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An aura of mystery surrounds the concept of ADHD. Some scientists think that ADHD is like a unicorn. Everyone knows what it is, but nobody has ever seen one. Other scientists argue that ADHD existed even before the authors of the DSM-IV invented the words for it in 1994. The one side (the unicorn camp) holds that hyperactive and inattentive behavior result from stressors in the child’s psychosocial environment. This usually means stress or trauma in the child's home; but teachers and friends can stress a child as well. The other side (the DSM-IV and DSM-5 advocates) holds that the cause of ADHD-like behaviors is biological—a "chemical imbalance" in the child’s brain that presumably has genetic causes.
The latest to take a stand on the issue of whether or not ADHD exists as a real disease entity is Houston trauma specialist Bruce Perry, M. D. Perry is the author of the fabulous book on childhood trauma,The Boy who was raised as a Dog. He is also a blogger here at Psychology Today. Perry was one of the first to notice that children’s brains are shaped not only by their biology, but also by their social environments. Perry would prefer to see doctors look at the way parents behave with their children and to try non-pharmaceutical therapies for hyperactive kids before going straight to medication.
At a recent interview in London, a reporter for the Guardian quotes Perry: "There are a number of non-pharmacological therapies which have been pretty effective. A lot of them involve helping the adults that are around children. "Part of what happens is if you have an anxious, overwhelmed parent, that is contagious. When a child is struggling, the adults around them are easily disregulated too. This negative feedback process between the frustrated teacher or parent and disregulated child can escalate out of control."
Perry suggests that attention deficit hyperactivity disorder (ADHD) is not "a real disease." This puts Perry in the unicorn camp. He does not deny that hyperactivity, impulsivity and inattentiveness are real. Of course they are. But to say they are a disease entity is like saying that a man who comes to the doctor's office with chest pain and sweating has a "fever." The fever can be treated with medication, but what about the underlying cause of the fever? Fever is a symptom, not a disease.
The unicorn camp is widely misunderstood. The unicorn believers do not deny that some kids are so energetic that they have a hard time sitting still and focusing on their schoolwork. We don’t deny that some kids are so impulsive that they blurt out answers in class without waiting for their teacher to call on them. We don’t deny that stimulant drugs can help a child—or anyone else for that matter—calm down and concentrate. However, the unicorn camp does not think that drugging kids is the best and safest way to help them. The best way to help them is to treat the underlying cause in the child's social environment. Family therapy, behavioral therapy and even parent training classes have proved to be sufficiently effective in reducing hyperactivity and inattentiveness.
Of course none of these methods for helping hyperactive kids are as easy as handing a child a pill. The problems with a pill, however, are many. First, the drug covers up the real cause of the child’s misbehavior. Medicating a troubled child merely silences his story; second, children are learning that life’s problems can best be tackled by taking psychotropic drugs; third, children who take stimulants over a long period of time can become addicted to them as adolescents and young adults; finally, stimulants can have unpleasant and even serious side effects.
Nor does the unicorn camp buy into the widespread myth that stimulant drugs will only help a child if the child actually “has ADHD.” It’s truly surprising how many parents have been told that if their child did not have ADHD the child would not respond to stimulant drugs. In the blitzkrieg of World War II, German bomber pilots took a stimulant drug with a chemical structure similar to that of Adderall. When the American military discovered how much the stimulants helped German pilots, they put stimulants in the kit of every American and British bomber pilot to improve their concentration and alertness on long-haul missions. Surely not all these pilots had ADHD.
If a small fraction of the resources spent on finding biological causes for ADHD were used for researching the psychological and social causes of the symptoms, there would be real progress on finding ways to help over-active and distracted children without drugging them. Dr. Perry is a leader in this new direction for scientific research.
Copyright © Marilyn Wedge, Ph.D.
Marilyn Wedge is the author of Pills are not for Preschoolers: A non-drug Approach for Troubled Kids. Her new book on ADHD is forthcoming.
