ased on how you define things, or the words you use to describe those things, the process of labeling alone may help create your perceptions of reality and the way you see the world. In one of my books, I used the drawing below to illustrate this fundamental point.

Labels as Perceptions of Reality
This simple drawing is presented so you can see how perceptions change as the words or labels used to describe the drawing change. First, however, please look at the drawing, and let your imagination go. What do you think it could be? What does the drawing represent? Look at it for a while before proceeding.

Is it a picture of flies stuck to a Shell Pest-Strip? A window with curtains half open, revealing snowflakes or rain outside? Germs under a microscope? People seen from the top of the Empire State Building? A partially open observatory dome showing the stars? Although the lines of the drawing never change, one begins to perceive them differently once a word, a label, a trait, a concept, or a belief is attached. From what I understand, this picture is actually a drawing in a museum entitled, "A giraffe passing a second-story window." In response to the suggestion that the drawing is a giraffes neck passing a second-story window, one sees it as a giraffe. One begins to see it, to believe it, and to react and feel toward it as if it were really a giraffe.

This fundamental principle-that the words used to define a concept have profound effects on the way the world is seen-is one of the critical problems in education in general, the whole area of learning disabilities, and the concept of attention deficit/hyperactivity disorder, specifically.

Schools Plus the Medical Model Equals the Diagnosis of Kids
There are two major conceptual ways to explain school related discipline problems. One is from a social, cultural, psychological, educational, training, or learning perspective; the other is to explain these problems from a biochemical, neurological, medical model. Both of these ways of conceptualizing the world have profound effects on the way problems are seen, and the way intervention is undertaken.

In the past thirty years, the medical model has infiltrated psychology and educational institutions in a big way. The Diagnostic and Statistical Manual (DSM), the psychiatric bible of labeling individuals, has grown from about 60 disorders in its first addition to over 300 disorders in the fourth edition. Almost all of these disorders, largely created by committee, have fallen prey to the medical model's assumption that any deviations or variations from "normal behavior" are "caused" by genetics or a biochemical imbalance. In recent years almost every behavioral phenomenon has moved from a psychological, educational, learned or choice perspective to a medical model, genetic, biochemical imbalance determined perspective. Fears, anxiety, phobias, compulsions, eating disorders, learning disabilities, ADHD, alcoholism, etc. are just a few of the now popularly believed medical disorders. I've also read reports in which the medical field is trying to link violence, criminality, homosexuality, and even marital infidelity to genetic and biochemical imbalances.

Most disheartening to me is that within two to three decades proponents of the medical model have created a delusional reality that millions of American children, mainly males, are biochemically imbalanced, neurologically defective, genetically flawed rejects, and, in some shape or form, handicapped--regardless of the fact there is no hard scientific evidence to substantiate their position.

Some years back, Stanton Peele wrote a book, The Diseasing of America: Addiction Treatment Out of Control. The main thesis of the book, which dealt with how various addictions, such as alcoholism, moved from a cultural, behavioral, characterlogical problem to a very profitable medical "disease", could be applied to various educational difficulties and the book could be retitled, The Diseasing of American Children: Biomedical Treatment Out of Control in Our Schools.

A good example of the magnitude of the shift in education from a cultural, learned behavioral perspective to a medical modal perspective would be the assumed "biochemical disorder" of attention deficit disorder (ADD), or attention deficit/hyperactivity disorder, (ADHD). If this biochemical disorder were true, then within a normal distribution curve of all children there would be a "magical diagnostic" line that would separate normal biochemistry from abnormal biochemistry.

The ultimate question is, is there any test or assessment instruments that can determine this biochemical imbalance, let alone the magic line that differentiates the groups? The answer emphatically and absolutely is no. If you have doubts about what I say, I challenge you to critically reread the literature on AD/HD. As a way to challenge your thinking about this literature and, I hope, see there is no substantiated evidence for this medical model perspective, I give you two examples, out of hundreds which say the same thing, that there is no proven evidence for a biochemical imbalance. The first is taken from School Psychology Review - VOLUME 20, NO.2, 1991. This particular section of the journal was designed to inform us about the "Neurobiological Basis of ADHD" and was written by George Hynd, Kelly Hern, Kytja Voeller, Richard Marshall. I have underlined words or phrases which will point out the speculative and unsubstantiated position of their argument.

