If only teachers' ratings  were used, the numbers would be even greater. In one study involving 16 different schools and more than three thousand children, teachers filled out the standard ADHD diagnostic checklist of behaviors for the students in their classrooms.[2] In that study, where teachers' ratings were not averaged in with the ratings made by parents, 23% of elementary school boys and 20% of secondary school boys were diagnosed as having ADHD. What an amazing finding. By teachers' ratings, nearly one fourth of all elementary school boys and one fifth of all secondary school boys has the mental disorder, ADHD!

ADHD is Fundamentally a School Adjustment Problem

What does it mean to have ADHD? Basically, it means failure to adapt to the conditions of standard schooling. Most diagnoses of ADHD originate with teachers' observations.[3] In the typical case, a child has been a persistent pain in the neck in school--not paying attention, not completing assignments, disrupting class with excessive movements and verbal outbursts--and the teacher, consequently, urges the parents to consult with a clinician about the possibility that the child has ADHD. Using the standard diagnostic checklists, the clinician then takes into account the ratings of teachers and of parents concerning the child's behavior. If the ratings meet the criterion level, then a diagnosis of ADHD is made. The child may then be put on a drug such as Adderall or Concerta, with the result, usually, that the child's behavior in school improves. The student begins to do what the teacher asks him to do; the classroom is less disrupted; and the parents are relieved. The drug works.

The diagnostic criteria for ADHD, as outlined by DSM-IV (the official diagnostic manual of the American Psychiatric Association), clearly pertain primarily to school behavior. The manual lists nine criteria having to do with inattention and another nine having to do with hyperactivity and impulsivity. If a child manifests at least six of either set of nine, to a sufficient degree and over a long enough period of time, then the child is identified as having one or another version of ADHD. Depending on which set of criteria are manifested, the child is given a diagnosis of ADHD Predominantly Inattentive Type; ADHD Predominantly Hyperactive-Impulsive Type; or ADHD Combined Type.

Here, for you to peruse, are the complete lists of criteria, quoted directly from DSM-IV:

Inattention

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

Hyperactivity & Impulsivity

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often reacts as if "driven by a motor".
6. Often talks excessively.
7. Often blurts out answers before questions have been finished.
8. Often has trouble waiting one's turn.
9. Often interrupts or intrudes on others (e.g., butts into conversations or games).

OK, after reading this list, who is surprised that so many boys have been diagnosed as having ADHD and that teachers usually initiate the diagnostic process? Raise your hand (but please don't blurt out your answer before I call on you).

How convenient that we have this official way of diagnosing kids who don't sit still in their seats, often fail to pay attention to the teacher, don't regularly do the assignments given to them, often speak out of turn, and blurt out answers before the questions are finished. They used to be called "naughty"--sometimes with a frown, sometimes with a smile of recognition that "kids will be kids" or "boys will be boys"--but now we know that they are, for biological reasons, mentally disordered. And, wonder-of-wonders, we even have an effective treatment. We can give them a powerful drug--a preparation of methylphenidate or amphetamine, both of which have effects on the brain similar to those of cocaine (but without the euphoria) and are, for good reasons, illegal to take unless you have been diagnosed with a mental disorder and given a prescription. The drug works. The children become more tractable and classroom management becomes easier.[4]

The most common subtype of ADHD is the Predominantly Inattentive Type. This is the disorder that used to be called just ADD. A highly respected pediatrician at Yale University who treats (with drugs) many children diagnosed with this disorder made this interesting confession: "A disproportionate number of children labeled ‘ADHD without hyperactivity' are exceptionally bright and creative children. I've often thought that these kids find their own inner theater much richer and more interesting than the outer theater of the classroom and, so, naturally, focus on it at the expense of classroom attention. . . The proper fix for this problem would be done at the school level, a place where I am unlikely to have any significant effect. I can, however, help these children concentrate and return their attention to the classroom."[5]

Why Do So Many Kids Have Difficulty Adjusting to School?

From an evolutionary perspective, school is an abnormal environment. Nothing like it ever existed in the long course of evolution during which we acquired our human nature. School is a place where children are expected to spend most of their time sitting quietly in chairs, listening to a teacher talk about things that don't particularly interest them, reading what they are told to read, writing what they are told to write, and feeding memorized information back on tests. As I have detailed in previous essays, during the entire course of human history until very recently, children were in charge of their own education. They learned by following their own inner, instinctive guides, which led them to ask countless questions (their own questions, not someone else's), to converse with others as equal partners, to explore their world actively, and to practice the skills crucial to their culture through self-directed play in age-mixed groups. [See Children Educate Themselves II: The Wisdom of Hunter-Gatherers.]