I'll scream and scream and scream

Jamie screams and kicks. He throws his toys. He won't sit still, even in front of the television. He dresses in a wild selection of clothes. He impulsively attacks his siblings. He hardly sleeps. His mother takes him to the doctor and she gets Ritalin. Within a few days, he is calm. Ritalin is an amphetamine ("speed") but, paradoxically, it calms pre-pubescent children down. Jamie's mother is a convert.

Angus screams and kicks. He throws his toys .... And so on. His mother takes him to the doctor. The doctor does not see Angus's problem as medical. He suggests a parenting course or family therapy. Angus's mother is reluctant, as are his siblings. They are fed up with Angus and want him to stop destroying their things now. The therapy route is a long, hard haul. Will Angus's mother be able to grit her teeth and persevere?

Otan is in trouble at school. His teacher is saying that she cannot deal with him. He is seven but behaves "like a three-year old" at times, can scream and kick, throws things. His schoolwork is fine, but they are thinking of an educational psychologist. Is he, dread word, "hyperactive"?

A recent media spat (in The Daily Mail) has revived the debate about hyperactivity. On the one hand are the doctors who treat the "probably one per cent" of children with attention deficit disorder (ADD) with Ritalin. On the other are the psychiatrists and neurologists who see the "no more than one per cent" of children with ADD as distracting from the undoubted problems which many families experience with children who are hard to control. While wild media frenzy may have created a specious conflict between points of view, there is no smoke without a fire. In this case, there are two fires.

First, as in the fictionalised examples above, it is commonly boys who are said to be "hyper-active" and it is their mothers who have the problems controlling them. Some connection here, surely, with ideas of masculinity and femininity? It's hard to credit explanations which ignore this dimension and only talk of hormones, sensitivity to artificial additives to foods, environmental pollution and so on. In any case, is another powerful chemical the answer to biochemical imbalance?

Second, there is the all-pervading blameillness double bind. Under this cruel edict, anything that happens to anyone is their own fault. They must take the blame. The only exception is if they are ill, in which case they need help - a lot of it - and it is probably someone else's fault. This world view leaves no place to be unfortunate, or not particularly competent, in a situation which you cannot make wonderful but which you could improve with effort. This, of course, is the situation of having to parent a difficult child.

Who can blame parents in this situation if they opt for the medical model, especially if the alternative is the moral model in which "it's all the fault of the parents" is going to be trotted out? Yet it is not necessarily helpful to dose a child with drugs when his behaviour could be altered by firm, consistent responses by those around him. Or by helping those around him to establish some firm, consistent responses.

There is that one per cent of children who do, for whatever reason, have a brain chemistry malfunction, and they will benefit from medication. But there are a lot of other children who just have ants in their pants, a short attention span, poor impulse control, inability to see the other person's point of view. Some of them are "boys who will be boys" and some will take machismo all the way and become delinquent; some will behave so badly to their parents that they get battered; some will grow up to be England footballers.

Most of them, given a reasonably stable, exasperatedly affectionate home, will just grow out of it. As Otan's mother says, "He's just a fidget. He's not one of those children you can just tell to sit down. You have to keep telling him to sit down."And telling him, and telling him. But hey, it's not as if the rest of us have such perfect children that they never have to be told things twice, is it?

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