Note particularly the last paragraph in which the authors say, "It is relevant to note that none....", yet their conclusion some how suggests a neurobiological basis for ADHD.

As a second example, look at the 1991 Zametkin study that has been cited by CHADD (The parent organization for Children with ADHD), Barkley (a leading expert on ADHD) and Time Magazine as proof that there is a biochemical basis for this disorder. Listed below are some excerpts from the original study. Again, I have underlined the speculative words and phrases and have made some comments which are italicized.

These two examples from the literature are typical. Their conclusions sound convincing, but on closer examination, they have no evidence to substantiate their conclusions, yet many people assume a case for biochemical causes of ADHD has been made. Witness some of following news releases. (My underlines for emphasis.):

The Zametkin study, which really showed nothing and proved nothing, found the front pages of the Washington Post, New York Times, and other major newspapers, with four major television networks all carrying the same story on November 15, 1990. That was the day before Congress voted on whether ADHD should become a handicapping condition under Individuals with Disabilities Education Act (IDEA). I personally find it interesting that four years later, just before Congress was slated to begin procedures for reauthorization of IDEAS, Time Magazine, July, 1994, dedicated its cover story to ADHD. As evidence of this disorder they showed the same pictures of the "no differences in the brains" that Zemetkin found in 1990. Despite the fact that ADHD has been extensively studied, there is no biochemical or medical evidence to determine this disorder. If leading medical or psychological experts on ADHD were given the biochemistry, the PET scans, the MRI's, the evoke potentials, genetic information, or any other medical information from children with ADHD and an equal number of children that were considered normal, could they tell you which group was which? The answer is no, they cannot. Yet, pro ADHD groups do not even question the medical bias and because of that millions of children have been labeled as biochemical-genetically flawed individuals. Most estimates of the incidence of this supposed disorder are in the 3 to 5% range. I find it interesting however, that in a recent report submitted to the Department of Education, so they could have accurate information to help make policy, Shaywitz and Shaywitz estimated that from 10 to 20 percent of all children are ADHD. There are roughly 66 million school aged children in America. Ten to twenty percent equals 6.6 million to 13.2 million children that are supposedly ADHD, and biomedically flawed, according to Shaywitz and Shaywitz. All of this is based on an unsubstantiated medical assumption.

NO PHYSICAL MARKER, NO TESTS FOR THE PHYSICAL CONDITION, THEN WHAT?

ince there are no medical tests and there are no physical markers which can demonstrate this "disorder", how does the profession determine that a child has this disorder? The answer is, they ask the parents and the teachers if they believe the child has the disorder, using rating scales and assessment instruments. The scales ask questions of the parents and teachers which for all practical purposes end up being, "Is this child a problem to you?" If the results of the questionnaires are above a certain theoretical cutoff score then the child could have the disorder. The really technical diagnosis and assessment of ADHD amounts to nothing more than asking teachers and parents for their opinion. Read the following excerpts regarding asking the parents and/or the teachers via questionnaires about ADHD.

"... the good news is that once diagnosed--through a detailed personal history -- ADD is treatable, either with stimulants such as Ritalin or antidepressants..."

DIAGNOSIS EQUALS MEDICATING

nfortunately, if the medical model says that a particular set of behaviors is an "illness, disease or disorder" the solution and the only intervention they have to offer to solve the problem is medication. The following chart emphasizes just how much methylpenidate (Ritalin) is being consumed in the US today compared to other countries.

If ADHD is biological, I assume that roughly equal numbers of children in different countries, states and zip codes within those states should have the disorder.

