Distracting the Truth: Seven Fallacies behind Attention-Deficit/Hyperactivity Disorder

#FromThePenOfEdwardLouis: #AttentionDeficitHyperactivityDisorder #ADHD #DistractingTheTruthTheSevenFalaciesBehindADHD

Brian Burt | Dr. Brian Greve | Integrative Seminar IDST 397-1 | 10 December 2008 | #HolyCrossCollegeNotreDameIndiana

Distracting the Truth: Seven Fallacies behind Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (AD/HD), as classified by the Diagnostic and Statistical Manual, fourth edition (DSM-IV), is a chronic neurobiological condition distinguished by inappropriate levels of inattention, impulsivity, and hyperactivity. Affecting almost five to eight percent of school age children and approximately four percent of adults, AD/HD is one of the most widely recognized and researched disorders to date. However, in light the amount of research devoted to this subject and the prevalence of AD/HD, to accurately address AD/HD, we must move beyond the fallacies behind AD/HD by focusing on what we know at this point.

“AD/HD, A.D.D, A.D.H.D., what’s the difference? It’s all the same thing.”

Previously referred to as minimal brain dysfunction, the 1968 Diagnostic and Statistical Manual, second edition (DSM-II) labeled AD/HD as “hyperkinetic reaction to childhood.‖ The DSM-III in 1980 introduced the term ―Attention-Deficit Disorder with or without hyperactivity.

In 1987, the revised edition of the DSM-III-R, expired the term ―Attention-Deficit Disorder (ADD)‖ and replaced it with ―Attention-Deficit Hyperactivity Disorder.‖ (Attention Deficit Disorder) With the release of the DSM-IV in 1994 and the DSM-IV-TR in 2000, the latest classification refers to it as ―Attention-Deficit/Hyperactivity Disorder (AD/HD)‖ noting that the AD/HD classification contains three primary subtypes: AD/HD predominantly inattentive type(AD/HD-I), AD/HD predominantly hyperactive-impulsive type (AD/HD-HI), and AD/HD combined type (AD/HD-C) (―WWK #1‖ 2). As Mary Burt pointed out in a personal interview, while these subtypes serve more as a guide for further diagnosis and that the terms ADD and ADHD are still widely used throughout both the professional and non-professional communities, it is important to note that ADD and ADHD, while similar, are not synonymous with each other.

As a consequence, a person may be diagnosed as ADD, but not meet the criteria to be diagnosed as ADHD. Additionally, it is also important to note that some people may be diagnosed as ADHD during childhood, and then lose the hyperactivity aspect as they mature and are then ADD during adulthood. For clarification purposes, the DSM-IV‘s term AD/HD will be utilized throughout the course of this text, except where specifically noted or in reference to a direct quote from an outside source.

“AD/HD is not a real disorder, it’s just an excuse.”

In order to address AD/HD, we must remove the notion that AD/HD is a fictional disorder invented to help pharmaceutical and other companies sell products. To the contrary, AD/HD is one of the best-researched disorders in psychiatry‖ as quoted by the American Medical Association Council on Scientific Affairs and has strong support from other professional medical groups including the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) (―WWK #3‖ 1). As noted by the National Resource Center on AD/HD, children exhibiting inattentiveness, impulsivity and hyperactivity were documented by medical science as early at 1902 (―WKK #1‖ 1). Furthermore, a subtype of AD/HD as it is known today could reach as far back as 1798 based on the work of Dr. Alexander Crichton. In his book, An Inquiry into the Nature and Origin of Mental Derangement, Dr. Crichton noted a sense a mental restlessness and that some children had a problem attending even how hard they did try‖ and that ―these children needed special educational intervention‖ (Attention Deficit Disorder). Beyond Dr. Crichton, there is also Dr. Charles Bradley who, in 1937, ―reported that a group of children with behavioral problems improved after being treated with the stimulant Benzedrine‖ (Attention Deficit Disorder) and medications such as Ritalin were utilized as early as 1957 to treat AD/HD related symptoms.

Aside from Dr. Crichton‘s findings, the prevalence of over a century of research clearly indicates that AD/HD is in fact a very real disorder.

“My kids are smart; I don’t have to worry about AD/HD.”

Despite the fact that almost thirty-seven percent of those with AD/HD do not graduate high school and less than five percent of those with AD/HD receive a college degree in the United States (Attention Deficit Disorder), we must remove the notion that those with AD/HD are not as smart as those without AD/HD or that if someone is smart, then that person cannot have AD/HD. To the contrary, as Toni McDougal pointed out in a personal interview, many people can be both intelligent and have AD/HD. In some cases, intelligence can even mask the symptoms of AD/HD. The key is at what stage in a person‘s life AD/HD is diagnosed and whether or not that person utilizes AD/HD to his advantage or allow it to serve as a detriment.

