A New York Times Debate: Is the ADHD Diagnosis Helpful or Harmful?

Marilyn Wedge, PhD
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“We should shift from treating their distraction as a clinical disease, to targeting the best ways to help children maximize their ability to focus.” So says Dimitri Christakis, a pediatrician at the University Of Washington School Of Medicine in a recent debate in the New York Times (February 1, 2016) on whether the ADHD diagnosis is helpful or harmful to children.

A Clinical Disease or a Subjective Opinion?

Christakis points out that giving a child an ADHD diagnosis is a subjective process on the part of parents, teachers and physicians:

“In one of the most widely used and well-validated diagnostic tests, a child needs to demonstrate 6 of 9 specific behaviors on a standardized form to be diagnosed, and thereby qualify for disability accommodations. But the assessments, usually completed by a teacher and parent, are subjective. They must decide, for example, whether a child “often” has “difficulty organizing tasks and activities” — or “very often.”

Clearly the choice is based on subjective opinion not on science.

ADHD is a Failure to Conform to Societal Expectations

Philosophy professor Susan Hawthorne thinks that ADHD is a failure to conform to societal expectations, not a medical condition akin to diabetes. She writes:

“Current conventional wisdom is that A.D.H.D. is a chronic, physical and medically treatable condition, comparable to diabetes. But this is not the case. The diagnostic criteria really measure whether children (or teens or adults) fail to meet today’s social expectations.”

According to Hawthorne, kids are diagnosed with ADHD “not because they experience impairment but because they are difficult to manage, like a very active preschooler who will not sit quietly at circle time. Again, social failure accounts most acutely for the diagnoses of this disorder.” Medication, she says, may help children in the short term, but research shows that ADHD medications do not produce improvements in long-term education or work achievements.

Medication is Not Always the Answer

The other side of the debate is represented by Tanya Froelich, Associate Professor of Developmental Pediatrics at the University of Cincinnati Medical Center. Although Froelich admits that over-diagnosis and medication misuse is a widespread concern, she also thinks that children who struggle are helped by the diagnosis which gives them access to special help in the classroom.

Medication, however, is not the only answer for a child who displays ADHD-like symptoms argues Froelich:

“The attention and self-regulation capacities of all children can be improved by increasing physical activity, maintaining a healthy and well-balanced diet, improving sleep, limiting electronics, teaching organizational skills, and increasing structure and consistency at home and in school. Pediatricians must take a larger role in educating families about these critical lifestyle interventions, in addition to diagnosing A.D.H.D. and managing its medical treatment.”

Froelich also points out that children should not be diagnosed in a 10-20 minute visit to the pediatrician. It is the doctor’s job “to rule out the many other diagnoses and circumstances that can produce A.D.H.D.-like symptoms by carefully interviewing the family, conducting a physical examination to rule out mimicking medical conditions, and diligently collecting information from the school.”

Consider the Child’s Social Context

Donna Ford, a professor of education and human development at Vanderbilt University, insists that diagnosing a child should not be rushed. Instead of using a twenty minute checklist, “it is worth considering, in every case, how a child changes his or her behavior based on location and time of day.” She also points out that simply because a child is more active than his peers, he should not be labeled with ADHD. “The structure of the school day also needs to be considered when we address the shorter attention spans, disinterest and frustration of students. Hours of seat work, few breaks, lack of recess, and few tactile and kinesthetic activities do not match how many students prefer to learn; it does not reflect their home and community experiences. Schools need to be restructured to be more hands-on. This will help decrease unnecessary referrals, mislabeling and over-medication.” Ford encourages educators to examine their tolerance levels for children who require more active days, “rather than jump to unnecessary labels and medication.”

I urge parents, doctors, educators and everyone concerned with the well-being of children to take a look at the debate presented in the Times. The series of articles makes it clear that the hard line separating ADHD-like behavior from normal childhood reactions to environmental stress or normal developmental phases is beginning to soften. In that respect, the debate in the Times is encouraging and long-overdue.

