Is ADHD Real?
When I told people that I was spending the summer working at a treatment program for children with ADHD, the response I often got was something along the lines of “doesn’t everybody have ADHD?” I distinctly remember one friend of mine who spent his summer working in a regular sleep-away camp responding that “in that case, I’m also working with ADHD kids, just unofficially.”
It’s hard for me to blame people for these reactions. The fact of the matter is that the media paints a very negative picture of ADHD. In the past 6 months, the New York Times alone has published articles entitled “More Diagnoses of ADHD Causing Concern” (March 31st), “Diagnosing the Wrong Deficit” (April 27th), and “Concerns about ADHD Practices and Amphetamine Addiction” (February 2nd), among others. One of the most popular talks on TED.com is entitled “How Schools Kills Creativity” by Sir Ken Robinson, in which the speaker dismisses the validity of ADHD as a psychological condition, stating that “some people have to move to think.” Judging by the rhetoric streaming forth from the internet and media, ADHD sounds more like a conspiracy theory than a real condition affecting the lives of numerous children.
After having studied ADHD and worked extensively with children diagnosed with ADHD, I believe that the attitude of Ken Robinson and the mainstream media towards ADHD is very dangerous. The children whom are most affected by ADHD are often not well adjusted. Many of them have pronounced social deficits and have few, if any, friends. Both their inattention and hyperactivity (which often translates into aggression) have negative social effects which drive peers away from them. No one – not even a child – wants a friend who literally does not listen when they speak. A lack of impulse control often results in meltdowns and an inability to exhibit basic self-control when something does not go their way. No child wants to play baseball with a kid who is going to throw a tantrum after getting out.
The deficits in school are even more pronounced. It goes without saying that the inability to focus and remain seated quite simply does not fly in a classroom. This is why children severely affected by ADHD often work individually with paraprofessionals in the classroom, in small groups, or in non-traditional classroom settings. However, their lack of focus means that they are missing out on key information that the teacher is trying to impart. Groundbreaking new research has also shown that children with ADHD show significant deficits with organization, time management, and planning (OTMP) skills, making school (and later in life, work), even harder for them. It’s not that they have to “move to think,” it’s that when they are moving, unfortunately, they are often not learning.
Fortunately, the situation for many children with these deficits is not as bleak as it sounds. There are many excellent options available for children with ADHD, as well as their parents and teachers. Behavioral modification strategies such as interaction therapies, frequent reinforcement of positive behaviors, and reward schedules have proven very effective. There are clinical psychologists, psychiatrists, and researchers who are constantly discovering new methods and improving older ones.
And, yes, there is medication. Medication is arguably the most controversial topic with regard to ADHD, and its abuse is the focus of much of the media’s attention. That said, medicines such as Ritalin, Adderall, Focalin, and Intuniv, among many others, improve the lives of countless children on a daily basis – when taken as prescribed under the auspices of a medical doctor.
To give a personal account, one child I worked with took a daily medication for ADHD. When medicated, he was intelligent, friendly, and generally very well adjusted. Off his medicine, however, he would lose control. He would become oppositional, aggressive, and act impulsively. He entered a zone which made him unapproachable. For children like this, medication along with therapy, can be the difference between success and the possibility of utter social, academic, and psychological breakdown.
I agree with some of the gripes of professionals and parents about our approach to ADHD. There probably is too much medication going around. Though I do not believe medication has to be a last resort, doctors must carefully mull over the decision to prescribe psychotropic medication. Hyperactivity in a classroom is also not necessarily ADHD. It can just as well be a sign of avoidance due to anxiety, or a host of other behavioral functions. Doctors have to analyze the behaviors of the child very carefully before deciding on medication. Additionally, many problems have arisen when medication was not used as prescribed. These medications are only safe when used by the person it was prescribed for, taking the prescribed dose. Giving out medication to friends is both illegal and very dangerous.
One other issue with the way we approach ADHD is the gender issue. ADHD is much more commonly diagnosed in boys than in girls. This can mean one of two things: Either this really is a problem associated with boys, in which case we have to examine why that is, or ADHD manifests differently in girls than boys, and many girls with ADHD are going untreated. Numerous studies show that aggression is often seen as socially acceptable for boys, while it is seen as anti-social for girls. Therefore the case might be that girls are more likely to exhibit other behaviors, such as inattention, which are less noticeable. This gender difference must be explored more.
Our approach to ADHD has implications that extend beyond ADHD. I think there is a tendency for people to say that people with mental disorders, who appear to be functioning normally, do not really have a “disorder.” No one will say that a schizophrenic who runs around thinking the CIA is chasing him does not have a disorder. However, it is often hard for us to understand that the child sitting next to us in class may have a behavioral disorder, or that our friend has a mood disorder; it’s difficult to grasp that these conditions are real handicaps. Some like to talk about there being a “stigma” to psychological disorders. I actually think it is the opposite—we have become so comfortable with these disorders that we do not take them seriously. “Oh, your child has ADHD? Join the club!” The truth is that people suffering from disorders – though they may be functioning – have struggles in areas that other people take for granted.
ADHD, like any other disorder, does not define anyone. However, it is a real condition with real-life social and academic effects on children. When the media and figures like Ken Robinson downplay the significance of these disorders, describing ADHD as “kids who need to move to learn”, they are, often inadvertently, trivializing the struggles that thousands of children endure on a daily basis. We should not be rolling our eyes and focusing on the few people who became addicted to amphetamines.
The story we should be telling is one of triumph, of the countless children who work day in and day out to overcome this condition.
