October is ADHD Awareness Month and I want to take some time to clarify misconceptions about this complex disorder. There continues to be a plethora of myths and false claims about ADHD on the internet that blatantly say ADHD is a disease made up by pharmaceutical companies. I think there may be some truth to this, however, this does not mean that the condition does not exist.
I've worked with many children and adults who have ADHD. It's definitely real, but why are seeing children being diagnosed with the disorder in unprecedented numbers? Are mental health professionals over-diagnosing the condition? Are parents trying to fix behavioral problems with medication instead of discipline?
There are many different factors contributing to the rise of ADHD, but let’s start with the mental health system. Many clinicians, definitely not the majority, are inept at diagnosing children. They might not have children themselves, or had formal one-on-one training with kids to know what is "normal" and what is not. Unfortunately, the mental health system is set up that clinical therapists, as long as they are generally licensed, can diagnose children without having taken one class or internship in child psychology. This is a major problem. How can a therapist make a diagnosis that can potentially last a lifetime when he or she hasn't been given the proper training to know what is truly abnormal and what isn't? I don't why this is professionally and ethically allowed, but it is.
Secondly, the way most healthcare is set up is that insurance will not pay for treatment for those who need it unless there is a diagnosis. Well-meaning clinicians who want to help children and families, who need clinical treatment for whatever reason, use ADHD as the go to diagnosis when they don't what they are doing or how to substantiate treatment for the person. This is not right for many reasons, but it's one reason why ADHD has become overused and/or misdiagnosed.
The mental health system is part of the problem, but not the only one behind the ADHD epidemic. Another major issue we have contributing to over-diagnosis is society’s unreasonable expectations for children. Twenty years ago kindergarten offered an am and pm option for parents. Parents got to choose whatever fit their schedule, but it was not common or sometimes allowed for a child to be in both. At the time, that meant 5-year-olds would go to school for a few hours to socialize and pretty much prepare for the following year when real school started. Now kindergartners go to school the whole day. They wake up around 7 am and come home around 3 or 4 pm, and then some are expected to do homework after their long day at school.
And this is just the beginning. The older children get the increasingly tough the demands become. Many of middle and high school students have told me that they go to school all day to come home to hours and hours of homework. This is extremely tiring and not conducive for child mental health long-term. If the average adult works 9 am to 5 pm, how can we expect teenagers to work more hours than their parents?
Why are long hours of schooling relevant to ADHD? ADHD has many symptoms and presentations, but in general it has a lot to do with not being to focus and pay attention. Some people also have a hard time sitting still and not being hyper. If children are now being expected to meet unreasonable academic expectations beyond their developmental capacity then many children are not going to focus and sit still. This combined with overworked and underpaid teachers who are at their wits end with the dysfunction of their own school system will have much less tolerance for kids who are not paying attention and sitting still. Parents of kids who are not fitting into the robotic nature of day to day school life will be told to go and get their children help. Where these parents go? Most go to local clinics where clinicians are relatively fresh out of grad school, have no kids or kid training, are underpaid and overworked as well. Can you guess what diagnosis these overworked kids, taught by overworked teachers and treated by overworked mental health professionals get? ADHD.
Lastly, unnecessary frustration with ADHD comes from our society’s ongoing struggle with tolerating differences. Although it’s unfortunate that "normal" children are being diagnosed with ADHD when they shouldn't, there are still children who truly have substantial difficulties with paying attention, sitting still and following through with directions. This is not because of bad parenting, but because these children truly have different brains. These children see, interpret and experience the world in different ways than most people. A lot of them follow the beat to their own drum, are creative (not necessarily defiant), and like to learn in alternative ways. These kids, who are not "normal" simply because they are a minority, are intelligent but need different teaching strategies to learn and stay engaged. In a healthy school environment a trained teacher might have the time and energy to help these students. In the average school, these teachers don't. These students are academically neglected and made to feel dumb. If these children had some behavioral issues before starting school they will be amplified. If there were no behavioral issues before they can easily start: These children are not learning in the same way as their peers, and are labeled as less-than. Over time these children internalize that there is something wrong with them and many feel defeated leading them to giving up or acting out.
Children with ADHD are not bad children; their brains are just different and the school system is not set up to meet their needs. In a society where anything different seems to be a disorder we need to rethink how we look at ADHD. Will some of these children need medication? In some cases yes, but not always. Running to pathologize everything and instantly medicate is not in the best interest of anyone except pharmaceutical companies. We need to try behavioral therapy, change children's diets and really work hard with teachers to help these children be successful in school. Is it easier to just medicate than to spend time we don't have to help these children? Yes. But, this doesn't work in the long-term because medications don't magically fix our problems. And more importantly, it's truly an injustice to not help these children who never signed up to be different.
In a nutshell, ADHD is over-diagnosed and over-medicated, but it does exist. Telling these children and their families that their kids are spoiled or need more discipline is extremely insulting. To fix this growing problem we need to take the time to help these children and their families. We also need to evaluate and fix how broken all the different systems that these families come in contact with so we have a healthier and more inclusive society.