity Albert's generation enjoyed

* expensive childcare services, that children often do not want to use

* some adults' overly-rigid views about how children should learn and behave

* adults sometimes blaming any problems on the child, such as casually saying, 'He's probably got ADHD'

* other children who copy adults' disapproval, so that 'naughty' children get trapped into feeling lonely and anxious, bad and rejected

* being punished at home for events at school, which break home-school contracts (agreed between adults) - parents are allowed to hit children

* league table competitions that encourage schools to punish and exclude the challenging children, such as by saying they have uncontrollable ADHD

* parents trying to get the extra resources their child needs, such as by asking for a formal diagnosis of ADHD

* education and health authorities saving costs by using the quickest, cheapest treatment for over-active children - medication

* psychologists being too busy testing children to have time to work with adults and children on preventing problems and making schools and nurseries happier places for everyone

* hundreds of play parks being closed, and far fewer clean, safe, exciting spaces where children can play freely away from adult supervision

* school children being allowed to go away on holiday only during the weeks that holidays are most expensive, which many families cannot afford

* parents working the longest and least regulated hours in Europe, with less time and energy to enjoy being with their children

* high rates of poverty - 47 per cent of inner London children live in poverty3

* undue fear of stranger-danger that keeps children at home - each year, six to eight children are murdered outside their home, but about 80 are murdered inside their home

* for many families, the stresses of experiencing crime, racism and neighbourhood conflict, poor housing and diet, family disruption.

Finding solutions

Instead of asking why ADHD rates are so high, perhaps we should be asking why so many children today manage to behave well in spite of all these pressures.

Here are some suggestions. The above list of problems might seem fairly general and remote. But you could think through each one, and perhaps discuss them at a staff meeting, to consider how they affect the children you care for and teach.

The vital task is to ask the children for their views about any problems in their group or class, and about their ideas for solutions and practical ways forward, so that adults and children can work together to solve problems1,4. This involves trusting the children, treating them as the thoughtful, sensible people they can be. Some ideas that look mad at first turn out to be good ones. The most active children might have the best ideas.

Your discussions might tackle these questions.

Which problems can you change? For example, how can the children be helped to be less restless, bored, irritable or unhappy? Rearrange crowded rooms to make more space for active and messy play? Go to a large outdoor space every day whatever the weather? Vary the activities and routines? Rethink rules that might be petty, and cause unnecessary conflict?

Which problems could you make more allowance for? For example, if there is a child who is often upset or angry, how could everyone understand the child's point of view better, and offer more help and support?

Which problems can you challenge?

Caring for young children is the most important activity there is. Yet it has a low status. This prevents the voices of the adults involved, and through them the voices of the children, from being heard and respected. If they were taken seriously, we would not have so many social problems.

How often do you feel forced to do things that do not help the children - by Ofsted inspectors, local authority officers or senior managers who rarely meet the children? Can the staff and families join together and challenge these authorities to change their views or their rules, or to improve a local service?

When ADHD and related problems are tackled as social and even political concerns, instead of medical ones, changes might be made that benefit everyone involved. NW

Priscilla Alderson PhD is professor of childhood studies at the Social Science Research Unit of the Institute of Education, University of London