It is clear from Fig. III that this is a disorder mainly in the United States - 1,758,000 grams of Ritalin consumed in 1991. The next closest country in consumption was Canada with 160,000 grams. When you combine the rest of the total world's use of Ritalin (over 80 other countries), the United States uses three times more Ritalin than the rest of the world combined. The more recent 1992 and 1993 data shows that the use of Ritalin in the US has more than doubled and Ciba-Geigy, the manufacturer of Ritalin, was running out of Ritalin and petitioned the government to increase its production quota. (Ritalin is still a Class II, highly addictive drug which is in the same classification as amphetamines and cocaine and the production quotas are regulated by the government.) This 1991 data is relatively old. The point to keep in mind, however, is that the use of Ritalin increases each year at an ever increasing rate. The 1995 DEA background paper on methylpenidate (Ritalin) indicates that the US now uses five times the amount of Ritalin than the rest of the world.

The use of Ritalin by state within the United States is also interesting. According to the Drug Enforcement Agency, in 1991 the top states in the use of Ritalin in grams controlled per 100,000 population were: 1. Idaho - 1401.25; 2. Michigan, 1206.09; 3. Utah, 1116.98;

4. Ohio, 1114.19; 5. Iowa, 1073.49; all the way to the low usage of Hawaii, 338.62 and Maine, 283.61.

Within these states the increased difference in grams of methylphenidate used from 1990 to 1991 by specific three digit zip codes (see Fig. IV) show some of the top locations in this country to have the disorder:

GRAMS INCREASE IN ONE YEAR(1990-1991)	CITY	FIRST 3 DIGITS OF ZIP CODE
7587	COLUMBUS, OH	431
3727	PHILA., PA	190
3454	INDIANAPOLIS, IN	462
3383	HOUSTON, TX	770
3290	BIRMINGHAM, AL	352
3203	CLEVELAND, OH	441
3190	LAFAYETTE, LA	705
3085	CINCINATTI, OH	452
2499	ST. LOUIS, MO	631
2445	ROCHESTER, NY	146
2374	SOUTH BEND, IN	465
2328	HOUSTON, TX	773
2294	TAMPA, FL	336
2235	SUBURBAN, MD	208
2209	FT. WORTH, TX	760
2161	ST LOUIS, M0	630
2157	FT. WORTH, TX	761
2119	DETROIT, MI	481
2034	OAKLAND, CA	945

It is interesting to note that the change in one year within any one of these three digit zip codes represents more Ritalin used than the total change in some states or even more Ritalin used than most countries in the world. In the US, school psychologists and principals have told me that they can have almost any child walk into certain doctor's offices, clinics or hospitals and know the child will come out with a diagnosis of ADHD. In Louisiana recently, some principals told me that since ADHD has become recognized by law in their state, the school staff spends anywhere from an hour to two and a half hours a day just handing out the medications, where two years prior to this they could count the number of kids on medication in the entire school on one hand.

A Colleague of mine asked a psychiatrist what basic information he needed to obtain from the school and the parents regarding what they had done to change the child's behavior, instruction, curriculum, and/or home or school environment, and how long were these changes in place and evaluated before he considered a child ADHD and put him on medications? Based on the nature of this question one might wonder what basic research has been done with regard to educational, and family interventions; what priority has been given by the Department of Education to researching these interventions rather than just accepting the medical models assumption that this is a biochemical genetically caused disorder. The Chesapeake Institute report to the federal government entitled "Executive Summaries of Research Synthesis on the Assessment and Identification of Attention Deficit Disorder" by James McKinney, Marjorie Montague and Anne Hocutt indicated, of the 1,300 articles reviewed which were relevant to assessment and identification of children and youth with ADD, the research on educational characteristics was "limited." "Only about 90 articles even reported education characteristics" and of those 90 articles there was "very little replication of studies." (Does that mean at least one or two were replicated?)

If you systematically investigate this subject, not only are there "very few" studies on any relevant educational or family variables, but few if any are well designed longitudinal studies on any outcome measures either educational or medical. See if you can find any definitive data on just basic demographic information -- socioeconomic status, racial or ethnic backgrounds--for this supposed biological disorder. Why isn't this information available? This is the most studied disorder of childhood. There have been over 10,000 studies done on ADHD, yet there are no basic demographics, let alone well-designed longitudinal studies on any meaningful educational or family outcomes. Why not? From what little demographic data is available however, the trend seems to be an increase labeling of the poor, lower SES students and especially minority Black and Hispanic males.

