ADHD Nation Children, Doctors, Big Pharma, and the Making of an American Epidemic

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Alan Schwarz

ADHD Nation is as important for understanding the evolution of the diagnosis and treatment of attention disorders, the role of Big Pharma, and how attention disorders have been mismanaged as are the books NeuroTribes and In a Different Key for understanding the evolution of our understanding of autism.

Alan Schwarz is an award-winning investigative journalist whose work made public the seriousness of concussions in the NFL. Like concussions in sports, the potential side-effects of ADHD medications have been largely ignored. Big Pharma and the scientists they support have been complicit in this omission.

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ADHD medications have the potential to improve attention, motivation, and energy which is not dependent on having ADHD. When used properly, the drugs can help many people and the side-effects are minimized. But the statistics make it clear that the condition is being over-diagnosed in this country. The drugs are also being used (and misused) by many high school and college students and by others who feel that they need a boost and have never been diagnosed. The causes of their problems are not being investigated nor are other possible means of treatment. Consider the following…

In the 1930s, a drug was developed with the goal of treating asthma or nasal congestion which, serendipitously, was found to make people feel good. Smith, Kline, & French “licensed it before knowing exactly what medical condition the stuff might actually treat. Finding out was a lot easier then than it is today: Lax federal regulations did not require any proof of safety, let alone efficacy, before a drug was released for public experimentation. So SKF sent boxes of what it called ‘Benzedrine sulfate’ to any doctor willing to try the drug on patients with various ills, from asthma to postpartum depression.”

Due to known problems with amphetamines, a close cousin to amphetamines was developed to have the same effects with fewer side effects. “CIBA termed the chemical formulation of this drug ‘methylphenidate’. The company released it to the American market in 1956 as Ritalin, a treatment for narcolepsy, chronic fatigue, depression, and erratic behavior caused by senility. (Again, only in adults; the medication was untested in children.)”

Dr. Keith Connors, author of the Connors Rating Scale, is the best-known researcher in the field of ADHD. “Connors needed no questionnaire to assess the effects of Ritalin on himself. Late one afternoon, following an exhausting day in the lab, he had to attend an eight-p.m. lecture by Harry Harlow, a behavioral psychologist famous for locking young monkeys away from their mothers and studying their emotional demise. Knowing he’d never stay conscious for the whole thing, Connors found the tub of Ritalin capsules so generously donated by CIBA and took one. Within thirty minutes he snapped awake and thought to himself, ‘This is fantastic!’ He kept working until eight. He skipped dinner. He zoned in on the lecture, chatted with folks afterward, and stayed up until three in the morning. Just one dose felt so beguiling, that he never tried the stuff again for the rest of his life.”

In the early 1990s, Obetrol was an amphetamine which was prescribed for weight control but it was not a financial success. After a pediatrician discovered that it worked for some children who did not respond well to Ritalin, Obetrol was remarketed as Adderall.

“Psychiatry journals teemed with more than a thousand studies on ADHD conducted by Biederman, Barkley, and other pharma-sponsored scientists. The Food and Drug Administration relied on them when green-lighting medications as safe and effective. Their findings served as the backbone for the lectures that drug companies’ key opinion leaders delivered on world tours. The whirlwind created a self-affirming circle of science, one that quashed all dissent.”

“While almost all other developed nations immediately closed the loophole that Metadate had exploited – expressly banning direct-to-consumer advertising of controlled substances, usually through legislation – the United States sat back and let the market take over. To this day, the United States is only one of two developed nations that allow advertising of ADHD medications to the general public.”

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“Appallingly, some children have heightened anxiety interpreted not as a side effect of medication, meaning the drug should be reconsidered, but a new condition needing additional treatment…. Diagnosing young children with several overlapping psychiatric conditions became de rigueur in the 2000s, resulting in what some call a ‘medication cascade’. No doctor was more responsible for the trend than Joe Biederman up at Harvard, who evaluated dozens of drugs on behalf of his Big Pharma benefactors and almost invariably declared them safe and appropriate for children with multiple diagnoses like ADHD and bipolar disorder. Yet neither he nor anyone else tested the performance or risks of these drugs in combination – no pharmaceutical company would ever sponsor such a study, considering it too risky to their product’s reputation.”             “Adderall and methylphenidate have always been among the most addictive substances in medicine. Weird as it may sound, stimulants are dangerous by being not dangerous enough – the drugs have found a sweet spot in which their advantages are more common and immediately obvious than their more latent risks, lulling all involved into complacency.”

