A new study, published in the International Journal of Qualitative Studies on Health and Well-being, aims to highlight popular misconceptions about ADHD and promote considerations for teachers and mental health professionals who work with schools.
“Teachers and other school personnel are often the first to suggest the diagnosis of ADHD in a child,” they write. After all, “Previous research suggests that teachers tend to feel insecure about dealing with behavioural problems and hesitant to accept responsibility for students with special needs.”
Attention deficit hyperactivity disorder (ADHD) is a controversial disorder that is often first diagnosed in schoolchildren, as its primary features are restlessness and difficulty focusing on complex tasks for extended periods of time. However, researchers have raised concerns about overdiagnosis and overmedication.
Critics have stated that the diagnosis is overly broad and the symptoms are vague enough that anyone could meet the criteria. In 2011, for instance, approximately 20% of high school boys in the US carried a diagnosis of ADHD. The supposed evidence that ADHD is a medical disorder has also met with intense criticism in the research community, and a recent controversy was reported on here at Mad in America.
The researchers of the present study included Sanne te Meerman, Laura Batstra, Hans Grietens, and Allen Frances. Frances was the chair of the DSM-IV taskforce and has written extensively about ADHD overdiagnosis and overmedication of children.
The authors suggest that the medical explanation of ADHD is popular amongst teachers, as it absolves them of the responsibility of engaging students who are seen as problems in the classroom.
Once students are classified as having ADHD, they become the responsibility of the medical system instead of the school system. Thus, the problem of classroom behavioral engagement is redefined as a medical problem with the individual student, rather than an issue with the teacher’s inability to generate an engaging learning environment for children.
However, the researchers note many misconceptions about ADHD that contradict the medical narrative of the disordered brain.
One of the points raised by the article is the finding, replicated in numerous studies, that the youngest children in the classroom are twice as likely to receive a diagnosis of ADHD and to be put on stimulants.
“Apparently, health care professionals and teachers tend to classify relative immaturity as ADHD.”
Thus, the authors suggest that “Teachers should be aware of the many potential causes of a child’s unruly behavior” and that teachers and psychological professionals should consider the child’s age (relative to the others in the classroom) before suggesting a diagnosis of ADHD or prescribing stimulants.
The second point made by the researchers is that ADHD does not “cause” behavioral problems. Rather, ADHD is simply what we call those problems when they appear. As such, saying that ADHD causes behavioral problems is circular reasoning.
The researchers remind us that “There are no measurable biological markers or objective tests to establish the presence or absence of ADHD (or any other given DSM syndrome).” Although it could be useful to label a cluster of behaviors, that does not imply that an underlying illness causes those behaviors or that the category of those behaviors is itself an explanation for them.
The researchers encourage teachers and psychological professionals to keep in mind that a daunting list of environmental factors is associated with the behaviors termed ADHD. These can range from “divorce, poverty, parenting styles, low maternal education, lone parenthood and reception of social welfare, sexual abuse, lack of sleep, heritability and perinatal issues to eczema, artificial food additives, mobile phone use, and growing up in areas with low solar intensity.”
The researchers also note that almost all children diagnosed with ADHD have “normal” brains—that is, brains that are similar to children who are not diagnosed with ADHD. Additionally, they write that the evidence that there is a genetic component is overstated. These factors have also been written about here at Mad in America as part of the ongoing controversy.
Another point brought up by the researchers is that ADHD medications are not effective over the long-term: they write that long-term studies show “no significant difference between medicated and non-medicated children” or “worse outcomes and adverse effects” after several years. This means that outcomes for unmedicated children diagnosed with ADHD were the same or better than outcomes for children who were placed on stimulant medication.
Finally, the researchers bring up concerns about the effects of an ADHD diagnosis for children. They write:
“Some known disadvantages of a diagnosis are: low teacher and parent expectations that become self-fulfilling prophecies (Pygmalion/Golem effect); prejudice and stigmatization of diagnosed children; children applying stereotypes to themselves, leading to self-stigma and low self-esteem; decline of self-efficacy; a less effective and potentially counter-effective focus on fixed traits instead of behaviours; a more passive role towards problems; difficulties getting life and disability insurances later on in life; and the risk of overlooking contextual, social and societal explanations, due to the specious explanation offered by labelling.”
