# Field Research Report on ADD and ADHD: A Critical Analysis

André Michaud

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André Michaud. Field Research Report on ADD and ADHD: A Critical Analysis. Current Approaches in Science and Technology Research Vol. 2, Book Publisher International (a part of SCIENCEDOMAIN International), pp.80 - 89, 2021, 10.9734/bpi/castr/v2/8835d. hal-05121043

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# Field Research Report on ADD and ADHD: A Critical Analysis

André Michaud<fnref n="1" />*

DOI: 10.9734/bpi/castr/v2/8835D

## ABSTRACT

Analysis of a research report shedding a disquieting light on the reasons that were identified for diagnosing a constantly increasing number of children as suffering from ADD/ADHD and subsequent prescription of Ritalin and other psychostimulants. This study attempted to identify, without success, whether learning problems observed in some children could be due to some brain pathology.

Keywords: Psychostimulants; ADD; ADHD; elementary school; literacy.

## 1. INTRODUCTION

The present analysis abstracts the main conclusions of an exhaustive field study carried out by a Canadian research team regarding out of control ADD and ADHD diagnosing and psychostimulants prescription to elementary school children in the city of Laval, Canada [1], which appears to be a reflection of the diagnosing and prescription trend in North America. Complete identification of the research report is given in Appendix A.

To the study authors' knowledge, this study was the first exhaustive attempt to estimate the extent of use of psychostimulant drugs in relation with ADD/ADHD diagnosis for elementary school children to have been carried out in Canada.

Its objectives were:

1) To describe the perceptions of the various actors involved in the follow up of the cases of children who have been diagnosed with ADD/ADHD,

2) To estimate the extent of psychostimulant drugs prescription to elementary school children in the city of Laval.

The study reports that the psychiatric label ADD/ADHD, which stands for *Attention Deficit Disorder / Attention Deficit and Hyperactivity Disorder*, stems from another label, that of *minimal brain dysfunction* originating from an American study that was conducted in the 1960's. This study attempted to identify, without success, whether learning problems observed in some children could be due to some brain pathology.

The Cohen et al.'s field research report [1] provides a historical recap of the development of the concept of *Attention Deficit Disorder / Attention Deficit and Hyperactivity Disorder*, or ADD/ADHD, of its scientific foundations and of the prevailing opinions regarding its causes in medical circles.

The systematic non-involvement of two groups of scientists whose contribution could be critical is noted with regards to the development of this concept. They are the communities of neurophysiologists and doctors in pedagogy.

<footnote n="1">¹SRP Inc., Canada.</footnote>

<footnote>*Corresponding author: E-mail: srp2@srpinc.org;</footnote>
The study mentions that a preliminary study carried out in 1997 in the province of Québec, Canada [2] showed that a constantly increasing number of children were diagnosed as being *hyperactive* and subsequently medicated in the province's elementary schools.

It was observed that the school system submitted parents and physicians alike to enormous pressure to medicate these children.

The present analysis will bring to light the helplessness of the actors to take control of the situation, the actions of each actor being the outcome of the actions of the others, which apparently creates synergy causing the constant increase in prescribed psychostimulants, despite their proven inability to improve the condition of children except for an observed calming effect, and that no data exists confirming any relation between ADD/ADHD and any brain dysfunction.

Despite a voiced intention by all actors to help these children, this effective means made available to calm *troublesome* children seems to have become socially accepted and freed of guilt, and appears to have become over time the last resort tool of choice to maintain order in classrooms in the school system, given that children so medicated become passive and that most of them are typically not provided with complementary help beyond the psychostimulant prescription itself, mainly consisting of Ritalin (methylphenidate, 85-90% of cases), but also of Dexedrin (dextroamphetamine) and Cylert (pemolin).

It was also observed that prescription of psychostimulant drugs increases so quickly that statistics are already obsolete when published in scientific journals.

