The ADHD Diagnosis is a War of Semantics, Waged on Children

Since I am new on Mad in America, I will tell you; my mission is to debunk the ADHD diagnosis. My goal is to add common sense to a world where drugging kids for acting like kids is all the rage. When discussing ADHD with concerned adults I share how little is required to earn a diagnosis of ADHD. Learning just how non-scientific the diagnosis actually is, for many, is a shocking discovery.

Having an honest look at the 18 childish behaviors that pro-ADHD experts call “symptoms” can help even the most ardent believers realize there is something fishy going on. Understanding the details of how ADHD is diagnosed clarifies how every child with a healthy heartbeat and an appropriate level of immaturity can be “diagnosed” ADHD. So, without further ado, let us dive into the stagnant waters of Dubious Diagnosis Bay, home to Club ADHD: The Last Resort.

According to the DSM-5, there are two categories of ADHD, with two sets of nine symptoms for each. The categories are:

1) Inattention (this used to be considered the ADD part of the diagnosis in previous DSM editions)

2) Hyperactivity and Impulsivity

Under today’s standards, if a person is younger than 17 years of age they need to “have” (display or experience) six or more of the nine symptoms, in one of the categories, to be diagnosed ADHD. Those 17 years or older only need five.

However the DSM-5 further explains that if a child or adult has only a few (one or two) of the symptoms required they can still be labeled ADHD. This is called “ADHD Not Otherwise Specified.” And if the patient does not have any of the symptoms, but the professional doing the diagnosis still feels the patient is ADHD, they can still label the patient “ADHD Unspecified.”

Yes, you read this correctly: A person can be diagnosed ADHD and drugged even if they show only a few – or even none – of the symptoms.

While holding less stringent membership requirements than, say, a public library, Club ADHD gets even worse. The following symptoms have been typed word-for-word from pages 59-60 of DSM-5. As you read through each of the nine symptoms, please just say “yes” and put a mental check mark next to those that describe how you might have behaved when you were a kid or – quite possibly – behave today as an adult.

ADHD-Inattention Symptom Checklist

• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or during other activities (e.g., overlooks or misses details, work is inaccurate). ____
• Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). ____
• Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). ____
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily distracted). ____
• Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order, messy, disorganized work, has poor time management, fails to meet deadlines). ____
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). ____
• Often loses things necessary for task or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). ____
• Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). ____
• Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). ____

How many of these nine symptoms did you say “yes” to? If you felt that at least 5 or 6 of these relate to how you behave today or did as a child you should not be surprised.

Beyond just describing how all kids behave while they are learning to be good students and responsible, polite adults, you might have noticed that the sentences describing the symptoms all seem to be quite similar or have been written basically to represent in essence the same thing. For example, if you said “yes” to “difficulty sustaining attention”, you probably said “yes” to “distracted by extraneous stimuli” and “often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.”

Also, did you find the DSM wording of these symptoms to be slightly vague or bothersome? For example, “reluctant to engage in tasks that require sustained mental effort”? Hello? We are talking about children. And, while we’re at it, adults. There is a reason that reality TV shows such as Real Housewives, American Idol, The Voice, Goldrush or Finding Bigfoot have huge viewership.

“Distracted by extraneous stimuli”? Uh, yes. Isn’t that what “extraneous stimuli” are?

And what exactly is meant by “often”? How many times a day, week, month or year constitutes “often”? The use of such vague, subjective terms leaves too much room for interpretation, variance and error on the part of a parent, medical professional, mental health practitioner and educator.  From a research-based child development perspective, stating that a child often exhibits many if not all of the nine symptoms is stating the obvious. To some degree children in nearly all developmental levels from infancy to adolescence exhibit these symptoms. It’s normal behavior. The begged question is; when does it become abnormal?

Now, to be fair, it should be stated that using this list of nine symptoms as a checklist for symptoms one happens to connect with is not the way the DSM suggests the diagnosis be performed. What I am asking you to do is, basically, the laymen’s approach to diagnosing ADHD. What I am getting you to do is, however, similar to the way the DSM is being misused – by far too many with a license to pill.

