Jared DeFife Ph.D.

The Shrink Tank


Is Attention Deficit-Hyperactivity Disorder a fad?

Pay attention to those struggling with inattention.

Posted Aug 20, 2010

Attention Deficit-Hyperactivity Disorder, ADHD

ADHD is a real problem needing real solutions.

When people have trouble with their abilities to work productively, learn new things, and form new relationships, that's not a fad...it's a problem.

In a head-shakingly condescending editorial for the Christian Science Monitor, Stephen Herr of Murray State University asserts that the construct of Attention Deficit-Hyperactivity Disorder (ADD or ADHD) has passed its time as "a credible diagnostic term", labeling it as a fad and equating it with "phrenology, hysteria, eugenics, compulsory sterilizations, shock therapy, and Thalidomide".

[Apparently, someone forgot to tell Dr. Herr that electroconvulsive therapy, also known as shock therapy, is still widely practiced and, when used responsibly, a surprisingly effective treatment for severe depression.]

To pick this apart, let's start with the idea of diagnosis. I am a firm proponent of the belief that psychiatric diagnosis is descriptive, NOT definitive. That means that a diagnostic label is something that simply describes an observable phenomenon, not necessarily providing information on the root cause of that phenomenon.

Hypertension is an established diagnostic term, but there are many different root causes of high blood pressure. And before you go saying "there is a medical test for hypertension but not for ADHD", take your blood pressure now and then go run up two flights of stairs and see if that measurement is the same. This is the same way ADHD is diagnosed, with dimensional observations of an individual taken at different slices of time.

Dr. Herr suggests that the establishment of ADHD was in part a way of dealing with the burdens and troubles of raising children and has since grown into "an urban legend". He also seems to forget that ADHD isn't simply a childhood problem, but one many adults face, as well. Herr attempts to write ADHD off to emotional states such as sleeplessness, boredom, and futility.

This is the same kind of stigmatizing prejudice that writes off people crippled with major depression as simply "sad", "too sensitive", or even worse, "lazy".

ADHD is problem which can have a number of different root causes.  From a national sample of hundreds of clinicians across the country, research work in our lab suggests that there are a number of different paths to the childhood and adolescent diagnosis of ADHD. To put it simply, one kid's ADHD is not the same as another kid's ADHD.

Some children with ADHD have underlying emotional dysregulation problems which lead them to act out in impulsive and dramatic ways. Others meet the criteria due to instrumental aggressivity which is rebellious, unreliable, and oppositional. Some are socially withdrawn and may be dealing with other problems affecting attention and concentration such as depression or anxiety. Finally, there is a subset of children with the ADD diagnosis who are highly adaptive. They tend to be sociable, well-liked, articulate, and achievement oriented.  Unfortunately, they struggle in significant ways with maintaining attention, restlessness, and impulsivity.

Don't children and parents of children with each of the above problems deserve to get proper guidance, equal educational opportunities, and appropriate health care? Is ADHD over-diagnosed? Almost certainly. Are physicians too often, too quick to medicate children with stimulants when they could be helped otherwise? You bet.

But the path to improved care is not to be found in stigmatizing suffers, blaming beleaguered parents and teachers, or condemning overburdened doctors. Instead of shrugging off the problem as yesterday's news, we need to rise to the challenge of understanding, education, and intervention.

Let's not throw out the struggling child with the dirty diagnostic bathwater.


Jared DeFife, Ph.D.