Health professionals are so overwhelmed by the sheer number of requests that the risk of misdiagnosis has become extreme for all children who attract attention in the school system since the official diagnosis criteria for ADD/ADHD are strictly behavioral.

The Cohen et al.'s report indicates that the procedure does not even involve that the child be examined by a physician for the diagnosis to be established, which means that it is established mainly on the basis of information obtained from teachers and parents to the effect that the behavioral traits associated *by them* to ADD/ADHD are manifested by the child.

This means that children who *disturb the peace* by being overenthusiastic, or attract attention by becoming restless due to feeling bored in class, are at high risk of being misdiagnosed ADD/ADHD, without being examined by competent professionals.

The study concludes that once the evaluation process has been triggered, the majority of children manifesting a range of behavioral traits of various origins WILL eventually be medicated, and it is unfortunately observed that psychostimulant medication is immediately considered as soon as a child is first perceived as presenting a problem in class, whatever the cause.

## 2. ADD/ADHD, THE ORIGINS OF THE CONCEPT AND ITS FOUNDATIONS

Even if the 1960 American study failed to identify any brain dysfunction that would explain ADD/ADHD associated behavior, numerous behavioral traits were identified and associated with these labels, while various drugs were experimented with to potentially remedy the condition of diagnosed children.

Thirty years later, the final conclusion of the *Consensus Conference on ADD/ADHD* that was held in November 16th to 18th of 1998 at the *United States National Institute of Health* [3], unequivocally stated that: "*There are no data to indicate that ADD/ADHD is due to a brain malfunction*". The report concludes moreover, that no objective testing procedure allows singling out any child as being affected by this problem, and that the official diagnosis criteria of ADD/ADHD are strictly behavioral.

Despite this final conclusions, in excess of 5 million American children in 1997 (9 million in 1999) and tens of thousands of French-Canadian children are needlessly diagnosed ADD/ADHD and prescribed psychostimulant medication to control behavioral traits that have no recognized medical foundation.
## 3. THE EFFECTS OF PSYCHOSTIMULANTS

An important study published in 1993 [4] summarizes the results of thousands of other studies carried out on the effects of psychostimulants on children.

This summarizing study shows that all children, diagnosed or not, as well all animals on which the drugs were tested, display the same reaction the drugs. It was found that psychostimulants increase concentration and effort while minimizing impulsivity and increase obedience for a short initial period going from 7 to 18 weeks in all subjects tested, a period after which *all effectiveness was lost*.

It was found that the medication did not improve complex abilities such as reading, nor social interaction. The medicated children's results in school showed improvement, but that their observed various learning disabilities were not corrected by the medication.

No improvement was noted for any significant emotional problem. No evidence was found of any long term improvement in academic results or decrease of antisocial behavior for children submitted to psychostimulant prescription.

The list of known potential negative side effects of psychostimulant medication are a decrease in appetite, sleeplessness, damaging effects on self image and on cognition, such as lessening of creativity and spontaneity; appearance of stereotyped behavior, nervousness, emotional instability, restlessness, head and belly aches, thwarting of the growth curve, and on occasions, increase or emergence of verbal or motor mannerisms or motor twitches, that in some cases reached the level of psychotic behavior.

## 4. PRESSURE FROM THE SCHOOL SYSTEM TO DIAGNOSE AND MEDICATE

According to the Cohen et al.'s analysis, here are the main factors determining the diagnosis and prescription of the medication.

It was concluded that the various problems that teachers identify as possible symptoms of ADD/ADHD during the first year of elementary schooling typically are disturbances in the classroom, failure, inattention and a variety of behavioral problems.

Teachers then refer children, who draw attention for these reasons, for psychological evaluation, and inform the parents that their child should be evaluated by a physician. The study shows that teachers are the initiators of the process but that they are only minimally involved afterwards.

Parents tend to resist considering medication and children are eventually referred to specialists for medical evaluation (pediatricians or neurologists) after they have been evaluated by the psychosocial authority in the school.

