Take Two #79: What is ADHD?

By Kyra-lin Hom

I recently peer reviewed a classmate's statistics paper on ADHD. Her son had been exhibiting hyperactive traits. So she decided to look at the rates of ADHD diagnosis in children and the various treatments proscribed in the US. To put things simply, no matter what demographic you look at, ADHD and the prescription of stimulants to treat the disorder are staggeringly on the rise. I'm using the term 'staggeringly' to mean 'in a really, really hard to believe way.'

That's not my opinion, though I agree with it. The belief that ADHD is being over-diagnosed and stimulants over-proscribed is the professional opinion of several child psychologists, including Dr. Ned Hallowell. He previously pushed for prescription stimulants saying they were “safer than aspirin.” Nowadays he's telling a different story and says that he, “regrets the analogy.”

Here are some numbers to chew over. According to the federal Centers for Disease Control and Prevention, 11% of all US school-age children (roughly ages 4 to 17) have been medically diagnosed with ADHD. About two-thirds of all these diagnosed children receive prescriptions for stimulants such as Ritalin or Adderall.

Now 11% doesn't seem like a frightfully high number until you apply it to the classroom. 11% means that, in any given average public school classroom of 32 students, 3.5 of those children have been medically diagnosed with ADHD by a medical professional. Of those 3 to 4 students, 2 to 3 of them are on proscribed stimulants. Again this is per classroom. Oh, and one more thing, these stimulants are commonly referred to as 'brain steroids' and frequently taken by otherwise 'healthy' children during school crunch times in place of (or in conjunction with) caffeine.

When you zero in on the high school-age demographic, the numbers get even much higher. In high schools, nearly one in five boys and one in ten girls have been diagnosed with ADHD. That means, in a high school with a student population of about 2,000 (based on the high school I graduated from), 580 of those 2,000 students have been diagnosed with ADHD. Now that is a big, eye-catching chunk.

Does this mean that the frequency of ADHD is actually reaching society impeding heights and we should start seeding Ritalin into our water supply like Flouride and Calcium? Or does this mean that the diagnosis of the disease has increased? Probably a bit of both. The last time the rate of ADHD diagnosis was (according to national health surveys) this high was in the 1980's when the disorder was first coined and all the new rage.

But hold up, what is ADHD? Sure, most of us know that those four letters stand for Attention Deficit Hyperactivity Disorder. But what is that? Surprisingly enough, that answer is up for debate.

In the US, psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a guideline with which to diagnose their patients. Elsewhere in the world, psychiatrists use the International Classification of Diseases (ICD). A couple others are the Chinese Classification of Mental Disorders and France's CFTMEA (which stands for a lot of words in French that I don't know or understand). Each one is a bit different from the other. As a result, what constitutes a disorder as ambiguous as ADHD is subject to interpretation.

In the US, psychiatrists view ADHD as a biological-neurological disorder, essentially that is something tangibly wrong with the brain. It is a material problem with a material solution. The issue here is that we don't yet know exactly what to look for in brain scans. Institutions like John Hopkins have tried and have only been so successful. Without being able to procure definite evidence then, the DSM provides a list a symptoms for psychiatrists to look for. Please, google search for “DSM V ADHD” and read the list yourself. It is speculative at best.

French psychiatrists take a much more psycho-social approach to child psychology. Instead of pathologizing child behavior, they investigate why a particular child might be acting out. This includes family situation, school life, nutritional intake, etc. Consequently what we in the US would consider disruptive and potential ADHD behavior is coached out of children with carefully designed therapies. Very few French children are diagnosed with ADHD – 0.5% actually. Compared with our 11% that's impressive.

ADHD is very real and can be very damaging. I do not claim the contrary. For those of my friends diagnosed with ADHD, stimulants do make their academic and professional lives easier and smooth their social interactions. But I have to wonder, what if someone had caught these 'socially undesirable behaviors' earlier? Say in childhood. And what if someone had made an effort to instill more patience and discipline in my friends as children? Would they still be as dependent upon pills now?

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