The Problem with the “ADHD” Label
You can’t swing a dead cat today without hitting about nine children who have been professionally diagnosed with ADHD. One of these children is my 10 year old brother, who was diagnosed by a family doctor a few years ago after teachers started to complain about his distracting and at times disrespectful behavior in class. He fits the bill: he’s fidgety, bored by schoolwork, and has trouble focusing his attention long enough to read a book or solve a long math problem. The diagnosis came as a relief to my stepmother, who was encouraged to start my brother on stimulant medications to alleviate his behavioral issues. But there was one major problem with this whole scenario: my little brother does not have ADHD. He just doesn’t like school very much – he is 10 years old, after all.
I noticed some attitudinal changes toward my brother’s behavior after he received his diagnosis. Unfortunately, in my parents’ house, the ADHD card is more often than not used to excuse what would otherwise be unacceptably bratty behavior. Several children in the cushy suburban neighborhood where my parents live have similarly received this diagnosis, a disorder which supposedly is quite rare and yet happens to be something of an epidemic on my little brother’s street. This large volume of ADHD diagnoses raises an important question: is the “ADHD” label bringing about positive change in the school environment?
Batstra, Nieweg, and Hadders-Algra (2014) set out to examine the implications of five common assumptions associated with ADHD: that ADHD (1) causes deviant behavior, (2) is a disease, (3) is chronic, (4) is best treated with medication, and (5) diagnosis should precede treatment. Regarding the first assumption, the researchers note that there is a widespread misunderstanding that ADHD is an explanatory diagnosis, when in fact the syndrome is descriptive; this results in the common misconception that “ADHD” is a term that explains why children behave problematically when in reality it is only meant to describe the behavior of a child who is impulsive and inattentive. In this same vein, the researchers argue that ADHD is not strictly a biological “disease” as it is commonly understood, but rather a grouping of behavioral traits resulting from a wide variety of dispositional and environment influences. Findings from longitudinal studies also challenge the idea that ADHD is a chronic condition, as one study showed that only 30% of diagnosed individuals still met criteria at an 8-year follow-up. For assumptions 4 and 5, the researchers argue that medication should come only after starting psychosocial interventions for treatment of attention and hyperactivity problems, and that a diagnostic label is not required to begin such treatments (Batstra, Nieweg, & Hadders-Algra, 2014). As far as psychosocial interventions go, Evans and colleagues (2015) found that implementing an after-school program twice weekly that focuses on organizational skills, social functioning, and academic study skills for just one school year significantly improved time-management skills, problems with homework, inattentive symptoms, and overall GPA in students with ADHD, and that these improvements carried on into the next school year (Evans et al., 2015).
Viewing ADHD simply as a biological disease that causes problems in the brain instead of the complex cognitive and behavioral condition that it is allows parents, teachers, and children themselves to dismiss conduct issues as mental deficiencies. This encourages excuse-making rather than improvement. All in all, research suggests that for at least some communities in the U.S., ADHD overdiagnosis results in differing educational outcomes among students treated for the disorder, and suboptimal management of behavioral problems (LeFever, Arcona, Antonuccio, 2003). Instead of hastily medicating difficult-to-control children, perhaps we should, as a society, reevaluate the way we are raising modern children in the first place. If children are overstimulated with electronics and constant entertainment, is it any wonder they find school too boring to pay attention to? Can we really expect a child who is used to endless choices and little to no responsibilities at home to respond in a respectful way to the rules and expectations laid out by teachers? This is not to say that ADHD is not a serious condition requiring medication for some children, but it should not be used as a pass for poor parenting and adult impatience with normal childhood vigor.
References
Batstra, L., Nieweg, E. H., & Hadders-Algra, M. (2014). Exploring five common assumptions on attention deficit hyperactivity disorder. Acta Paediatrica, 103(7), 696-700.
Evans, S. W., Langberg, J. M., Schultz, B. K., Vaughn, A., Altaye, M., Marshall, S. A., & Zoromski, A. K. (2015). Evaluation of a school-based treatment program for young adolescents with ADHD. Journal of Consulting and Clinical Psychology. Advance online publication.