The report concludes that physicians are generally constrained by circumstances to diagnose children on the basis of psychosocial or psychological evaluations that they deem incomplete or unsatisfactory. Physicians report that they tend to be overloaded with cases and that they cannot avoid being sensitive to the pressure that the school exerts on parents.

The schools' psychosocial personnel are critical of the rigor of the medical evaluation while front line physicians experience difficulties in establishing a proper diagnosis, considering the absence of physiological criteria, which adds to the contradictions between the various evaluations done by the parents, the teachers and the school psychosocial personnel. Specialists on their part harshly criticize the lack of knowledge of the psychosocial school personnel.

All actors are aware of a lack of communication between the various groups, and note that resources are minimal after the diagnosis. A lack of support is observed for all actors and families. But most critically, lack of follow up for the medicated children is noted.
"Family, physicians and specialists alike are unanimous regarding the pressures exerted by the school on parents for them to consult a physician. Consequently, the parents understand that if they do not consult a physician, their child will be removed from the class and suspended from the school." ([1], p. 22).

The pressure that the school exerts on parents to prescribe psychostimulants is so acute in many cases that some parents even ask physicians to reassure the school teachers and psychosocial personnel regarding the intellectual abilities of their children.

The acuteness of the pressures exerted by the school on parents is a major problem for physicians, coupled with the pressure that the school directly exerts on them. Physicians who tend not to give positive diagnoses and do not prescribe the medication tend to end up not being referred children, because school authorities then end up referencing the names of physicians who are more open to diagnose positively and medicate. ([1], p. 26).

Frontline physicians and specialist assert that once medicated, the school withdraws all support to the child and his family. One of the physicians who was party to the study went as far as stating that "A school problem has been medicalized because the school has abandoned its primordial role towards children."

It is observed that the medication should not be the only action taken, but that it factually is. It is observed that medication is used as a pretext to diminish services to children, because none of the actors feels able to take on the responsibility of following up medicated children, in the current situation.

The availability of the medication and the insistence of the school that it be used even without complementary resources force the actors to act against their convictions. The interviews of the various actors bring to light that each actor feels helpless, isolated and unable to escape the pressure to prescribe psychostimulants that emanates from the other actors or from the school.

The final conclusion is so damning that the authors expressed it in the form of a question: "Is medication used mainly to restore "order" and "calm" in the system?".

It can also be wondered if the extremely restrictive budgetary policies applied for years at all levels of the school system by the Quebec government could have been a driving factor in this explosion in the number of declarations of cases of hyperactivity, which coincided with the establishment of these policies (which is a point not covered by the study), because these policies are such that the amounts allocated to schools by the Ministry to support each child declared in difficulty are superior to the amounts allocated for children who are not declared in difficulty, since this policy applies even when the diagnosed children receive no extra service besides the actual psychostimulant prescription, for which the school incurs no costs at all.

## 5. POSSIBLE UNDERLYING CAUSES

It was established in the 1950's by French neurophysiologist Paul Chauchard [5] that an inadequate activation of the brain's verbal centers between birth and the age of approximately 7, systematically results in an incomplete development of children's verbal centers, which can cause a significant thwarting in the development of the ability of verbal comprehension and expression:

"Once the normal age for the development of the verbal areas is passed, such training will become difficult.

The fundamental law of cerebral development, that is, the possibility of possessing later a completely normal brain, endowed with all of the human aptitudes, requires that cerebral maturation always takes place in an environment, not only physical, but cultural and affective, that will favor it. Nothing can be done too soon, but soon, it is too late."

Paul Chauchard, 1960 ([5], p. 52).
The consequence of belated development of all verbal areas of the brain can then obviously only be an increased level of difficulty for these children to clearly understand teachers' explanations after they reach school age, inducing a state of inattention, that can be an obvious cause of learning problems in school and of the disturbing behavioral traits that are now associated to ADD/ADHD.