The researchers hope that their work will help promote effective ways of working with the kids who exhibit restlessness and inability to focus. According to the authors, “Research indicates that many young children, particularly those diagnosed with ADHD, thrive with more space for physical activity, playful learning, and smaller classrooms.” With these environmental changes, there may be no need to diagnose and medicate 20% of high school boys.
te Meerman, S., Batstra, L., Grietens, H., & Frances, A. (2017). ADHD: a critical update for educational professionals. International Journal of Qualitative Studies on Health and Well-being, 12(sup1), 1298267, http://dx.doi.org/10.1080/17482631.2017.1298267 (Abstract)
My pastor has taken charge of a young man whose family was unable to care for him. When I heard the young man had ‘adhd’ I gave my pastor the link to this website with the hope that he might be open to recognizing the horrible scourge being waged against young people who often are simply restless from long hours of sitting…
Regarding “….Allen Frances. Frances was the chair of the DSM-IV taskforce and has written extensively about ADHD overdiagnosis and overmedication of children.”
I disagree that the psychiatric drugs are medication. The children are not being over-medicated, but over-drugged.
In my generations time we obeyed authority out of fear due to the Patriarchy. Today fear can not be induced in the child due to the Matriarchy being in power. Most coercion today is done with drugs renamed as “medicine”.
Your (bad) choices are not your fault “We are helping you with medicine!”
What will be the outcome? http://eastloshigh.com/thesiren/sagging-pants/
While I of course disagree with the medical terminology used in the article, I am very pleased to see mainstream psychiatrists finally taking a stand and putting out some real data. The lack of scientific support for the diagnosis, the association with younger age, the multiple reasons why this kind of behavior might occur, the total lack of evidence that ANY long-term outcome is improved by stimulants, the adverse psychological impact of being labeled – short of saying that ADHD is a fraud, this article covers all the important bases (except maybe for diet/exercise and alternative medicine) and I’m just astounded that this is published in a mainstream journal. This presents a great opportunity for us to build on an excellent summary of the data from a source that psychiatry itself can’t invalidate. Though I’m sure they’ll still try…
Thanks for your comment. Although we were as thoughtful as possible choosing our vocabulary, I have to admit that in retrospect I’m not too thrilled by words like ‘medicine’ and ‘diagnosis’ either. Although I’m sure that some keyfigures in the ADHD-community have willfully introduced some rhetoric elements into the discourse, I think most of such reifying language has become a bad habit that most of ‘us’ are not aware of and that’s hard to break, so thanks for keeping us sharp.
Having said that, I also want to distance myself from words like ‘fraud’. Although I find myself angry at times with the state of affairs as they are (and I might even have been judgmental about Allen Frances when I met him) I think such words have a tendency to polarise, creating a dichotomy where we should be seeing the different shades (even if they seem grey). I think for instance the DSM-IV-TR guidebook is quite thoughtful on ‘ontological issues’ and dimensionality of behaviour.
Despite unholy forces from the overly liberalized healthcare market –particularly in the US, I think most psychiatrist like Allen Frances have good intentions, and we have not intended to suggest ADHD is a fraud. Some children are really difficult to deal with, even if it is just their temperament in most ‘cases’ that has spiralled into problems in interaction with overworked parents, stressed out teachers in overcrowded classrooms, off-the-scale divorce rates and other sociological issues.
However, yet another possibilty–in line with the biopsychosocial model Allen Frances proposes on the video of the MIA homepage- is that the heterogenous group of those being diagnosed might also be populated by some FAS children. These are notoriously hard to distinguish from children who have attentional problems for other reasons. I feel this could even explain some of the small, average, group differences in anatomical studies looking at brain size. I do not want to suggest they should be treated with drugs (they’ve had their share I’d say) but it does suggest that we should really keep communicating with biologically oriented professionals and avoid going from a biological narrative straight into an exclusively psychosocial one. Although for this small subgroup of children I’d say the social adversity and low SES related to drug abuse should be our first concern –as is often the case.
Kind regards, Sanne te Meerman
It makes me wonder – the issue here is economic, surely.
