Debating ADHD – Is It For Real?

ADHD is getting a lot of attention these days, with good reason: it’s reported to be on the rise and possibly affecting 1 in 10 children. The New York Times has posted an intriguing range of opinions on ADHD in their Room for Debate feature. Sorting through them all, you will find the full gamut of perspectives. At the core for parents, though, is the bottom line: Is ADHD for real? Or is it: a) something concocted by the mental health industry to generate business; b) a reflection of inappropriate expectations of how children should behave; c) something that can be used to either execute bias (in the case of minority youth) or connote advantage (in the case of gaining special privileges in educational settings); or d) you can insert here another counter hypothesis. 

With so many complex opinions out there, I suggest that there are two answers to this question. The first answer is that ADHD is a real clinical phenomenon. It is quite true that there is no “gold standard” way to diagnose ADHD like you would  medical conditions that can be validated with biological tests (like diabetes). But I’m not saying that ADHD is a disease – I’m saying that it can be a clinically meaningful way to gauge where a kid is at developmentally and what their future may look like. How do I know this? Well, I’ve seen kids in clinical settings whose behavior is vastly different than nearly all other kids their age and gender. I’ve also seen kids experience all kinds of struggles in school, again not experienced by their peers. And I’ve seen – both personally and professionally – young kids with ADHD continue to have difficulties in school through the years and eventually NOT graduate from high school. Paradoxically, even though ADHD is on the rise, the reality is that many kids who have ADHD do not get proper assessment and treatment. That’s why awareness of what ADHD is (and the potential consequences on development) is important.

Now, the second answer. ADHD is indeed over-diagnosed. My guess is that maybe 2-3% of kids – not 10% – fit the clinical profile described above.  It’s also true that, if you look at the symptoms of ADHD, they can be displayed by many kids – the key issues of course are in the frequency, severity, and impairment. A host of factors can sway perceptions of the roots and consequences of these behaviors – inappropriate testing and labeling, bias, home and classroom settings that are either not optimal or exacerbate the behaviors. Note that for some of these kids there are behavioral issues to attend to – but thinking about them diagnostically is probably not very helpful.

So where does this leave a parent who is trying to determine if their child has ADHD? Philosophical discussions are important, but the reality is that a parent has to figure out what to do, in real time, with real consequences for their child. To this end, my suggestions are as follows:

  • Seek out a comprehensive assessment at a reputable facility which has lots of experience dealing with a wide range of kids
  • If they suggest your child has ADHD, ask them what leads them to that conclusion. The important thing here is that there should be some evidence (e.g., neuropsychological testing, some indicators of severity or persistence) of impairments in functioning that should be rectified (rather than just having a high score on an ADHD questionairre)
  • Consider very carefully how medication can be used and do seek out either alternative or complementary psychosocial and educational treatments – you’re not trying to control behavior, you want a plan to help your child be the best and happiest person they can be
  • Trust your gut feelings as a parent – be open minded and honest but remember you know your child better than anyone else

In the final analysis, you will need to be in charge of your child’s care. Even if your child does not get diagnosed with ADHD, you still may need to attend to suggestions for improving their behavior. And if your child does get diagnosed with ADHD, you will need to closely monitor the treatment plan and see what works and what doesn’t work – and who you trust and don’t trust. After all, when you are talking about your child, all of the rhetoric becomes secondary to your need to serve your child as best you can. That’s what matters most to a parent.

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  1. [...] Debating ADHD: Is it real? ( [...]

  2. by Heather

    On October 15, 2011 at 9:34 am

    Thank you so much for this fascinating perspective! My mom has been a first grade teacher for 30+ years and we’ve discussed this issue many times because so many more children in her class are being diagnosed with ADHD these days. I just sent her your post:)

  3. by Beth S

    On October 15, 2011 at 2:38 pm

    As a teacher and a mother of 3 I believe that ADHD is for real, however, I feel that it is highly over-diagnosed/treated. I have been teaching Kindergarten for 8 years and have only seen 3-4 kids who were truly ADHD. Mostly, parents and doctors want to medicate children with behavior problems in school not looking at other factors (poor structure, home environment etc.)That being said my own son is truly ADHD and will probably need medication. We’ve explored every other treatment option (diet changes, sleep changes, behavior management, picture dharts,etc.) with no improvement in his impulsivity. I really don’t like medicating but it is beginning to effect his school performance. There is a research study that I read in a Psychology Journal that said that two non medicating ADHD therapies were just as effective as medication alone. So for example behavior modification AND diet changes were just as effective as Ritalin (ex). Something to ponder

  4. by nicola

    On February 16, 2012 at 12:49 pm

    my son has adhd,and has medication for school,this is a big improvement for his schooling,at the age of 6 he could not read,or Wright,we as parents have been on so many courses and changed so much in our lives to help our son. I do think well know that a lot of people out there are pushing for a diagnosis on their child,knowing fully that they do not have it. my son get`s reviewed every 6 months,and while sitting in the clinic,over-hearing other parents,play up, exaggerate,and did you drink all of that energy really upsets me that people take advantage of a medical problem like this,they just want an excuse to say why he does behave like this,no wonder why people have a problem with recognising adhd is a mental health disorder, which cardiff university have proven,i do think that they should find a better way for diagnosis ie=a week with the children and family,24 hr supervision,hmm maybe then it would not be so easy to pull the wool over peoples eyes.