The question now comes to mind as to what repercussions the Cohen et al.'s 1999 study [1] had in the local educational community after its publication in 1999. In 2015, that is, 16 years after the report was published, it appears that the increasing rate of prescription of Ritalin and other psychostimulant drugs went on unabated to reach unheard of records in the province of Quebec [6], which troublingly parallels the constantly increasing illiteracy curve in this Canadian province, which in turn elicits the following question: Can the psychostimulants prescription increase in the absence of sufficient early verbal stimulation be linked to the increase in illiteracy in the province of Quebec?

# 6. HISTORICAL PERSPECTIVE

According to the 1994 OECD figures, the functional illiteracy rate progressively increased over time in the province of Quebec to reach the alarming level of 34% of the adult population aged 16 to 65. This author was not alone being highly worried by this unexplained increase in the level of illiteracy in a province in which all children had to learn reading to autonomy by the end of the first year of primary school in the 1950's under pain of having to re-follow the first year program before graduating to second grade, and in which schooling was mandatory up to 16 years of age since the 1960's, despite which such a constantly growing number in our population ended up illiterate [7].

Worried by the increasing prescription of psychostimulants in addressing the learning issues of children, that this author associates with an insufficient teaching of verbal skills, the team led by Dr. Cohen separately undertook their field study in search of the root causes of such high levels of psychostimulants prescription during the same second half of the 1990's during which this author's in depth sociological study was being carried out [8] in search of the ontological origins of this apparently out of control degradation of language teaching in the French-Canadian community of the province Quebec, eventually pinpointing its origins in a major reform of the Quebec education system that was implemented in the mid-1960s.

The paperback version of the study was published in the same year as the Cohen et al. report, that is in 1999, complemented by a systematic awareness-raising operation documented in Appendix A of the eBook version of the study that was republished in 2013 [8]. But this operation raised no more interest in the Québec education community than the Cohen et al. field study.

Clear evidence of this indifference is the fact that the chronic literacy degradation trend continued unabated to eventually reached over time the barely believable level of 53% of the adult population of the province of Quebec in 2013 according to OECD figures, and that the increase in prescriptions of psychostimulant drugs also went on unabated to this day, apparently without any indication that any radical measures were being implemented or even considered to reverse these degradation rates.

The OECD figures are unforgiving with regard to the constant increase in illiteracy in this province, which even suggests, since this issues is also related to the same children's learning problems for which psychostimulant drugs are being prescribed, that such use of these drugs without complementary help to these children might even contribute to the illiteracy condition, given that except for an observed calming effect, such prescriptions are known not to improve the condition of children as confirmed by the 1993 study [4].

In Canada, education is entirely under provincial jurisdiction, which means that each province developed its own education system. The sociological study made in the 1990's [8] concerns exclusively the evolution of the education system in the province of Quebec, so the observed deterioration applies in no way to the French-Canadian communities of the other Canadian provinces.

The Quebec education system was unique in North America before the 1960's reform in that, unlike the education systems of the other Canadian provinces that were grounded on the traditional
university based teaching methods of the Anglo-Saxon communities, it was the result of a local tradition that had been evolving over the course of the previous 350 years and was grounded on traditional teaching methods that were entirely European in inspiration. These teaching methods also served as a model for the education systems of the French-Canadian communities in the other Canadian provinces, since many teachers from these communities came to receive their training in the Quebec teacher training schools, which contributed to the standardization and maintenance throughout the country of the French-Canadian culture.

This system was managed by an elite specialized to the level of master's degrees in educational pedagogy, trained in a European-style system separate from the North American university network, that had been training field teachers for generations in a network of Teachers training schools ("écoles normales") where the importance of correct and timely mother tongue learning was considered paramount for all children. These field teachers therefore ensured, under the supervision of inspectors appointed by the Teachers training schools, that all children learned to read to autonomy during the first year of primary school so they experienced no difficulty learning all the other subjects on account of an insufficient mastery of their mother tongue.

