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.
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.