Posted in ADHD

I Haven’t Seen it, Therefore it Does Not Exist

ABNORMAL PSYCHICAL CONDITIONS IN CHILDREN

ADHD is real. The fact that it first appeared in the DSM in 1968 doesn’t mean it was somehow invented out of thin air. It has been identified, though called by other names, as far back as the 18th century. Modern names (post 1900) include “minimal brain damage”, “minimal brain dysfunction”, “hyperkinetic impulse disorder”, and “learning/behavioral disabilities.”

Interview: Russell Barkley

…there is no controversy among practicing scientists who have devoted their careers to this disorder. No scientific meetings mention any controversies about the disorder, about its validity as a disorder, about the usefulness of using stimulant medications like Ritalin for it. There simply is no controversy. The science speaks for itself. And the science is overwhelming that the answer to these questions is in the affirmative: it’s a real disorder; it’s valid; and it can be managed…

RESTRICTIVE DIAGNOSIS

The DSM-5 is very clear. Normal, age-appropriate inattentiveness or activity does not mean that a child is ADHD. In order to correctly diagnose ADHD symptoms must…

…have been present for at least 6 months, and they are inappropriate for developmental level…

Inappropriate for developmental level means that the average child’s normal impulsiveness, distractibility, and restlessness are not criteria for a diagnosis of ADHD.

Additionally, the condition must be present in more than one area (for example, home AND school), and other conditions, such as childhood depression, must be ruled out first. The condition must also create “significant” life issues in those two (or more) areas. A child who is “very active” but has no problems related to his “activity” should not be diagnosed with ADHD.

MIS-DIAGNOSIS?  OVER-DIAGNOSIS?

In his blog post, Is ADHD A Fraud?, teacher Tom does not come out and deny that ADHD is a real condition, but he doesn’t acknowledge that it’s real either.

I’m not a psychiatrist, but I know the symptoms (inattention, hyperactivity, impulsivity) and I can honestly say that of the hundreds of children that have passed my way over the past couple decades, I’ve never met one upon whom I would hang that label.

Now, I admit to be completely unqualified to make that diagnosis, but you would think that by now I would have run across at least one child who set off my alarm bells. Or perhaps there is something about our school that attracts non-ADHD kids, or maybe I’m looking right at the symptoms and just see normal behavior, or it could be that the folks performing the diagnoses are wrong more often than they are right.

Is ADHD over- and mis- diagnosed? Very likely, but that doesn’t mean that the condition doesn’t exist As Teacher Tom said, he’s not qualified to answer that question.

A German study found that most diagnoses do not meet the DSM criteria for ADHD. The study also found that, given the same symptoms, boys were diagnosed with ADHD more than girls.

Do these erroneous diagnoses mean that the condition does not exist? Diagnosing ADHD isn’t easy. The idea of what constitutes appropriate developmental behavior is not as easy as looking at an x-ray to identify a broken bone. But, the difficulty of the diagnosis is, by itself, not sufficient to deny that the condition exists. The anecdotal fact that Teacher Tom never “ran across” an actual case of ADHD as a teacher for several decades might be unusual, but it doesn’t mean that the condition is non-existent.

He suggests the possibility that the condition was created by “big pharma” in order to increase profits. It’s true that the over-diagnosis of the condition might be a product of pharmaceutical salesmen putting ideas in doctors’ heads about how easy it is to “treat” the condition, but since the condition has been identified for more than 2 centuries, making the claim that it was created in order to cash in is questionable (I also expect that many doctors would object to being characterized as that easily swayed by pharmaceutical salesmen).

Is ADHD Overdiagnosed or Underdiagnosed? Looking at Evidence.

The problem with misdiagnosis is that it undermines the legitimate condition that is ADHD. Some people that are severely affected by this condition may be overlooked and/or not properly treated. Some would argue that the most successful individuals with ADHD tend to be those who find ways to cope with and manage the symptoms on their own.

Although there are drawbacks associated with ADHD, some people are able to channel their hyperactivity towards being productive. Keep in mind that there are many different types of ADHD that a person could be dealing with. According to the DSM-5 there are 3 types, but according to others there are 7 types. Therefore individuals that don’t know much about this subject may be prone to making a misdiagnosis.