That in the short term it is cheaper to put the kids on drugs, rather than re-gearing our entire education system, which is always subject to cuts and incredibly tight budgets.
And when the schools do get funding – it’s always to infrastructure – buildings, sports fields. It’s never to the arts and music program (which saved many a kid’s well being, including mine!), and never to increasing staff or training. I’m also thinking about “gym class” – which we always dreaded – but which was a structured form of play to get us to burn off some energy.
And I’m reminded of the helicopter Health and Safety codes (and the heavy hammer of lawsuits). A local school in Australia removed the monkey bars from the playground because a child broke her arm. What? Isn’t that a normal “growing up” lesson? And what are the other hundreds of kids supposed to do with their energy? Stand around on an empty playground? Play with their devices?
I grew up in an educational family – father Dean at a University, stepmother Principal of a High School. Education (and the economic resources we don’t devote to it) is the source of the problem, medical policies only reinforce it.
That teacher who is happy to “diagnose” children is in an understaffed classroom, using materials that are dictated by state curriculum – any extra materials must come out of that teacher’s meager salary. Additionally that meager salary includes time/attention obligations like – showing up for sporting and social events as chaperone, grading on evening and weekends. The teacher has very little to work with, and yes, it might be a relief to numb out the exuberant, restless, or traumatized child.
I’ve thought about my own childhood. All my report cards indicated that I had trouble paying attention, that I looked out the window or talked in class. My whole education was an effort to get me to “pay attention!” But I always had “good grades” so “I got away with it.” And that was the 1970’s, geez.
I also remember ONE friend who was “hyperactive” and was on some sort of amphetamine. He wasn’t in my class, but he was at my school and in my neighborhood. ONE. During my entire schooling career! I wonder what the “drug to kid” ratio is in a classroom today?
As privitization sweeps the country, the “charter schools” start filling the niche of these “kids who nobody wants” – do we expect it to get better?
Rotten to the Core.
Getting back to my original issue, the short term benefits – if we look at the long term cost and damage of these kids growing up to become “bipolar” and “schizophrenic” in adolescence because they’ve always depended on a pill to adjust their behaviours – and the cost to society of having chronically ill children from earlier and earlier “interventions”…
“Intervention programs” surely don’t save the society money – but are instead means to cull out “certain types” and put them in a “useless box.” Drugging ADHD children is a huge (but invisible) societal cost and means of social control.
How can we pitch it to our School Boards and State Boards of Education that these interventions cost more in the long run? Or does anything matter beyond their short term in office?
“Researchers Reveal Misconceptions About ADHD”…..The title of your Article almost says it all.
Misconception : a view or opinion that is incorrect because it is based on faulty thinking or understanding. ADHD Researchers, in my opinion, are suffering from both problems.
Dr. George F. Still presented his second Goulstonian Lecture in March, 1902. The Goulstonian Lectures are an annual lecture series given on behalf of the Royal College of Physicians in London.
Dr. Still mentioned a proband in his Study, a young boy, who would steal items from his classmates while in school, ie pocket knives, marbles etc., and later that day after school, he would go to town and give those items away. Dr. Still reasoned that the boy didn’t need or want the stolen items. Dr. Still concluded that the boy must be suffering from ( A Defect Of Moral Character ), one of the first names ascribed to ADHD.
We Humans do and say things because we, ‘get something out of it either consciously or unconsciously’. So ‘what did the young boy, in the above scenario, get out of his behavior?
Fear of getting caught, stress and anxiety and associated depression. And what do these emotions cause?…..A increase of systemic Dopamine Levels. ADHD is a ‘Lower than normal level of Dopamine’ problem. Our ADHD kids are self medicating with ‘Bad or unacceptable and obnoxious behavior’. The behavior is unconscious and if you ask them why the did or said something that got themselves in trouble, they will tell you that they don’t know…..and they are telling you the truth.
ADHD kids and young Adults are perfectly normal, both physically and mentally. Researchers, there is a very good reason for lower than normal levels of dopamine and serotonin.
For all of you Neurotransmitter Imbalance Deniers, please google: The “Chemical Imbalance” in Mental Health Problems, by Joseph M. Carver, PhD., Clinical Psychologist