“Today, misuse of ADHD medications by high school students is far more widespread that most anyone realizes. About a million high school kids nationwide use Adderall, Concerta, Vyvanse, and others without a doctor’s prescription, getting them either from friends or from dealers for a few dollars a pill.”

“Dozens of studies since the 1990s have estimated that about 8 to 35 percent of undergraduates take stimulant pills illicitly to try to improve their grades; a reasonable estimate among high-pressure colleges is probably 15 to 20 percent. Most students, of course, don’t experience terrible outcomes – if they did, the dangers would already be better recognized. But many do. One 2006 study found that about one in ten adolescents and young adults who misused ADHD medications became addicted to them, with some of them becoming psychotic or suicidal.”

“A different study found that teachers suspected ADHD far more often in elementary school children whose birthdays made them one of the youngest in their grade – just a tick over six, say, when the rest of their classmates were nearing seven. Therefore, many kids were being diagnosed merely because they were born in the wrong month: ‘The youngest children in fifth and eighth grades,’ it concluded starkly, ‘are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.”

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At the end of his working career, Dr. Keith Connors sent a letter to a colleague and closed with the following: “Beware the simple & sovereign explanation.” That is good advice to all of us.

Alan Schwarz includes in the book a mock doctor/patient interview from a certified continuing education program purported to teach physicians how to diagnose ADHD. From the start of the conversation to the writing of the Rx was six minutes. Also, it was not revealed that there was a possible conflict of interest but the following was discretely printed at the end: “Supported by an independent educational grant from Shire.”

http://www.psychologytoday.com/tests/health/adhdattention-deficit-disorder-test

There are many possible causes for ADHD behaviors other than primary “brain dysfunction”. Since there is no litmus test for ADHD like blood work or imaging, ADHD is primarily a diagnosis of exclusion. Other possible causes of ADHD should be investigated and ruled out prior to considering medication. Visual problems are one of the possible causes of these signs and symptoms but so are the accelerated curriculum, fewer recesses in school, less time playing outside, more stimulation from video games, more organized activities which reduce free time, instant communication and responses, less sleep, and more pressure. Children whose problems are not primarily due to attention, may also do better with medication, but their underlying problems are not being addressed and they may be being medicated unnecessarily. “The human brain has evolved over many thousands of years, yet only in the last hundred, a blip on that time line, have we demanded that each and every young one sit still and pay attention for seven hours a day.”

MONASTRA VIDEO

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https://www.cdc.gov/ncbddd/adhd/index.html

 

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Body by Darwin

Jeremy Taylor

This book presents the growing evidence that we cannot continue to make progress in health care unless we consider the influences of our evolutionary past. Jeremy Taylor addresses seven areas:

  • Our immune system;
  • Issues regarding fertilization, pregnancy, and childbirth;
  • The effects of upright posture;
  • The development of the eye and macular degeneration;
  • The challenges of cancer;
  • Coronary artery disease; and
  • Dementia.

Each chapter stands on its own. I have chosen excerpts from his discussion of our immune system because these disorders affect such a large (and growing) number of our patients. “It is impossible to get to the root of the very peculiar human immune system and design really effective cures for allergies and autoimmune diseases without a fresh understanding of how the immune system evolved and for what reasons.” p. 7

“The world of our ancestors was a much dirtier place than it is now. Evolution took the expedient route, since microorganisms in prehistory could not be eradicated, of allowing humans to live with them rather than continually fight them. The great collateral cost of self-inflicted damage to our tissues caused by permanently raging immune systems was avoided by handing over the regulation of our immune systems to the microbes inside us, so that we ended up tolerating them. Evolution could not foresee a world where public hygiene, antibiotics, and chemicals that kill 99.9 percent of all household germs has so depleted this microbial population inside all of us that our immune systems no longer mature properly or are properly regulated, giving rise to dramatic increases in allergy and autoimmunity.” p. 8

