According to the DSM-IV TR, the manual that outlines generally accepted definitions of “mental disorders,” Attention Deficit Hyperactivity Disorder (ADHD) can be diagnosed when an individual (usually a child) exhibits six or more symptoms from one or both of two categories. The first includes signs of inattention such as inconsistent focus, careless mistakes, forgetfulness, distractibility, trouble concentrating, and difficulty completing tasks. The second category covers symptoms of hyperactivity and impulsivity that include fidgeting, squirming, difficulty remaining quiet or seated in school, talking excessively, interrupting, and always seeming “on the go.” The symptoms need to have been present before the age of 7 and must be apparent in at least two of four settings: school, home, job, or community. If they are only observed at school, they should not be diagnosed as ADHD. The common thread that runs through all these symptoms is the individual’s difficulty with self-regulation – with controlling his or her own behavior, feelings, or body states.
The diagnostic criteria are illuminating, but they have a significant limitation. While they describe how ADHD looks, they do not explain what it actually is. In fact, there is no generally accepted explanation, although there are a number of viewpoints. Most of them seem to concur that that ADHD has to do with the way a person’s brain is “wired.” Where they disagree is in their opinions about how the “wiring diagram” is determined.
Many base their opinions on scientific research. Some studies have concluded that ADHD is associated with environmental factors such the chemicals found in food preservatives or pesticides. Other research has connected ADHD with prenatal exposure to nicotine. A large and growing body of evidence indicates a distinct correlation between ADHD and intense early childhood stressors such as natural disasters, abandonment, insecure bonding, domestic violence, neglect, and abuse, all of which can interfere with the child’s ability to self-regulate. Another series of research studies has suggested that ADHD is caused by a child’s allergies to specific foods in his or her diet or by consumption of processed foods. A recent report by CNN cited research indicating that ADHD may represent one of the ways in which children experience or express depression.
Some social science professionals have looked at ADHD less in terms of research than of theory. A number have argued that ADHD reflects the way in which evolution protected prehistoric human tribes by equipping certain males with the restlessness and distractibility that made them especially sensitive to danger. Other social scientists offer a different viewpoint. They cite statistics indicating that approximately 10% of children between the ages of 3 and 17 (again, mostly boys) are diagnosed with ADHD and argue that because ADHD is so common, it should be classified not as a “disorder” but as a normal human variation like left-handedness (which also occurs in 10% of the population), red headedness (5%), or height (less than 3% of Americans are over 6’2” tall).
Parents Speak Out
Finally, an increasingly vocal group of parents points out that ADHD is by far the most frequently diagnosed disorder among children, that the diagnoses have increased by about 30% in the past 10 years, and that nearly two thirds of them now result from referrals by educators They conclude that ADHD is essentially a classroom problem having to do not only with children but also with schools. Some parents describe it as the mismatch of a child’s learning style with the prevailing American teaching style, which tends to emphasize standardization over individualization. Others have characterized ADHD not as a learning disorder but as a teaching disorder, a problem managing, engaging, or tolerating the more active children in the classroom. A particularly militant group of parents and doctors has argued that many or most diagnoses of ADHD are actually misdiagnoses of other problems such as allergies, vitamin deficiencies, hearing loss, impaired vision, and color blindness. One outspoken doctor has described ADHD as a non-existent disease promoted by the drug industry.
One Child At A Time
A common goal of all these arguments is make the case for a single explanation of ADHD. However, my own experience as a therapist, parent, and teacher inclines me towards a different and increasingly popular perspective suggesting that although ADHD may be defined by a single set of symptoms, it may occur in different children for very different reasons. If so, the essential task for those who seek to help these kids is to look at each as an individual, explore the unique nature of his or her symptoms, and address them with a custom tailored plan developed by a multidisciplinary team that includes parent, teacher, school psychologist, physician, and therapist.
Another task is to recognize that ADHD is seldom a problem experienced by a child alone. It often results in “collateral damage.” ADHD can leave children feeling emotionally troubled, parents feeling over-stressed, and families feeling unhinged. For this reason, an effective approach to treatment may need to go beyond the doctor’s office or classroom. It may also require individual counseling for children, consultations for parents, and therapy for families.
If you would like to consult with me about someone who may have symptoms of ADHD, please contact me at 213.405.6745 or email@example.com. I will return your e-mail or phone call the same day.