The number of ADHD diagnoses in the United Sates has exploded by 300 percent since 1983. With a shocking 12 percent of America’s children receiving the ADHD diagnosis, it’s time to look at the social, environmental, educational, and economic factors that have lent steam to the exploding epidemic.

6 COMMENTS

  1. The ADHD diagnosis and the medication that follow is an epidemic that is ruining lives!

    The deck is stacked against the struggling child because the teachers and the parents are being hoodwinked.

    My oldest son suffered head injuries in a car accident when we was 6 months old that delayed his development. We continually had to fight the school system to assure them he didn’t have ADHD or need drugs. You cannot imagine the pressure. We persevered and he is a hard working adult.

    However ADHD became a door to drugs for our youngest son. Who was attending M.I.T. in Boston, miles from our midwest home. Failing to keep up he convinced a local pdoc that he was suffering from ADHD. He was handed a prescription of adderall and months later we had to pick him up and bring him home because of a psychotic break. To add to the pain we were trapped into seeing more pdocs and given more drugs to fix what we and he were clueless to understand.

    The wolves cry in fear…stop and think!

    ADHD isn’t the problem…It is the pdocs that know this is a fictitious illness and hand out drugs only to grow their incomes. It’s the teachers in the classrooms that have been convinced this diagnosis and treatment is a benefit. It’s the parents that lack the education on this subject to properly support their child.

    This is the short story…

  2. Hi Marilyn,

    “Medication, she says, may help children in the short term, but research shows that ADHD medications do not produce improvements in long-term education or work achievements.”

    Whipping a child with a belt will also help children in the short term (i.e. it will keep them quiet),
    but of course we know how damaging it is. Giving a child something similar to cocaine for bad
    behavior? I don’t know which is worse. There must be better options. And some parents are worried about giving kids too much sourbelt candy(not that it’s good)? I’m not going to say how what happened to me as a victim of someone who went crazy on ADD medication, it’s just too sensitive a topic right now.

    All the best,
    Even.

  3. The American educational system is boring as all get out. Couple this to the facts that we are expecting more and more out of three and four year olds, cutting recess and P.E. time as well as the creative classes that engage children’s imaginations and guess what we have? We have a situation where the children who are much more active and less able to sit quietly for hours at a time are going to be penalized by teachers since they won’t tolerate any disturbances in their classrooms and they don’t want to give extra time to the more active kids to keep them occupied and productive. We do not teach kids how to think, we teach for the standardized test scores that determine teachers’ pay raises or firings these days. Take it from me as a former teacher of high school students, school is BORING! But we penalize the kids rather than shouldering the burden of finding better solutions for education than what passes for education these days.

    • I agree, Stephen, the schools are bad. I volunteered to run an art program at my children’s school, because the state refused to pay for an art program. And, by eighth grade, I was told my school district was “not equipped” to deal with my child, because he did so well on his state standardized tests, so I had to send him to a private school for high school. Although, the school social worker did try to stigmatize my child, prior to that admission by the school – apparently they want to drug up all the brilliant children.

      And I also believe it is wrong that the federal government is paying schools to put children on drugs. I understand the need to financially assist schools that have children with special needs, but forcing children to take speed is plain stupid, and disgusting. Especially, based upon a subjective and unprovable disorder.

      It appears to me that this may be the philosophy behind today’s US public school system:

      “In our dream we have limitless resources, and the people yield themselves with perfect docility to our molding hand. The present educational conventions fade from our minds; and, unhampered by tradition, we work our own good will upon a grateful and responsive rural folk. We shall not try to make these people or any of their children into philosophers or men of learning or of science. We are not to raise up among them authors, orators, poets, or men of letters. We shall not search for embryo great artists, painters, musicians. Nor will we cherish even the humbler ambition to raise up from among them lawyers, doctors, preachers, statesmen, of whom we now have ample supply.”

      – Rev. Frederick T. Gates, Business Advisor to John D. Rockefeller Sr., 1913 [1]

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