April 11, 2009

ADHD: Does ADHD exist?

I am sometimes asked if ADHD is a real disease. There are good reasons for questioning.

Medicine doesn't always get it right, and there's no reason to believe that the way we currently think of certain diseases is the way they will be diagnosed and treated a few years from now. I picked 3 examples. It wasn't until 1974 that the American Psychiatric Association announced that homosexuality wasn't a mental illness. They made this decision by a vote. Until 1982, generations of people were told that their ulcers were because of their 'Type A' personalities, anger issues, or stress. There was a body of research supporting this. It was shown to be complete nonsense, needless to say, when the bacterial infection that causes stomach ulcers was found by Australian scientists. My favorite is the long medical history of 'hysteria' in women and its curious treatment. I read a fabulous book about it, bought lots of copies, and sent one to everyone I knew (knew well, anyway).

ADHD has a long history. In 1902, a group of children, all boys, were described to be unusually impulsive, overactive, attention impaired, and accident prone. This particular group was also defiant, dishonest, and aggressive. We'd probably define them as Oppositional-Defiant. There was an epidemic of encephalitis in 1917-18, which left some affected children with these symptoms. So doctors at the time reasoned that the behavior issues were a result of brain damage. As more children with these problems were identified, and most were found to have no history of illness or injury, and most were of normal intelligence, it acquired the name of 'minimal brain dysfunction.' By the 1960's, 'hyperactive child syndrome' was defined. Just a few years ago, the group of diagnoses were divided up so that we could distinguish kids who were mostly hyperactive from those who had attention problems.

What became of those 'spirited' children, mostly boys, in the past? Before there was mandatory education, there was plenty for a child who wanted to keep moving to do on the farm. While some tasks required careful attention, it's not hard to imagine a kid doing a wide range of tasks to keep him interested or major tasks under careful supervision. Girls who daydreamed might never have been the most productive makers of needlepoint samplers, but there were many jobs for them to do, too. I believe that the conformist model of education which requires long hours of sitting quietly at a desk is exactly the kind of environment which will accentuate the symptoms of ADHD and call affected children to our attention, maybe even for treatment.

I do not believe, however, that ADHD is simply a cultural issue, and if our children were allowed an unstructured childhood, they wouldn't have the problem. In an unstructured environment, the natural inclinations of kids with ADHD would lead to their unsustained learning of anything in particular, and failure to acquire necessary knowledge and skills. The lives of truly ADHD children are filled with dysfunction in all areas of life--school, social interactions, relationships with parents and siblings.

Should we avoid medication by getting these children out of the school setting? This ignores the intellectual potential of the child, which is unrelated to their attention issues. In fact, medication for this problem has been used for about 50 years and has been well studied. It's one of the surest treatments we have for any kind of medical problem. Stimulant treatment shows clear success when done carefully and with good monitoring. Parents are sometimes afraid of the potential for substance abuse, but teens who aren't treated have significantly higher rates of substance abuse than those who are treated. And if you're reading this, you've probably successfully finished quite a bit of school. Statistics show that those who fail at school have a very hard time in our society. So maybe the strategy should be to help every child do as well as they possibly can do, and try to keep them advancing in school as far as they can go.

Next Post: ADHD in girls.

The photograph above is from about 1932, by Dorothea Lange, taken for the Farm Services Administration. Sorry, but it's the only photograph I had of kids on a farm.


  1. Having spent many years working with children and families who were involved in the child welfare/deliquency system, I learned early that there was a high percentage of my clientele who appeared to have an Attention Deficit Disorder AND who used illegal drugs to self medicate. Beverly Eller

  2. I was diagnosed as an adult, so I can say that not having known these things as a child, I grew up to be a very broken man. Although I continue to try to keep moving in treatment, there are just some things you can never leave behind. My ADHD has completely went off the handle for the last two years while I attempted to keep my already shaky life foundation in tact when moving into adulthood. Other then problems with anxiety, depression from feeling worthless since kindergarten, it wasn't until I finally became consistently medicated that I realized that my grave eating habits were actually anorexia that subconsciously came up with the ADHD package. I enjoyed a short period of being able to eat more then three bits of food per day and some much cherished mental sanity until I began a going unmediated again. After a couple months, I just cut my losses and started buying my medication on the street so I could go to class and start eating again.

    Now with being medicated properly again, I hope no one ever has to go through what I went through trying to find a doctor.

    I honestly think it's time for a cultural wake-up with this. Instead of accepting that diagnosis of ADHD has really just begun, critics with their full sized frontal lobes have already begun the "over-diagnosed" label. Do you think it's just coincidence that there are a higher percentage of delinquency when ADHD is involved? Of course not, instead of beating their children senseless because of 'unexplained behavior problems that just so happen to be showing a very distinct pattern', these parents should have the kids checked out.

    It's not easy, in fact- it's a bit of a shame. Then again, we all do have to admit that the medical community is being very responsible in their reactions to the criticism... "While we appreciate and consider your input... you were not qualified in any way to even have an input on this." :D


Please let me know what you think. Do you know a child or situation like this?