“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.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.