I'm writing this with the hope that we will think seriously, just like the Dalai Lama asked us to do. Well, that is jumping the gun; let me share with you how I got here. A few weeks ago, I attended a panel discussion here at the University of Wisconsin that featured His Holiness the Dalai Lama titled, "Change Your Mind, Change the World." During the discussion, His Holiness asked what it means to say one's mind is "wandering." Another panelist responded, joking that here in the U.S. we call it Attention Deficit Hyperactivity Disorder (ADHD), and we give our kids Ritalin for it. Naturally, this provoked a good laugh from the crowd.
The irony that this joke occurred during a presentation on mindfulness, where empathy was purportedly valued, startled me. I was upset, but it wasn't until the end of the panel when the Dalai Lama asked us to think seriously that I considered doing anything about it. As it turns out, I have been thinking seriously about ADHD for 18 years, and this experience inspired me to share what I've learned.
This episode disturbed me because I have ADHD. Comments like that one help people dismiss my experience as a true problem, and that of millions of others. I have gone through relational, educational, and vocational problems as a result of my ADHD. I have overlooked deadlines, missed appointments, been placed unattended outside the classroom to "help me concentrate," impulsively bought items I could not afford, and said more poorly-timed comments than I can count. At the same time, I have had support throughout my life -- people who are patient with me because of, not in spite of, my diagnosis. This has allowed me to learn from my missteps and develop the skills and internal resources necessary for a person with ADHD to achieve success.
While I understand people's disbelief in the reality of ADHD because of the recent explosion of diagnoses, which may well signal a tendency toward over-diagnosis, it is important to know the difference between states and traits and recognize that potential over-reporting does not negate the reality of the disorder as a whole. We all have moments when we are distracted, inattentive, hyperactive, and/or impulsive. These are states of being and not permanent or harmful. Someone with ADHD experiences these as constant traits, meaning they are more pervasive and usually create dysfunction in their life. Quipping about ADHD by saying all of our minds wander is like telling a chronically-depressed person that we all get sad. There are two truths here: We have all experienced similar symptoms and at the same time this does not mean that we all experience them with the same intensity or duration. To imply that we do is to devalue and deny the very real struggle of people for whom those symptoms are traits rather than states.
To help people better empathize, I want to provide some facts about ADHD, with the hope that it may help promote openness to its validity as a diagnosis. According to a large meta-analytic review of the literature conducted by Erik Wilcutt of the University of Colorado at Boulder (2012), ADHD is prevalent around the world. This review included 163,688 youth and 14,112 adult participants, with diagnostic rates for ADHD of 5.9-7.1 percent and 5 percent respectively (rates of major depression are 6.7 percent). These relatively high rates of ADHD significantly affect many aspects of society, including the education system and workforce. It has been estimated that compared to every $318 spent on a non-ADHD student, the incremental cost to society for the ADHD student is $5,007 (Robb, Sibley, Pelham, Foster, Molina, Gnagy, & Kuriyan, 2011). Similarly, the cost to workforce productivity resulting from ADHD is very high, estimated at $67-$116 billion (Biederman & Faraone, 2006).
Luckily, there is hope. ADHD can be a gift when properly addressed, and technically "ADHD" is actually a misnomer. It is not really a deficit of attention, but rather a variability of attention. If you were to find something that an individual with ADHD likes to do, they will be able to focus. In fact, they might hyper-focus. Individuals have used this variability to their advantage by harnessing their adaptability, non-linear thinking, and thrill-seeking to change the world in positive ways. Thus it is important to engage with schools and parents to determine the best way for our children to learn, particularly our children who have ADHD diagnoses. Are our children visual, audio-visual, tactile, kinesthetic, or other kinds of learners? Understanding individuals' unique learning styles can help us tailor our classroom and work settings to maximize the attention capacities of all types of thinkers to support success.
Some groups are attempting to do just that. I worked with a wonderful organization called Project Eye-to-Eye, which paired college students who had learning disabilities and/or ADHD with middle school students with similar diagnoses. Through mentoring and activities, the children were able to identify how they learn most effectively, establish resources, and begin to build skills that lead to success in school, work, and relationships. Witnessing the impressive results of Project Eye-to-Eye's work makes me hopeful that such programs can be expanded to serve young students across the nation.
Now that I have laid out my position, I return to my original statement: I hope we can all think seriously. In particular, I hope each of you will think seriously about ADHD. With the age criteria changing in the newly released American Psychiatric Association Diagnostic and Statistical Manual, there may be another increase in ADHD diagnoses. Will this lead to greater validity of the diagnosis or more widespread belief that it is a false epidemic? Will we develop more accurate and effective assessment instruments? Are those giving diagnoses using the proper methods to ensure valid results? As a doctoral student in counseling psychology and an individual with ADHD, I think seriously about these questions all the time. I hope you will join me.
Biederman, J., & Faraone, S. V. (2006). The effects of attention-deficit/hyperactivity disorder on employment and household income. Medscape General Medicine. 8(3), 12.
Robb, J A., Sibley, M. H., Pelham, W. E., Jr. Foster, E. M., Molina, B. S. G., Gnagy, E. M., & Kuriyan, A. B. (2011).The estimated annual cost of ADHD to the US education system. School Mental Health. 3(3), 169-177.
Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics. 9(3), 490-499.
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