May 22, 2000 -- Nicholas Hill was an obstinate and defiant 4-year-old. He ex
May 22, 2000 -- Nicholas Hill was an obstinate and defiant 4-year-old. He exploded into violent rages. He yelled, screamed, and threw his toys. When his parents made reasonable requests, he seemed to take perverse pleasure in ignoring their wishes and doing exactly the opposite.
"He was a 4-year-old but he was still acting like a 2-year-old," says his mother, Sue, a special education teacher in Durand, Mich. "It was taxing for him and for us."
Frustrated, his parents took him to the local hospital, where doctors evaluated Nicholas and diagnosed him with attention deficit hyperactivity disorder (ADHD), a condition that affects some 4.8 million American children, according to the American Academy of Pediatrics. Like most children with ADHD, Nicholas was prescribed medication to help control his symptoms.
While the drugs helped, Hill still did not feel like Nicholas?s behavior was under control. Not wanting to place her son on yet another medication, she began researching nondrug options and stumbled upon Ross Greene's book, The Explosive Child. Hill began using Greene?s behavior modification techniques with Nicholas and found they made a huge difference in managing his outbursts.
Greene, PhD, director of cognitive-behavioral psychology at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School, has developed a drug-free approach to parenting children who are easily frustrated and chronically inflexible, including those with ADHD. Greene's method teaches parents to intervene before their children explode and helps kids develop the skills to handle frustration constructively.
Growing Numbers of Preschoolers on Drugs
Greene, who has discussed his approach on Oprah and other programs, is gaining a following among parents of kids with ADHD. The Journal of the American Medical Association reported in February that the number of preschoolers being prescribed stimulants for disorders such as ADHD tripled between 1991 and 1995; those on antidepressants doubled during the same period. The long-term safety of these drugs, researchers say, is unknown, and many parents are seeking non-drug alternatives.
No one knows just how many children are being medicated unnecessarily, but some experts suspect that doctors are reaching for their prescription pads far too often. Mark Stein, MD, director of the Hyperactivity, Attention, and Learning Problems Program at Children's National Medical Center in Washington, says 40% of the ADHD children referred to him for further evaluation have been diagnosed incorrectly. Conditions that can be confused with ADHD, he says, include mental retardation and autism; and some children have personality characteristics similar to symptoms of ADHD without having the disorder itself.
"There is enormous pressure on primary care physicians in HMOs to diagnose conditions in 10 minutes -- conditions about which they know very little," says Stein, who spends 3 to 6 hours doing a comprehensive physical and psychological exam on any child suspected of having ADHD.
A New Approach
Based on his research at Massachusetts General, Greene's strategy involves two steps. The first step is for parents to identify and avoid situations that habitually frustrate their child. For example, a kid who becomes over-stimulated in the supermarket can be left at home with a babysitter.
The second step is for parents to teach the child to accept a compromise when his demands can't be granted immediately. A child can be given permission to sleep over at a friend's house on the weekend, instead of during the week when homework needs to be completed.