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The author reviews volumes of research and shares a number of anecdotes including one about a boy with autism whose behavior was so uncontrollable that he had to be institutionalized. Soon after institutionalization, he had a complete reversal in behavior which was caused by chigger bites. To perpetuate his recovery, his immune system is now being treated with infusions of pig whipworms, without which his behavior regresses. This case supports the “hygiene hypothesis which links the bacteria, fungi, and helminths (parasitic worms) in our guts, on our skin, and in our airways and vaginas, with a host of autoimmune and allergic diseases. There is mounting evidence that the composition of all these organisms, living on and inside us – collectively known as our microbiota – can offer protection against a formidable list of autoimmune diseases, including the inflammatory bowel diseases Crohn’s disease and ulcerative colitis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, and, as we have seen, mental health.” p. 17

“Of all the autoimmune diseases, type 1 (or early-onset) diabetes is rapidly becoming the main scourge of life in the modern, hygienic Western world. Karelia is a large northern European landmass that used to belong to Finland but was partly ceded to Russia during World War II. As a result, the country has been partitioned. Although Russian and Finnish Karelians have the same genetic makeup, including the same susceptibilities to diabetes, the differences in their socioeconomic status and health could not be more stark. One of steepest standard-of-living gradients in the world exists at the border between Russian and Finnish Karelia, with the latter having eight times the gross national product of the former. Yet the incidence of type 1 diabetes, and a host of other autoimmune diseases, is far higher on the Finnish side. Finnish Karelians have six times the incidence of diabetes, five times the incidence of celiac disease, six times more thyroid autoimmunity, and much higher allergy levels than Russian Karelians.” p. 21

“The baby is born with a gut that is almost completely sterile and must be populated immediately with bacteria. If it is breast-fed, it starts to receive one of the most extraordinary products in the natural world. Human breast milk contains a complex array of fats and sugars – fast food – but it also contains immunoglobulin A, an antibody that protects the lining of the human gut and prevents pathogens from attacking and perforating it. It has also been estimated that a breast-fed infant receives over 100 million immune cells every day, including macrophages, neutrophils, and lymphocytes, together with a host of cytokines, chemokines, and colony-sustaining factors – molecules that signal between cells of the immune system and promote their growth. Over seven hundred species of bacteria have been found in human breast milk. It also contains oligosaccharides which the baby is totally incapable of digesting. It is present to feed the bacteria from the breast milk which are colonizing in the baby’s gut”. p. 24

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“Within a week or so after birth, the infant gut, originally sterile, has become colonized by up to 90 trillion microbes. The number of microbes in our guts eventually exceeds the total number of cells in our bodies by a factor of ten. Scientists now refer to the existence of a meta-genome to represent the combined genomes of human and microbiota, a superorganism in which we humans are the junior partner and without which we could no longer exist.” p. 27

“Our resident gut microbiota – the mass of over two thousand bacterial species identified as frequent, long-term inhabitants inside us – is extremely complex. Our relationship with them is so close and intertwined that many of the metabolic signatures that can be identified in human blood, sweat, and urine actually come from our commensal bacteria, not us.” P. 34

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“The gut has been called the ‘second brain’ and has its own dedicated nervous system embedded throughout the gut wall. It is becoming increasingly clear that our gut molecules can communicate directly with our brains, and they are implicated in brain development, brain chemistry, behavior, and mental illness.” pp. 36 – 37

This is support for the importance of children getting outside to play in areas that have a variety of foliage comes from a different perspective – as long as we check carefully for tics.

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The Power of Play

Let Them Eat Dirt

Gut: The Inside Story of Our Body’s Most Underrated Organ

Grain Brain

 

Smart Moves:Why Learning is Not All in Your Head

    Carla Hannaford

After hearing Carla Hannaford quoted many times, I decided that it was time to read this book and I was not disappointed. I started summarizing and excerpting books years ago to share with staff, but one of the primary benefits was to slow down my reading and to allow me the time to think more deeply about the implications of the author’s words. If you follow our blog, you have come across the understanding that thinking is not all in your head. We would have little difficulty with that if we didn’t already “know” that that all learning takes place in our brains. Changing our thinking, our beliefs, and our actions is much more difficult than learning when it does not require unlearning. I hope that the following excerpts cause you to pause as they have me.