“Where did we go wrong? We did everything right, yet our son still has AD/HD.”

Despite the many advances in the field of neurology and over a century of research, the exact origins and causes of AD/HD still remain debated. While some research points to prenatal problems such as maternal smoking and dietary deficiencies or complications such as low birth weight, the research of more than 20 genetic studies ―clearly indicates that AD/HD tends to run in families and that the patterns of transmission are to a large extent genetic‖ (―WWK #1‖ 3).

Though unclear which specific genes or a combination of genes result in AD/HD, Researchers believe that a large majority of ADHD arises from a combination of various genes, many of which affect [the brain‘s] dopamine transporters‖ (Attention Deficit Disorder). However, since dopamine is a natural stimulant that increases neural activity and flood flow through the brain, a study by the U.S. Department of Energy‘s Brookhaven National Laboratory in collaboration with Mount Sinai School of Medicine in New York suggest that it is not the dopamine transporter levels that indicate ADHD, but the brain's ability to produce dopamine itself (Attention Deficit Disorder). As more research is being done to pinpoint the exact genes and areas of the brain affected by AD/HD, it is clear that AD/HD is a neurological based condition that may be alleviated or worsened by parenting styles or parenting problems, but these in themselves do not actually cause AD/HD (―WKK #1‖ 3)

“It’s just AD/HD; what’s the big deal?”

It is important to note that, since AD/HD is a complex condition, approximately ―two thirds of children with AD/HD have at least one other coexisting condition‖ and that ―any disorder can coexist with AD/HD, but certain disorders seem to occur more commonly with AD/HD‖ (―WWK #5‖ 1). The most five most common coexisting disorders include (1) disruptive behavior disorders such as oppositional-defiant disorder and conduct disorder; (2) mood disorders; (3) anxiety disorders; (4) tics and Tourette Syndrome; and (5) learning disabilities such as dyslexia (―WWK #5‖ 2). Among those with AD/HD, approximately 40% have oppositional defiant disorder, 10 -30% of children and 47% of adults have both AD/HD and depression, about 20% are also bipolar, and 30% percent of children and 25 – 47% of adults with AD/HD also suffer from an anxiety disorder (―WWK #5‖ 2-3). Since many of these coexisting conditions are also neurological based, it is hard to distinguish whether one causes the other or vice versa. For instance, in the case of depression, ―Typically AD/HD occurs first and depression occurs later‖ (―WWK #5‖ 2) as children with AD/HD begin to feel left out, not the same as their peers, or that there is something wrong with them. Furthermore, to say that someone has AD/HD does not necessarily mean that person will also be depressed, bipolar, or have anxiety issues. For instance, about seven percent of those with AD/HD have tics or Tourette Syndrome; however, 60% of those with Tourette Syndrome have AD/HD. As for learning disabilities, while at least two-thirds of children with AD/HD have at least one coexisting condition, at least 50% percent of children with AD/HD have a coexisting learning disorder, such as dyslexia (―WWK #5‖ 4). Given this, what is important to keep in mind is that someone may not have just AD/HD. Without proper testing for other conditions, the symptoms of AD/HD may overshadow other more serious conditions. Unchecked, any one of these individual conditions yet alone a combination of these conditions could pose serious problems, which can carry over from childhood to adolescence to adulthood.

“He couldn’t sit still in class today; he must have AD/HD.”

To say that a child is inattentive or hyperactive does not necessarily imply that the child has AD/HD. After all, at one time or another, we all exhibit characteristics of AD/HD. Children are naturally energetic. Unless they have a productive outlet for their energy, either through recess or physical education class, it is only natural that children are going to be hyper and unable to sit still during class. Furthermore, when the average television show lasts for less than thirty minutes factoring out commercials, the average song lasts for less than three minutes, and all around us are devices of distraction, it is only logical that children are going to lose focus and not be able to concentrate for an extended period of time. What is important is to distinguish those that are persistently inattentive or hyperactive to the point that their inattentiveness or hyperactivity is causing a serious impairment in their daily activities either at home, school, or work or even in their social life.

“My new product is a sure-fire way to cure your child’s AD/HD.”

Given that AD/HD is a neurological condition that may exist since birth or even earlier, it is important to realize that, as with many conditions, there is no actual cure for AD/HD. There are; however, a variety of treatment options available to help mitigate the symptoms of AD/HD including medication and behavior management therapy. But with this comes other constraints.

