A clinical disease or a subjective opinion?
"We should shift from treating their distraction as a clinical disease, to targeting the best ways to help children maximize their ability to focus." So says Dimitri Christakis, a pediatrician at the University of Washington School of Medicine in today's New York Times debate on whether the ADHD diagnosis is helpful or harmful to children.
Chistakis points out that giving a child an ADHD diagnosis is a subjective process on the part of parents, teachers and physicians:
"In one of the most widely used and well-validated diagnostic tests, a child needs to demonstrate 6 of 9 specific behaviors on a standardized form to be diagnosed, and thereby qualify for disability accommodations. But the assessments, usually completed by a teacher and parent, are subjective. They must decide, for example, whether a child “often” has “difficulty organizing tasks and activities” — or “very often."
ADHD is a failure to conform to societal expectations
Philosophy professor Susan Hawthorne thinks that ADHD is a failure to conform to societal expectations, not a medical condition akin to diabetes:
"Current conventional wisdom is that ADHD. is a chronic, physical and medically treatable condition, comparable to diabetes. But this is not the case. The diagnostic criteria really measure whether children (or teens or adults) fail to meet today's social expectations."
According to Hawthorne, kids are diagnosed with ADHD "not because they experience impairment but because they are difficult to manage, like a very active preschooler who will not sit quietly at circle time. Again, social failure accounts most acutely for the diagnoses of this disorder." Medication, she says, may help children in the short term, but research shows that ADHD medications do not produce improvements in long-term education or work achievements.
Medication is not always the answer
The other side of the debate is represented by Tanya Froelich, Associate Professor of Developmental Pediatrics at the University of Cincinnati Medical Center. Although Froelich admits that over-diagnosis and medication misuse is a widespread concern, she also thinks that children who struggle are helped by the diagnosis which gives them access to special help in the classroom.
Medication, however, is not the only answer for a child who displays ADHD-like symptoms argues Froelich:
"The attention and self-regulation capacities of all children can be improved by increasing physical activity, maintaining a healthy and well-balanced diet, improving sleep, limiting electronics, teaching organizational skills, and increasing structure and consistency at home and in school. Pediatricians must take a larger role in educating families about these critical lifestyle interventions, in addition to diagnosing ADHD and managing its medical treatment."
Froelich also points out that children should not be diagnosed in a 10-20 minute visit to the pediatrician. It is the doctor's job "to rule out the many other diagnoses and circumstances that can produce ADHD-like symptoms by carefully interviewing the family, conducting a physical examination to rule out mimicking medical conditions, and diligently collecting information from the school."
Tthe hard line separating ADHD-like behavior from normal childhood reactions to environmental stress or normal developmental phases is beginning to soften. In that respect, the debate that the Times presents is encouraging and long-overdue.
The number of ADHD diagnoses in the United States has exploded by 300 percent since 1983. With a shocking12 percent of America's children receiving the ADHD diagnosis, it's time to look at the social, environmental, educational and economic factors that have lent steam to the exploding epidemic.
Marilyn Wedge
1 February
Marilyn Wedge is the author of a new book: A Disease called Childhood: Why ADHD became an American Epidemic (Penguin-Random House Group).