Dr Williams for COVD

We have missed a most fundamental and mysterious aspect of the mind: learning, thought, creativity and intelligence are not processes of the brain alone, but of the whole body. Thinking and learning are not all in our head. On the contrary, the body plays an integral part in all our intellectual processes from our earliest movements in utero right through old age. It is our body’s senses that feed the brain environmental information with which to form an understanding of the world and from which to draw when creating new possibilities.

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Neural connections can be altered and grown only if there is full attention, focused interest in what we do. In three weeks we can get ten times more proficient at anything if we are emotionally engaged with focused interest. Self-initiated movement, exploration, interaction and physical experience for the joy and challenge of it, facilitates neurogenesis (nerve growth) for a lifetime. (This has been proven over the last decade when it comes to treating amblyopia. Intensive visual tasks for 20 minutes are more effective than hours of patching without a challenging, engaging activity.)

What we know, feel, learn, and think is shaped by how we know, feel, learn, and think. How we do these things is in turn dependent on the sensory-motor systems though which all our experience of the world and of ourselves is mediated. These sensory-motor systems shape our experience, and are shaped by it. So the story of how these systems unfold is a vital key to understanding learning.

Our proprioceptive sense constantly sends feedback to the brain that readjusts the balance of our shoulder and neck muscles in order for the eyes to remain level while reading.

Touch, hearing and proprioception are important organizers of the visual aspects of learning. Vision is a very complex phenomenon, with only a small percentage (less than five percent) of the process occurring in the eyes. The other over ninety-five percent of vision takes place in the brain from the association with touch, hearing, and proprioception.

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It’s easy to forget, or ignore, how much of vision is learned. We have to train ourselves, through books, movies, and art to see three dimensions in a two-dimensional space. We could call this visual literacy.

The eyes must be actively moving for learning to occur.

Words can only be understood when they provoke some kind of image in the mind of the learner. If students cannot access the underlying images, the words are not comprehensible; there is no context or visual understanding.

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Computer scientist David Gelernter makes this point emphatically: “Emotions are not a form of thought, not an additional way to think, not a special cognitive bonus, but are fundamental to thought.” Gelernter goes on to assert that emotions are also “inextricably tied up with bodily states. The bodily state is part of the emotion, feeds it and helps define it. This means that ultimately you don’t think just with your brain; you think with your brain and body both.”

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One of the most important things a teacher can do, especially with students with disabilities, is to bond with them. CAT scans show that children process information through their emotions first, and information that is the most emotional and emotionally relevant to them, is what students will learn. On the other hand, insecurity and fear can bring learning to a screeching halt by shutting down higher brain connections.

Another unnatural challenge has to do with learning to print block letters as the first step in writing. Printing is a highly linear process that takes us away from the more continuous rhythmic flow of language, both as it is experienced in the mind and as it is expressed through the hand – as in cursive…. Part of the problem is hand development, and asking children to perform the complex process of printing, way too early. In order to print the child must first crawl for a good long time with hands forward, to develop the bones in both the hand and to gain upper arm strength…. If you look at an X-ray of hand development, you will notice that the very intricate bones of the area near the wrist – the carpals, are not fully developed until about age twenty. The more developed these bones, the easier to hold a pen or pencil to print. If the child has had a lot of sensory-motor activation of the hand, printing can be more easily taught at about ages eight to ten.

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Children who have looked at books in the home may have already acquired some foveal focus if the process was their choice and free of stress and pressure to perform, however, most children are not physically ready to read at age five as is now mandated in our schools.

Having been flooded a number of times, flood analogies come to mind. Trying to rush development is like trying to pump the water out of your basement before the level of the ground water goes down. You waste a lot of time and effort if you start too soon because the water keeps coming back in. You are eventually successful when the water (or the child) is ready. It is easy to fool yourself about the influence that you had be starting early. If we try to push children too early, we can also create failures as some children become confused and frustrated who would have done fine when they were ready and interested. Combined with this is the opportunity cost of what these children could have been doing and learning to enrich their experiential background prior to the vicarious experience that we get through reading. There is so much that can be experienced and learned in an interesting, interactive classroom. They can even go outside the classroom where most real learning takes place.

