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Our society’s views on ADHD may be as polarized as its views on politics. One camp views ADHD as a neurodevelopmental disorder with a biological cause. For this camp, an ADHD child has a brain deficit or a chemical imbalance. The other side views ADHD as a set of behaviors that have a variety of environmental causes. Some examples are childhood trauma, conflict between the child’s parents, being bullied, being exposed to an acrimonious divorce, over-exposure to electronic screens, the child’s immaturity for his grade level, or even dietary factors.
The biological disorder camp asks “what’s wrong with this child” and looks to a biological solution like medication. The medication is most often stimulants like amphetamines or methylphenidates but in some cases anti-psychotic drugs. The biological camp sees not medicating a child with ADHD as akin to child abuse. The environmental camp, on the other hand, asks “what happened to this child” and looks to interventions in the child’s family, social, or school life. The environmental camp views medicating healthy children with psychiatric medications as child abuse and a violation of a child’s human rights. Each side has produced arguments, research, and experts that support its views.
Much like the opposed camps of Republicans and Democrats, each of the ADHD camps sees its own reality and finds its own echo chamber of colleagues and research that support its own worldview. It is as though one camp watches Fox News and the other watches MSNBC. As in politics, so it is in families. Parents may be split on how they view their child’s behavior. For example, a mother can insist on testing, diagnosis, and medication, while the father believes the child “is just behaving like a boy" or “just like I was at that age before ADHD was invented.”
Bitter quarrels about whether treatment should be biological or environmental emerge between parents, especially in the case of divorce. The child becomes a victim of the power struggles between the parents. Each side offers its own experts. Just as Republicans and Democrats seem to care more about their side winning than about what’s best for the country, parents often are so invested in winning the power struggle that they overlook what’s best for their child.
Finding a synthesis that could emerge from the two dialectical opposite positions on ADHD seems, at least at this point in time, impossible. Yet there are exceptions. Some experts have changed their position, most notably Robert Spitzer, the highly respected lead author of the DSM-III, the psychiatric manual that first proposed that mental disorders like ADHD have biological causes. Years after the publication of the DSM-III, Spitzer admitted that there were no biological causes for any of the disorders in the manual, except organic disorders like epilepsy, Alzheimer’s, and Huntington’s disease. “No biological markers have been identified,” said Spitzer in a 2012 interview. Unfortunately, as a result of the DSM-III and the manuals that followed it, millions of children had been medicated for ADHD.
On the other hand, many argue that stimulant medications help children with ADHD, at least in the short term. This was proven by the famous MTA study (Multi Modal Treatment Study of children with ADHD) in 1999. The study found that methylphenidate drugs initially helped 8- and 9-year-old children diagnosed with ADHD perform nominally better academically than their peers who had not been medicated. In a three-year follow-up, however, the effects of the drugs leveled off, with the medicated and non-medicated students performing equally well. A follow-up eight years later showed no differences between the medicated and non-medicated children on several measures of academic achievement.
So perhaps a synthesis would look something like this. If a parent is interested in a short-term fix to help their child’s academic performance, the biological model offers some advantage. If parents are interested in their child’s well-being and academic performance in the long term, without risking the side effects of psychiatric drugs, then the environmental model is a good choice.
As in families, so in politics. Short-term fixes like stimulus packages and bail-outs to address a global pandemic can help in our current crisis, but only after people have become sick and lives have been lost. On the other hand, planning ahead by keeping a National Security Council section that would play a lead role in organizing a response to a global pandemic is a more long-term view that would have saved thousands if not millions of Americans from becoming ill and lives being lost.