In a desire to harmonize and integrate the education system of Quebec's French-Canadian community into the Quebec francophone university system, which at the time did not comprise a Faculty of Educational Sciences, such faculties were established in the 1960s by academics of various backgrounds who did not come from the Quebec elite of the time specialized in pedagogy who traditionally trained field teachers in the province.

This elite was then freed from the responsibility of training field teachers, and most of them were invited either to retire or to become field teachers, and all Teacher training schools were closed without their proven teachers training programs and methods being imported into the new Faculties of Education, and apparently without these academics, newcomers in the field of education, becoming sufficiently cognizant in the traditional knowledge in pedagogy provided in the Anglo-Saxon university network of the rest of Canada.

This new education elite, now in charge of managing the education system of the Quebec French-Canadian community, headed by a newly created Ministry of Education, unfortunately did not realize the need to continue teaching all children to read to the level of autonomy in the first grade to render easy for them subsequent learning all other subjects, which was mandated and closely supervised before the reform.

The indifference shown by the Quebec education community to the sociological study [8] and to both Cohen et al. reports [1,2] is at the origin of the neurolinguistics research project that led to the formal publication of books and articles [9,10,11,12], that provide a general overview of the research that was already formally published in the 1960's about conceptual thinking, and that already confirmed the need for such timely learning of the mother tongue in order for all children to achieve optimal intellectual development, that is, conclusions about conceptual thinking now confirmed by newly acquired functional knowledge on the brain, now made available by means of modern magnetic resonance (fMRI) and EEG devices [13].

The aim of this project was to put at the disposal of teaching communities, that may not already be aware of the need for early learning of the mother tongue by all children, an extensive set of references to long standing conclusive research in this domain that are not currently sufficiently referenced in the international community due to the fact that major related research papers and books still have not been translated to English, currently the general communication language in the scientific community.

## 7. CONCLUSION

It is constantly observed that when children are properly taught to read to proficiency before the age of 7 [9], they generally tend to remain calm in relation with the norm of their age, in accordance with the conclusions of Chauchard [5], Doman [14], Dodson & Durkin [15] and finally Piaget [16,17],
because they progressively think and analyze more and more clearly as they progressively master
with more refinement the language that they think with, and thus become progressively better
equipped to understand and control the progressively increasing complexity of the challenges that
they are confronted with as they grow up [11].

It can be observed that a promising practice is now being introduced in some communities that proves
to positively address this issue in the neighboring province of Ontario, as well as in France, where this
method is introduced beginning with three-year olds.

In *adapted classes*, young children are progressively introduced to the first rudiments of reading as if it was a game, since learning to read early is the most effective incentive for children to take a liking to reading and to eventually acquire a broad general knowledge base, which is a process necessary for social awareness to develop in a sufficient number of people to make a difference in our societies.

This systematic approach should cause our societies to improve in the mid term.

COMPETING INTERESTS

Author has declared that no competing interests exist.

REFERENCES

1. Cohen D, Clapperton I, Gref P, Tremblay Y. Déficit d'attention / hyperactivité: Perception des acteurs et utilisation de psychostimulants. ISBN 2-921606-36-4. RRSSS Laval, Canada; 1999.
Available:http://www.santecom.qc.ca/Bibliothequevirtuelle/santecom/35567000024221.pdf

2. Doré C, Cohen D. La prescription de stimulants aux enfants "hyperactifs". Santé mentale au Québec. 1997;22:216-328.
DOI: 10.7202/502104ar
Available:https://www.erudit.org/fr/revues/smq/1997-v22-n1-smq2304/502104ar.pdf

3. Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. National Institutes of Health Consensus Statement; 1998.
Available:https://consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110html.htm

4. Swanson JM, McBummet K, Wigal T, Pfiffner LJ, Lerner MA, et al. Effect of stimulant medication on children with attention deficit disorder: A "Review of Reviews". Exceptional Children. 1993;60:154-162.
Available:http://files.eric.ed.gov/fulltext/ED363086.pdf