ON THE OTHER HAND…

All that being said, Teacher Tom is right about several things. First, journalist Thom Hartman has written about the evolutionary aspects of ADHD…and why the condition is, in his opinion, not a disorder. Hartman makes a good argument, and I agree that the possibility exists that the condition is more a product of civilization than an inherent disorder. [Unfortunately, we live in a society built upon certain social norms. The societal conditions which combine to make ADHD a “disorder” must be considered. This, however, is a conversation for another time. Please see Hartman’s work…]

Teacher Tom is also correct in implying that the problem “belongs” to the adults. It’s our job as teachers to accommodate our students, not vice versa. ADHD, is real, but teachers shouldn’t use it as an excuse to ignore a child’s academic, social, and emotional needs.

On the other hand, denying the existence of the condition – or in Teacher Tom’s case, a “denial-not-denial” – isn’t helpful. Neither is blaming it on inferior teachers or schools, which he does as well.

Traditional schools emphasize paying attention, sitting still, and concentrating on one thing at a time and children who struggle with that simply show up as a problem. I mean, that’s tough for any kid, let alone one with a highly energetic brain and body. In contrast, when we don’t place those artificial expectations on kids, like in a play-based curriculum, the “problem” disappears.

and

I suspect that for the most part, ADHD is mental health disorder that largely only exists under certain, unnatural circumstances, namely in traditional schools…

Essentially, he’s saying, “I haven’t seen ADHD because my school and the way I teach is the ‘right’ way, and other people, who are doing it wrong, are ‘creating’ the condition by their unnatural circumstances and inferior teaching.” Unfortunately, the fact is that even in developmentally appropriate school conditions, ADHD doesn’t “disappear.”

Let me be very clear…

I agree that a play-based curriculum is developmentally appropriate and preferable for pre-schoolers and kindergarten.

Adults are responsible for creating a learning environment which fits children’s needs, not the other way around. Forcing children to accommodate adult preferences is counter productive to educational progress. It’s up to us to accommodate ourselves to our students’ learning needs.

ACCURATE DIAGNOSIS

However, Teacher Tom’s statement indicates that he really doesn’t understand what an ADHD diagnosis is. Perhaps that’s why he hasn’t seen it in his years of teaching. Check out the diagnostic criteria again. Read carefully…

Notice first, the DSM-5 requires that the behaviors in question are inappropriate to the development of the child. It would be (and is) completely appropriate for children attending pre-schools in which they were forced to sit still for long periods of time, be unable to concentrate, to fidget, and to act out. The same is true for schools which require long periods of sitting in kindergarten and primary grades. Developmentally appropriate means that the developmental age and needs of children are taken into consideration when a curriculum and means of delivery are chosen.

Second, the DSM-5 is very clear in its requirement that ADHD symptoms must be present in two or more settings. As a teacher, he wouldn’t be able to diagnose a child with ADHD because he is, most likely, with his students in only one setting – the school. That’s why an accurate and complete diagnosis requires input from teachers, parents, and others who have contact with the child. Neither should doctors diagnose children just on the parent’s say-so.

Third, the behaviors must interfere with a child’s functioning. They must “get in the way” of a child’s learning, or social development. If they don’t, then the diagnosis of ADHD can not be made.

COMMON MISCONCEPTIONS

Teacher Tom seems to accept common misconceptions about ADHD. Not every child who runs around yelling has ADHD. Not every child who is distractible has ADHD. A true diagnosis of ADHD is not easy to make, and shouldn’t be made on the basis of seeing a few symptoms and then slapping a label on a child. Like any other medical diagnosis, ADHD must be done carefully and by experienced professionals. Unfortunately, there are many cases where care is not taken and undiagnosed or untreated ADHD can result in emotional and academic damage which can last a lifetime.

The problem with misdiagnosis is that it undermines the legitimate condition that is ADHD.

ADHD exists, whether Teacher Tom has seen evidence of it or not. And, like other conditions affecting children in school (e.g. poverty, divorce), ADHD affects every aspect of a child’s life. It must be considered when creating a child’s educational program. Ignoring it, or claiming ADHD doesn’t exist – even with the half-hearted qualifiers that Teacher Tom included in his piece – is irresponsible.

This is a revisit of a topic I wrote about in a post titled, The Task of Your Life.

🙋🏻👩‍🏫🙋🏽‍♂️
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Retired after 35 years in public education.