You may think that it is a contradiction for me to disparage in any way the potential to learn through reading but we learn very little when we read about things we don’t already know quite a bit about. This book is a good example. It would have glossed off me forty years ago when I knew that all learning took place in the brain. Decades of experience has enabled me to take information from this book that I could not have understood earlier in my career.

Welcome to Your Child’s Brain

Thinking Goes to School:Piaget’s Theory in Practice

Tummy Time

Visual Factors in Reading

When will identifying vision problems that affect learning become a new standard of care?

 

Head in the Game The Mental Engineering of the World’s Greatest Athletes

Brandon Sneed

Head in the Game is about the growing use of new technologies to provide feedback on what is taking place in the brain and to use feedback to train the brain and to train the integration of the mind, vision, and body to enhance sports performance. Becoming aware of how our mind is enhancing our performance, or is getting in the way, is important to improve all visual abilities, not just those related to sports. As Yogi Berra is quoted as saying, “90% of the game is half mental”. The technologies are new, but the goals haven’t changed. To be successful, the athletes need to take what they learn from the electronics and practice to make it habitual. It doesn’t matter what you do in practice or in therapy if you can’t consistently apply your new skills to your challenges. The goal is to replace a less efficient behavior with a more efficient behavior and to have the more efficient behavior become more automatic than what you were doing before. The more automatic the behavior becomes, the more resilient it will be to fatigue and stress.

Brandon Sneed’s first example is using an EEG to provide feedback. “I do best when I put myself in a mind-set of relaxed control – not straining, but working, feeling zoned in but calm, thinking only of moving forward…. Most people need at least thirty sessions to get lasting effects from EEG training. Some, even more… It is work which may be why EEG training hasn’t caught on. It’s easy to pop a pill and see when happens, but EEG training feels almost like going to the gym.” This is the same mind-set that patients need to develop when they are learning to align their eyes, to improve processing with their amblyopic eye, and to focus better and to track better. In vision therapy feedback comes from specially designed targets which may also incorporate new technologies.

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“The reason why golf is so difficult is because you’re starting the action. Your mind wants to be in control, but the golf swing has to be done on a subconscious level. It’s impossible to think about the thousands of muscles and tendons and ligaments that have to fire in a perfect sequence in a fraction of a second.” I recently blogged on How We Read. The visual components of reading are as complex as the components of swinging a golf club and are even more difficult to observe. And, while both acts are too fast and too complicated to be directed through conscious attention, you quiet your conscious mind while swinging a golf club while in reading your brain must be simultaneously combining current input with prior input from the page, along with previously stored input, while also forecasting what is coming next.

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Brandon Sneed appreciates the importance of the placebo and nocebo effects. “Then there’s this stunning example of the nocebo effect: a study at the Oxford Centre for Functional MRI of the Brain in 2011, led by professor of anaesthetic science Irene Tracey. While studying the efficacy of an opioid drug, she found that something that should be effective can be rendered useless after a subject is told it won’t work. That’s right: even though something is scientifically proven to help people – such as a pill – if people decide it’s not going to work, sometimes it won’t.” Supporting people should be an integral component of all care from medicine, to surgery, to therapy, to coaching, to teaching. This is not in lieu of effective treatment, it augments it. If someone becomes a victim and develops learned helplessness. If they become a passive patient instead of a person involved with their care. If the expectations that are placed on them are too high or too soon and they feel that they can’t, working to change that attitude must be part of their care. The teacher is more important than the curriculum. The therapist is more important than the technique. And for coaches see The Talent Code

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“To master the mind, first master the body.” The Western World separated the mind and the body at the beginning of the Enlightenment because the connections could not be proven at that time. It took hundreds of years for this accepted wisdom to be reversed. So while we are mostly training the brain, we are doing it through the body. “Keeping the mind relaxed yet focused for extended periods of time is hard and a skill almost everyone takes for granted.”

