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.Add a Comment