Just as there is no single cure, there is also no single method to treat AD/HD, no single pill that will resolve all the symptoms associated with AD/HD. Almost a decade since most people jumped on the proverbial bandwagon that medicines, such as Ritalin, were the ultimate solution for children with AD/HD, many researchers are now calling for a ―multimodal treatment, which includes a combination of ―parent and child education about diagnosis and treatment, behavior management techniques, medication, and school programming and supports‖ that is tailored to the unique needs of the individual as best as possible (―WWK #6‖ 1). Though some might object to the multimodal treatment because of the medication aspect, it is important to ―look at medication as a place to start‖ (McDougal) ―like the training wheels of a bicycle‖ (Hartmann 95). As ―an adjunct to the solution… medication can make the issue more workable‖ (Burt).

Therefore, it is important to keep in mind that medication should not be seen as the sole solution, but as a way to assist a person with AD/HD to reach some degree of stability while he or she learns additional life-long coping strategies to mitigate the symptoms of AD/HD.

“Okay, so now what?”

Just as AD/HD is a complex condition, the way in which we perceive and treat AD/HD is equally complex. Despite all the research available, we do not have all the answers; if so this would be a paper on the history of a condition once called AD/HD. But also with the amount of research available, there is also great deal of misleading conclusions and opinions. In order to accurately address AD/HD, we must be vigilant in separating fact from opinion and move beyond the many fallacies surrounding AD/HD. We must focus on what we know. As previously discussed, we know that AD/HD is not a fictional condition and that has been around for over a century, just under different names. We know that because the origins and causes are still debated, there are no cures - only treatment options. At the same time, because there is no one universal treatment, treatment must be multifaceted and not rely on medication alone.

But it goes beyond what we know; it is also a matter of how we perceive AD/HD. As Thom Hartmann writes, ―"What you . . . tell the ADD child about himself can have a decisive effect. Children respond very differently to being told ?This is how your brain works‘ instead of Your brain just don‘t work right" (36). Too frequently in modern language, we are quick to treat adjectives as nouns. For instance, we hear phrases such as ―He‘s O.C.D.‖ or ―He‘s AD/HD‖, but if we were to break these phrases down, they would then read ―He is obsessive compulsive disorder‖ or ―He is attention-deficit/hyperactivity disorder.‖ As Hartmann further points out ―when we describe and define people, they will most often live up to that expectation‖ (Hartmann xxxi); instead of saying ―he is AD/HD‖ we need to focus more on saying ―he has AD/HD.‖ While some may view this as a minute detail, for others, it can make all the difference in the world; especially for a child who is already beginning to feel inferior or broken because his ―brain just don‘t work right.‖

However, along with this comes a sort of ―catch twenty-two.‖ While we need to distinguish those who have AD/HD from those that do not, we need to do so in a fashion that does not single out those with AD/HD as to make them feel inferior. We cannot allow AD/HD to cause us to loosen our standards, expectations, and allow children to be less accountable for their personal actions. But we cannot also expect a child with AD/HD to sit still through a typical class or concentrate if they truly cannot because of his brain‘s natural chemistry. Unfortunately, in my current capacity cannot provide any definitive solutions to this ―catch twenty-two,‖ but it is evident that we do need to provide some level of leeway.

As we further our knowledge of AD/HD, we must keep in mind that while we all have AD/HD tendencies from time to time, we do not all have AD/HD. AD/HD is a serious condition that should not be handed out as a diagnosis lightly. We should not utilize AD/HD as a crutch or an excuse for poor parenting or poor teaching. Persons with AD/HD are no less intelligent and no less capable of leading productive lives than those without AD/HD. When dealing with AD/HD or any disorder for that matter, we must constantly be aware of not only how we view the situation, but also how the person on the other side of the desk perceives the situation.

Works Cited

"Attention Deficit Disorder." 26 October 2008. Wikipedia.org. 26 October 2008

<https://en.wikipedia.org/wiki/Attention_Deficit_Disorder>.

Burt, Mary. Personal Interview. Brian Burt. Granger, 14 November 2008.

Hartmann, Thom. Attention Deficit Disorder: a Different Perception. 2nd . Grass Valley: Under

Wood Books, 1997.

McDougal, Toni. Personal Interview. Brian Burt. Granger, 18 November 2008.

National Resource Center on AD/HD. "What We Know #1: The Disorder Named AD/HD."

February 2008. www.help4adhd.org. November 2008

<https://www.help4adhd.org/documents/WWK1.pdf>.

—. "What We Know #3: Managing Medication for Children and Adolescents with AD/HD."

February 2008. www.help4adhd.org. November 2008

<https://www.help4adhd.org/documents/WWK3.pdf>.

—. "What We Know #5: AD/HD Co-Existing Disorders." 2003. www.help4adhd.org. November

2008 <https://www.help4adhd.org/documents/WWK5.pdf>.

—. "What We Know #6: Complementary and Alternative Treatments for AD/HD." 2008.

www.help4adhd.org. November 2008

<https://www.help4adhd.org/documents/WWK6.pdf>.