5. Chauchard P. Le cerveau et la conscience. Éditions du Seuil, France; 1960.

6. Mercure Philippe. Ritalin: la consommation atteint des records au Québec. La Presse (lapresse.ca); 2015.
(09 Mars 2015)
Available:https://www.lapresse.ca/actualites/sante/201503/08/01-4850438-ritalin-la-consommation-atteint-des-records-au-quebec.php

7. Rapport québécois du Programme pour l'évaluation internationale des compétences des adultes (PEICA). Institut de la statistique du Québec; 2015.
Available:https://statistique.quebec.ca/fr/fichier/competences-en-litteratie-en-numeratie-et-en-resolution-problemes-dans-environnements-technologiques-clefs-pour-relever-defis-xxie-siecle.pdf

8. Michaud A. Our bankrupt elite. SRP Books. Smashwords. Revised in 2012; 1999. ISBN 978-0-988-05275-8.
Available:https://www.smashwords.com/books/view/178846

9. Michaud A. The Neurolinguistic Foundation of Intelligence, SRP Books; 2003.
Available:https://www.smashwords.com/books/view/156882

10. Michaud A. Comprehension process overview. J Biom Biostat; 2016;7:317.
DOI: 10.4172/2155-6180.1000317
Available:https://www.hilarispublisher.com/open-access/comprehension-process-overview-2155-6180-1000317.pdf
11. Michaud A. Intelligence and early mastery of the reading skill. Journal of Biometrics & Biostatistics. 2016;7:4.
Available: https://www.hilarispublisher.com/open-access/intelligence-and-early-mastery-of-the-reading-skill-2155-6180-1000327.pdf

12. Michaud A. On the relation between the comprehension ability and the neocortex verbal areas. Journal of Biometrics & Biostatistics. 2017;8:331.
Available: https://www.hilarispublisher.com/open-access/on-the-relation-between-the-comprehension-ability-and-the-neocortexverbal-areas-2155-6180-1000331.pdf

13. Michaud A. The mechanics of conceptual thinking. Creative Education. 2019;10:353-406.
DOI: https://doi.org/10.4236/ce.2019.102028
Available: https://www.scirp.org/journal/paperinformation.aspx?paperid=90657

14. Doman Glenn. Teach your Baby to Read, Random House; 1963.

15. Dodson Fitzhugh. How to Parent. USA; 1971.

16. Piaget J. The origins of intelligence in children. International Universities Press. USA; 1974.

17. Piaget J. The language and thought of the child. Routledge & Kegan, London; 2001.
APPENDIX A

The field research report is in French and its title translated to English is: "Attention Deficit/Hyperactivity: Perception of the Authors and Use of Psychostimulants".

The original title is: "Déficit d'attention/hyperactivité: Perception des auteurs et Utilisation de psychostimulants". See Reference [1]. ISBN 2-921606-36-4.

The research team was comprised of: David Cohen, Ph.D., Irma Clapperton, M.D., M.Sc., CSPQ, Pauline Gref, M.D., FRCPC and Yves Tremblay, M.D., CSPQ, FRCPC. And the project also involved the collaboration of Sylvie Cameron, M.A.
**Biography of author(s)**

<figure><img src="image_2.png" /></figure>

**André Michaud**

SRP Inc., Canada.

He was born in 1944. He was Involved since 1982 in manufacturing a demonstration apparatus meant to help teaching classical mechanics and Translation of seminal papers for the *Minkowski Institute*. His Initial professional areas: Computer sciences in the domains of systems analysis, data processing, computer languages and equipment-computer interface. His Areas of scientific interest includes neurolinguistics, neural networks, early literacy in children, fundamental physics. He is the Current administrator of the *General Science Journal*.

© Copyright (2021): Author(s). The licensee is the publisher (B P International).

**DISCLAIMER**

This chapter is an extended version of the article published by the same author(s) in the following journal.
International Journal of Swarm Intelligence and Evolutionary Computation, 5(3): 1-3, 2016.