There are other caveats relating to the duration and the severity of the symptoms that should be attended to. Also, individuals using the DSM correctly are expected to rule out (establish beyond doubt) that none of  16 other diagnoses (e.g., Bi-polar) or categories of disorders (e.g., psychotic disorders) would better explain the symptoms. Conducting this level of differential diagnosis when working with young children takes time. Such efforts should most definitely take longer than a short visit to the pediatrician’s or general practitioner’s office.

However, it seems that the trend is for pediatricians to diagnose millions of kids with ADHD quicker than ShamWow can soak up 12 times its weight in nasty spilled liquids.

Wait, there’s more . . .

Some people want you to believe they have a test your child can take at a school. They say that the test  serves as an accurate indicator of ADHD.

Such tests are typically based on the two checklists of nine symptoms. Don’t forget, many of the folks doing this at school are not licensed to say whether or not someone is ADHD and, more importantly, the DSM makes it very clear that NO test exists for ADHD. 

More than 90% of people I share the diagnosis for ADHD-Inattention with during talks keep their hand up for “yes” for nearly all of the symptoms. In other words, if this first set of nine simple descriptions defines what pro-ADHD experts want to call ADHD-Inattention, we basically all are – or were as children – ADHD-Inattentive. When you have diagnostic criteria or a test for a mental disorder where nearly everyone answers “yes” to all of the questions, what you really have is a diagnosis of “normal.”

The DSM also states that

“Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.”

It’s common practice for mental health practitioners to rely on self-report from adult clients. But diagnosing kids requires a more cautious approach. Many mental health practitioners and medical doctors do not take  six months to explore such behaviors, in differing environments, as perceived by different individuals. Apparently, being cautious about rushing into a diagnosis – often requiring children to take dangerous ADHD stimulant drugs that the DEA classifies as highly addictive narcotics – is too time-consuming.

Instead, the clinical psychiatrist, mental health practitioner or medical doctor are expected to take the word of people whose possibly pre-conceived opinions are due to perceptions of disruptive behavior. Or, possibly, the word of a parent – a person not necessarily an expert in child development, or capable of determining if behaviors are inconsistent or maladaptive at specific developmental stages.

This despite the fact that the DSM-5 clearly states; “Adult recall of childhood symptoms tends to be unreliable, and it is beneficial to obtain ancillary [additional] information.” The word of individuals that may have personal agendas, or who as parents may lack an ability to provide an objective, non-biased, view, is used to determine if such behaviors were displayed often by the children for six months or more. These individuals, some who have only known the child for a short time, are expected to be able to determine if such extreme behaviors existed before the ages of seven or eleven.

For many of us, our lives are spent in an effort to correct such imperfect behaviors; an effort that helps us to be more organized, detail-oriented, attentive, polite and responsible. These “symptoms” might be okay for  an adult, trying to determine whether they could benefit from such a label and medication. For kids, however, the symptoms include set expectations for behavior that are unreasonable for the majority to achieve. I suspect that nearly every child that is sent to be diagnosed by an “expert” leaves the practitioner’s or clinician’s office labeled with ADHD.

The first nine symptoms were used to diagnose ADHD-Inattention. What about ADHD- Hyperactivity/Impulsivity, you ask? Once again there are nine highly generic symptoms that you only need to say “yes” to five or six times to be declared ADHD-Hyperactive/Impulsive. For this set of symptoms I suggest that (if you don’t have a female child that you are specifically concerned about) then as you read the symptoms answer from the hypothetical perspective of a boy between the ages of 5-11. I suggest this exercise because a high percentage of kids diagnosed ADHD are boys, and if you focus on this section’s connection to the behavior of young boys you might see why this is the case.

In other words; imagine you are a young boy (or girl) who has to sit in school, fully focused on the one-size-fits-all curriculum, as sunny days or snow-covered fields call your name for months on end. Are you ready? Begin . . .