LeFever, G. B., Arcona, A. P., & Antonuccio, D. O. (2003). ADHD among American schoolchildren: evidence of overdiagnosis and overuse of medication. The Scientific Review of Mental Health Practice, 2(1), 49-60.
Tags: education
Hi,
I really like your blog post about how easy it is to for people including parents and teachers to label children with A.D.H.D. I agree with you that there are way too many children with A.DHD. that probably do not really meet the criteria for it. What 10 year old boy likes school, does not get bored easily, and can sit still for long periods of time?
We went through a similar experience with our youngest son. He spent more time in the principal’s office than he did in the classroom. He was disruptive, fidgety, bored, and had a hard time paying attention and concentrating. That was in school, homework was another adventure all in itself. I couldn’t tell you how many pencils got snapped or paper torn to shreds. He was only 8 years old at the time. We got referrals from his pediatrician for two child psychologist. Both of which diagnosed him as A.D.H.D.
We kept him active and we did not label him or use A.D.H.D as an excuse. In baseball he was a catcher, no time to get bored in that position. With football he was a center so he had to keep his head in the game. School was a huge problem though. The guidance counselors made arrangements with teachers to provide work tailored to his needs and different methods of testing. The problem was not one teacher followed the plan. At home we got the internet and found sports pages that would draw his interest. Somehow we made it to graduation. With him we know it was not just a label to make teachers happy, he did fit all the criteria of the DSM at that time for A.D.H.D.
As far as A.D.H.D causing deviant behavior our son was no angel but he did not engage in deviant behavior. I also never looked at A.D.H.D as a disease; it is a clearly defined mental disorder that in this case was not chronic. He no longer exhibits symptoms of A.D.H.D and he is a regional supervisor of a major restoration and cleaning company in central Pennsylvania. I also think treatment has to include more than just medication. In our case he did take medication but also received psychological counseling which help considerably and kept the medication doses low.
It is rather easy today to label a child as hyperactive give them some medication so that they do not disrupt the class and take time away from the teaching plan. In some circles it is almost like some parents want that label for their child. It gives them an excuse for the behavior they do not want to acknowledge. I also think that if a child is going to be diagnosed as A.D.H.D. it should be done by a trained professional in the mental health field. Nothing against the primary care physician or the family doctor but they should refer that child to a psychologist for a diagnosis.
Nice blog post! It is quite surprising how willing parents are to label their children as having ADHD just because they hyper or do not like to pay attention. I am sure if ADHD was as prevalent as it is today, then I would have been diagnosed with the condition as a child. Most children are very active and find school boring as your little brother did. I think parents should put more effort into trying to teach their children to sit still rather than give them medications that at times can dull their characters.
What you mentioned about ADHD being descriptive not explanatory is very interesting! It really bothers me when people use ADHD as an excuse for behavior that could simply be corrected. Unfortunately, the nature vs. nurture argument is prevalent when trying to decide the origin of ADHD. I think that there are children that are prone to ADHD behavior as a result of genes, but I also think that parents that do not discipline their children properly harvest the gravity of the behavior. It is quite sad that I have never heard of the psychosocial interventions you mentioned being used as treatments for ADHD. I recall one little boy that used to attend a friend of mine’s daycare. He was a fun-loving, thin, and active little boy. Once diagnosed with ADHD, he became almost like a zombie and gained a lot of weight. Doctor’s should really try to avoid prescribing medications until it is absolutely necessary. Thanks for the thought-provoking information!
Hey,
Too man students are being diagnosed with ADHD and this is a fundamental problem. The issue is that most of these students aren’t developed yet and boys are going to be fidgety and have a hard time focusing because things are changing fast in their lives. Having worked in a school and reading your description of your brother, it sounds like he may be gifted in some areas and on grade level in others. It also sounds like he is just a 10 year old boy and instead of quieting him, maybe his teachers should find a way to tailor the less to his needs.
It’s proven that taking a break every 45 minuets helps young boys stay more focused. By having interactive lessons where students are moving around the classroom and talking with each other also helps in internalizing the lesson as well as keeping their attention. Most students are not going to be able to just sit there and listen to a lecture in those grade levels, they need to be stimulated right where they are. A well trained and well equipped teacher can do that.