“No performance-enhancing drug or piece of technology can compare to a good night’s sleep.” Research on sleep clearly indicates that it is our brain that needs to rest and not our bodies. This is a little like turning your electronic device off and on to allow it to reset, but our brains take more time.

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I share Brandon Sneed’s amazement as it is expressed in the following excerpt. “This brings us to one to one of the most stunning thing’s I’ve learned so far. We have five senses, right? We experience those senses because of specialized cells throughout our body called sensory receptors. Everything you feel, hear, smell, taste, and see comes from those receptors sending the information they gather to your brain. Of all the sensory receptors we have, 70 percent are in our eyes alone. That’s 260 million (130 million per eye) receptors taking information in through the eyes and sending it to the brain, by way of 2.4 million nerve fibers. This adds up to our eyes sending our brain 109 gigabytes of data every second.

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“Larry Fitzgerald, the great Arizona Cardinals wide receiver, did vision training as a child with his grandfather, an optometrist. ‘Parents need to understand,’ Fitzgerald once said, ‘that you need over 17 visual skills to succeed. Seeing 20/20 is just one of those. Vision problems can have a serious impact.’ And not just in sports, he added, but also ‘on a child’s education.’”

 

The Power of Play

Sleights of Mind

What if Everybody Understood Child Development? Part 2

Rae Pica

 

According to Marcy Guddemi, executive director of the Gesell Institute of Child Development, children are not reaching their developmental milestones any sooner than they did in 1925 when Arnold Gesell first did his research. “One of our misguided expectations right now in the education field is that every child should leave kindergarten reading. Well, not every child is going to leave kindergarten reading.” A child’s development absolutely cannot be accelerated or hurried in any way.

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Politicians pander to the ridiculous notion that education is a race. And teachers – from preschool to the primary grades – are being forced to abandon their understanding of what is developmentally appropriate and teach content they know to be wrong for kids.

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Demanding that children perform skills for which they’re not yet ready creates fear and frustration in them.

Childhood is not a dress rehearsal for adulthood. It is a separate, unique, and very special phase of life. And we’re essentially wiping it out of existence in a misguided effort to ensure children get ahead.

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We do have a great deal of research detailing the impact of stress on the learning process. Dr. William Stixrud sums it up quite nicely when he writes, “stress hormones actually turn off the parts of the brain that allow us to focus attention, understand ideas, commit information to memory and reason critically.”

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The experts insist that today’s children are no less safe than children of my generation. Stranger danger, which tends to top the list of parents’ fears, truly is a myth. According to the U. S. Department of Justice statistics on violent crimes, between 1973 and 2002, out of every thousand children kidnapped, just one of two of them were abducted by strangers. In fact, according to the National Center for Health Statistics, children are four times more likely to die of heart disease than to be kidnapped by a stranger.OLYMPUS DIGITAL CAMERA stranger

The pressure for students to spend more time on academics and to pass test after test – to win the race that education has become – is so great that basic human needs are being ignored and unmet.

  • Numerous studies have demonstrated that physically active students perform better in, and have better attitudes toward, school.
  • Movement is the young child’s preferred – and most effective – mode of learning, but we make them sit still regardless. Why do we insist on teaching children in any way other than via their preferred – and most effective – method?

When children move over, under, around, through, beside, and near objects and others, they better grasp the meaning of these prepositions and geometry concepts. When they perform a “slow walk” or skip “lightly”, adjectives and adverbs become much more than abstract ideas. When they’re given the opportunity to physically demonstrate such action words as stomp, pounce, stalk, or slither – or descriptive words such as smooth, strong, gentle, or enormous – word comprehension is immediate and long-lasting. The words are in context, as opposed to being a mere collection of letters.

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The Mislabled Child

Thinking Goes to School:Piaget’s Theory in Practice

Reading Instruction in Kindergarten

Worried Sick

A Prescription for Health in an Overtreated America

Nortin M. Hadler, MD

The theme of this book is clearly stated on the first page; “We are becoming increasingly medicalized, made to think that all life’s challenges demand clinical intervention, when the science dictate’s otherwise”. p. 1…

We don’t know why heart attacks are no longer so common or so evil. Medicine deserves little if any credit. But heart attacks are no longer your father’s heart attacks. p. 17

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