Are Children with ADHD just 'Naughty Boys'? Part 1

I met Dr. Sami Timimi in Lincoln, England in the autumn of 2001. He was a psychiatrist working in the Child and Adolescent Mental Health Services (CAMHS). I was doing my child placement there towards a Statement of Equivalence in Clinical Psychology.

Dr. Timimi was a controversial man. My placement supervisor Pete Ludlow had told me that Dr. Timimi did not believe that ADHD was a psychiatric disorder but a behavioral condition. Timimi was, therefore, opposed to medication, which he considered tantamount to poisoning children without delivering any sustainable benefits.

In Ludlow's view, Dr. Timimi's vocal opposition to medication was creating hurdles in the way of appropriate treatment. Pete thought that advising parents against the use of medication did more harm than good and that children were unnecessarily being deprived of evidence-based treatment.

What was the evidence base that Ludlow was talking about? Well, the most common treatment for attention-deficit hyperactivity disorder or ADHD is stimulant medication such as Ritalin. Many psychiatrists recommend combining medication with individual counseling and family therapy. Some studies also claim that ADHD has a neurological basis but the evidence is mixed at best.

I decided to approach Dr. Timimi for a clarification. Why did he not accept the 'neurological evidence' or the evidence base for effectiveness of stimulants. He was kind enough to answer all my questions and also gave me a free copy of his book 'Naughty Boys.'

Let me summarize his arguments: The Western culture is a hyper-masculine culture where mothers are blamed for children's behavior problems. Many mothers are single parents and a majority of teachers are also women. This places a double burden of blame and shame on women, who are relieved when the blame for the boys' misbehavior is shifted from them to the boys' brains.

In pre-modern societies, according to Dr. Timimi, boys' rowdy behavior was dealt with by the fathers with a firm hand. 'Spare the rod, spoil the child' was the motto of the public school headmaster who enforced discipline through an elaborate system of punishments including corporal punishment.

Are you advocating a return to physical punishment? was the logical follow up question to which he replied with an emphatic no. Instead he suggests the following:

-Dietary Interventions

-Family Time

-Fresh Air and Exercise

-Limiting time spent on TV and computer games

-Bedtime routines

-Chores

-Responsibilities, trust and independence

-Emotional Support.

A detailed account of these interventions can be found in his book Mis-Understanding ADHD: the complete guide for parents to alternatives to drugs. One may not fully agree with him, but I did finally understand where he was coming from.

Five years later when I moved to Pakistan, I heard an even more stunning statistic. A survey of school teachers done by the GCU Clinical Psychology department had revealed that nearly 60 percent of the children were considered as having ADHD by the teachers (To be continued).