Review of "Ritalin is Not the Answer Action Guide"
By David B. Stein Jossey-Bass, 2002 Review by Michael Sakuma, Ph.D. on Aug 4th 2003
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