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Mel Konner
Mel Konner MD, PhD

Is ADHD a Disease of Civilization?

Many kids we diagnose would be fine hunter-gatherers.

During my two years of research on children among the Kalahari San, or Bushmen, I watched kids scramble over huge termite hills, chase each other around the scrub brush in the savanna, practice dance steps, stop to dig up a tasty tuber, pick some berries, or throw a rock at a hapless bird or turtle which they could then cook and eat. I often wondered how many of them might be called inattentive or hyperactive in a classroom setting.

The answer, I think, is not none, but few—certainly fewer than the three to six percent who get diagnosed in American schools. My friend Peter Gray has posted on this discrepancy, which he learned about by interviewing fieldworkers who had studied hunter-gatherers. In anthropology, we call it the discordance or “mismatch” model. We as humans evolved in a certain context—the environment of evolutionary adaptedness. This crucible formed our genes.

Then, most of us entered a completely different environment, that of settled agriculture, a mere 10,000 years ago. But let’s say that’s enough time for some genetic change. We then shoved ourselves into yet another, even more different environment, the modern industrial/postindustrial state. No way our genes could have changed fast enough to adapt. The mismatch between genes and environment has brought us big increases in obesity, diabetes, heart disease, stroke, some cancers, and even dental caries—“diseases of civilization.”

Is ADHD one of them? There are reasons to say yes. First, some forty percent of kids diagnosed with it have had pressure from teachers to get evaluation and treatment, and this is by far the most common source of referrals. These kids stick out like sore thumbs in classrooms where you have to sit still all day, pay attention continuously to activities you haven’t chosen, and remember pesky details on command.

It’s not that hunter-gatherer children and adults didn’t have to concentrate intensely, control restlessness, and remember many fine details; they did. No man could succeed as a hunter who couldn’t keep still and quiet, no woman could feed her family without a prodigious memory for the details of a landscape and the appearance of countless edible plants in all seasons. Survival depended on doing these things well.

But they did them in the course of moving around in a vast, wild world they felt comfortable in, and when they stopped to focus in utter silence on a kudu’s trail or match a slim brown vine on a bush with the retrieved memory of an underground succulent root, these skills were part of the natural course of a day’s events, moving through the savanna, responding appropriately to compelling stimuli as they arose.

There was no question in this world as to the relevance of what they needed to do, even for children. There was no years-long slog through sedentary activities, many of which seemed irrelevant to life. There was no call to trade a huge part of your childhood for a future return that was difficult to imagine. Play merged with learning to survive.

So many of the children who would now be diagnosed with ADHD (or at least ADD) would have gotten a pass, and some of our academic stars would have been worse off—enjoying sitting still rather than getting up and moving for instance, or ignoring a stray distraction in the stimulus envelope that might turn out to be dinner or a leopard.

To be sure, the kid who is proverbially bouncing off the walls or unable to focus attention even for short periods would be poorly adapted in any culture, even one without walls. But most kids who get the diagnosis in our culture would be fine—normal. There’s a bell-shaped curve of the genetic tendency toward inattentiveness and overactivity, and the modern world lops off a much bigger chunk of one tail and deems it maladapted than would have been the case for our ancestors.

Still, we do want our kids to adapt to our culture. Both medical and behavioral treatments for ADHD have proven themselves, and the diagnosis is not a plot to control rebellious kids and adults (One paradox is that non-Hispanic whites are more likely to get treated than Hispanic or African-American kids.)

But we also need to think about the environment. Alternative schools with open classrooms have been around for decades and have allowed children to learn in ways that are more like the hunter-gatherer world we evolved in.

Meanwhile, No Child Left Behind—with its relentless narrow testing programs—combined with an economic downturn, have caused schools throughout the country to abolish recess, cut way back on art and music, and dismantle playgrounds. It’s not rocket science to predict an increase in ADHD. We’re just making the mismatch worse.

About the Author
Mel Konner

Melvin Konner's books include The Tangled Wing and The Evolution of Childhood. He has written for The New York Times, Newsweek, Nature, and Science.

Melvin Konner
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