Is ADHD overdiagnosed?
We need to find middle ground so different kids have the chance to be themselves.
Is ADHD over-diagnosed? Are we medicating children too quickly and frequently? Or are we simply doing a better job of recognizing and treating a pervasive disorder that afflicts almost one in ten children, and nearly as many adults?
That seems to be the current debate. Is there a middle ground between these two views, one in which parents and educators can find some consensus? I think there is.
Critics question whether ADHD should be seen as a disorder or just a natural human variation. They cite the limitations of a framework for diagnosis based on subjective impressions of symptoms rather than biological criteria used for many other medical problems.
Otherwise normal children are singled out because they don’t fit into regimented school environments, these critics say, and they worry about the side-effects of the stimulant medications used to treat ADHD and the cozy alliance between the psychiatric profession and the pharmaceutical industry.
Critics of the status quo also argue that ADHD is a social construction based on societal needs to enforce compliance and passivity in school-age children.
The diagnostic manual of the psychiatric profession relies on a list of symptoms without reference to underlying causal factors. If you have the symptoms, you have ADHD. The focus on medication as a primary treatment depends mainly on a body of research that some argue is far from robust. The long-term effects and unintended consequences of such medications are still open questions.
The psychiatric profession has yet to explain the explosion in some areas in the diagnosis of ADHD, nor are they able to point to solid research that calls for the diagnosis and pharmaceutical treatment of the disorder.
In general, the profession’s stance is that ADHD is real, it is reflected in these lists of symptoms as reported by individuals, parents and teachers, and its treatment is by stimulant medication because stimulant medication works.
This seems legitimate. It seems clear that there is a neurological variation of brain development that afflicts about five percent of children. Symptoms include difficulties with impulse control, distraction, activating to do work and keeping information in mind.
A small percentage of children face these challenges pervasively, and for them, stimulant medication can truly make a difference. Recognizing and addressing ADHD in better ways was one of the great changes I have seen since I started work in the field in 1987.
But we have to question how and why a serious childhood disorder, which most agreed for the better part of the last century afflicted about 5%of the population, has expanded in the past two decades to become a cultural phenomenon.
I believe societal factors have driven increases in diagnosis.
Since No Child left Behind was enacted in 2001, school systems have become less hospitable to students with certain learning profiles. Teachers, under pressure to guide their classes to high-performance on standardized tests, can control the classroom more effectively if they can recommend that high-energy students be controlled through medication.
Moreover, the competition to enroll in a top college or to succeed in a competitive workplace, coupled with relaxed criteria for ADHD diagnosis, has led families and individuals to seek and find legal pathways to these medications.
This obviously is a very slippery slope. If the annual rate of increase in diagnosis of ADHD holds steady at between 3 and 5%, a couple of decades from now we will have reached the point where more than one in five individuals will be diagnosed with the disorder. This possibility defies logic, but it is the course we are headed on unless we can find our way back to a middle ground.
The way to the middle is anything but obvious. Somehow we must change school systems to account for bright restless kids, and as a society, we must recognize that these problems are real. To borrow my employer’s tagline, we all need to “take a different path” to ADHD’s middle ground – working together to better support our nation’s next generation of learners and leaders.
MacLean Gander is a professor of English at Landmark College which serves students with learning disorders.