ADHD- Hyperactivity and Impulsivity Symptom Checklist

• Often fidgets with or taps hands or feet or squirms in seat. ____
• Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). ____
• Often runs about or climbs in situations where it is inappropriate (Note: In adolescents or adults, may be limited to feeling restless). ____
• Often unable to play or engage in leisure activities quietly. ____
• Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). ____
• Often talks excessively. ____
• Often blurts out the answer before a question has been completed (e.g., completes people’s sentences; cannot wait turn in conversation). ____
• Often has difficulty waiting his or her turn (e.g., while waiting in line). ____
• Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing). ____

So how did it go this time? Were you able to pay attention long enough to read basic descriptions that describe how the majority of young children behave? How many did you say “yes” to? Are you or your 7-year-old alter ego ADHD-Hyperactive/Impulsive as well as ADHD-Inattentive?

It is as if the individuals who wrote these symptoms have never been around kids before. It’s as if they don’t like kids, and most definitely don’t like little boys. Who, in their right mind, besides a few old school librarians and pastors protecting the sanctity of the quiet nature of their workplace, would expect children to play quietly?  Who would associate “quiet play” with kids’ leisure activity? For millions of kids, playing quite often encompasses – if not requires – running and screaming. This is called having fun when you are young.

When we try to keep such energy bottled up all day, while children receive seven-plus hours of direct instruction devoid of exercise, play and creative time, these behaviors will only get worse.

Experts refer to discriminant or convergent validity in the field of psychometrics to refer to the ability to distinguish between syndromal from non-syndromal phenomena. The bottom line is that the current 18 symptoms used to diagnose ADHD are so common to all children that it provides no valid method to discriminate who actually has or doesn’t have ADHD. The symptoms do not measure what they say they measure; which to some degree eliminates any claims of what is known as face, content, or criterion validity.

When it comes to the common childhood behaviors some call symptoms of ADHD, there is a wicked game of semantics – a war, if you will – being played with our kids’ futures. The pro-ADHD experts want to label basic childish behavior as symptoms.  They want us to believe that signs of being “fidgety”, “on the go”, or “driven by a motor” are symptoms of a disease or serious mental disorder. But such descriptions could also be called energetic, motivated and full-of-life.

These are just signs that kids like to be active; a welcome behavior in these days of rocketing childhood obesity. “Not waiting your turn”, “blurting out answers” or “interrupting” are painted as a bad thing rather than a sign of wanting to contribute with enthusiasm.  Supposed symptoms of ADHD such as “doesn’t follow instructions”, “doesn’t engage in a series of tasks” and “avoids organization” are also the hallmarks of highly creative and possibly intelligent minds. “Doesn’t pay close attention” and “doesn’t provide sustained attention or listen” are things that happen when we are thinking actively beyond what is being discussed.

These “symptoms” are a signs that kids are not comfortable with what adults expect of them, or able able to meet those expectations with what is provided at home and school . Some are bored while others need more time, structure, attention or love as they develop. Both are likely more accurate “diagnoses” than a label of “disorder.”  It all depends on which side of the desk – or prescription pad – you sit. ADHD is in the eye of the beholder.

For many visitors to this website, what I have shared here provides ample evidence to say “no” to the drugging of kids for acting like kids. For others who are stuck in this diagnosis’ stagnant waters, accepting such logic is not easy. Why? Because no parent medicating a child or person medicated for a supposed disease – one they have accepted as a defining part of their personality – wants to find out it was all based on pseudo-science. Rightly so; no one wants to find out they have been duped or find out they have drugged their children based upon false information.

At times the level of resistance seems strange. I will admit, at times during my efforts to convince others of ADHD’s many falsehoods, it has felt like I was telling 500,000 hippies at Woodstock to not eat the brown acid. For some surreal reason, there are millions out there that don’t care how bad the drugs are. But brave individuals such as Dr. Fred Baughman, Dr. Richard E. Vatz, Dr. Diane McGuinness, and Dr. Peter Breggin have warned us all for decades about the invented disorder of ADHD and provided ample scientific evidence to say “no” to the label and dangerous drugs. I will keep trying. Our youth deserve nothing less.