This disorder which varies so widely by country, state and zip code, which has no physical markers, no agreed upon definition, no agreed upon assessment and no relevant basic research, also has the unique ability to vary by social contexts. Dr. Russell Barkley, one of the supposed leading experts in the ADHD field, has outlined eight situational task factors that have been observed to affect symptom severity in ADHD, (i.e. one-to-one versus group situations, fathers versus mothers, novelty versus familiarity of the setting or task, etc.) It would be interesting to see how the experts explain how this biochemical disorder knows to turn off the symptoms when Dad walks into the room. At a large four state convention in Kansas for teachers of the emotionally disturbed, one of the major key-note presenters, a psychiatrist, used his hands and fingers to indicate how the neurons worked. He wiggled the fingers on his right hand to indicate the firing of the neuron; used the space between his hands as the neuro-synoptic junction between the dendrites and axons that the neurotransmitters had to cross over; and used his left hand as the receptors of these neurotransmitters which when received properly would then fire up his left fingers so they would wiggle. He then indicated that because of some type of biochemical imbalance the wiggle finger right hand impulses could not be transmitted across the space and make the fingers on the left hand wiggle which, if this were to happen, would somehow inhibit the child's inappropriate behavior. But, he said if we "gave him the gift of Ritalin" it would rectify the imbalance of the neurotransmitters and allow the right hand wiggle finger impulses to cross over the space and start firing the fingers on the left hand receptors, which then "of course" inhibits the child's inappropriate behavior. Combining these two lines of thinking perhaps we should give the child a different gift besides medication. Perhaps we should give those poor imbalanced neurotransmitters the "gift of Dad's" so those left fingers can wiggle to inhibit the symptoms.

The proponents of the medical position draw analogies between ADHD and other real diseases, such as diabetes. The symptoms of other real diseases do not change as far as I know when Dad walks into the room, nor do they change if the child is examined one on one or in a group.

If a child's symptoms vary based on social contexts, it would appear that the child has some degree of control over his behavior; has learned when or when not to behavior; and could be taught to control his behavior in other situations. If a child can control his behavior in church, when dad is around, in third period when the principal walks into class, in fourth period because he likes the teacher, or when a teacher or adult takes a firm stand and stops the child's inappropriate behavior -- then this child is capable of controlling his behavior and can be taught how to control his behaviors in other situations. Why? Because he has already demonstrated to you that he has "learned" to control those little neurotransmitters in "various situations." We need to get back to educating and training children rather than medicating them.

The picture of the giraffe passing the second story window graphically illustrates how one interprets the world is based on the beliefs held about the world. The picture (the lines and dots), or the facts (the child's behavior) are the same. The interpretation of the facts depends whether one has a medical or an educational bias. If it is a medical bias, the child is seen as incapable, diseased, and a flawed individual-someone who can't control his behavior. If there is an educational bias, the child is seen as capable and in the on-going developmental process of learning to control his behavior. There is usually overwhelming evidence that the child is capable and can control his behavior. The intervention strategy from this more hopeful and optimistic perspective is obvious and simple to understand, but often times difficult and time consuming to do. It requires adults to continue to teach, educate and expect children to behave and learn to be responsible for their behavior, and actions.

In my opinion, this nation better stop believing that there is a quick medical fix to all our social, academic and behavior problems by giving our children a pill, and begin, instead, to take responsibility for our children in an ongoing, caring, loving, involved, committed, developmentally appropriate long term basis by educating, parenting, teaching, training and disciplining our children -- and hopefully teaching them well.

••If you are interested in more information on the biomedicalization of education and psychology in general and ADHD specifically, I suggest you read the references in the Bibliography for Alternative Views on ADHD and/or order either my video tape on The Myths of ADHD and/or Dr. Breggin's videos and books on ADHD. (www.breggin.com)