Attention-deficit hyperactivity disorder (ADHD) is described as the most common neurobehavioral condition of childhood. It generates considerable controversy and some doubt whether it even exists.
What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is not a single disorder but a complex neurodevelopmental constellation of problems. Its core symptoms are inattention, hyperactivity, and impulsivity and some children have problems with one of these behaviours, while others have both inattention and hyperactivity-impulsivity.
Scientists are not sure what causes ADHD, symptoms can change over time as a person ages and it is more common in males than females
The ADHD Journey
Inattention, hyperactivity and impulsivity are clearly not new behaviours and the first example of a 'disorder' that appears to be similar to ADHD was given in 1798 by Scottish physician Sir Alexander Crichton.
Since then numerous other labels have been used, including minimal brain dysfunction, hyperkinetic impulse disorder and attention-deficit disorder with or without hyperactivity.
The first ‘official’ use of ADHD appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) in 1987. The DSM is regarded as the leading authority on mental health diagnosis and research and referred to as "the psychiatrist's bible."
There is no single test for ADHD. A diagnosis of ADHD is based on reported signs, symptoms, behaviour, medical history and environment and requires a comprehensive evaluation by a paediatrician, psychologist, psychiatrist. This could also be a learning disability specialist, social worker or occupational therapist with expertise in ADHD.
But who you consult about ADHD and what criteria they use really does matter. Some might refer to the DSM. If they do, children must meet the criteria laid out in the fifth edition of the DSM (DSM-5) and have six or more signs of the disorder for at least six months to a degree that's inappropriate for their developmental level. Adolescents and adults 17 years and over must exhibit five or more symptoms to receive the diagnosis.
As severity can change over the course of a lifetime, the DSM-5 requires that each diagnosis include an assessment of the severity of the condition, whether it’s mild, moderate, or severe.
ADHD is a modern-day crutch
But ADHD has some harsh critics and some see it as a cultural construct and a SENCO’s biggest time-waster. They say it is not real, it is a myth and a fraud.
Jerome Kagan is a renowned and tenured Harvard Psychologist and thinks that ADHD is a reckless label. He says ADHD is purely an invented condition rather than a serious illness.
Kagan doesn't like the label because it sounds like a real medical disorder which it isn't. He says that pharmaceutical companies and doctors are largely to blame. Children are misdiagnosed and then given the mind-altering drug Ritalin and so is a great money-making fraud.
Despite its popular remedy status, Ritalin is no mild intervention. This is a drug with serious side-effects that can reduce physical growth and it can precipitate self-harming behaviour. There is no evidence that it reduces the problems associated with ADHD.
He says there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.
Saul says that there is no doubt the symptoms such as an inability to pay attention to details, fidgeting, interrupting, difficulty staying seated, impulsive behaviour etc exist but lumping them together and turning them into a diagnosis of ADHD is wrong and neglectful. He says "ADHD makes a great excuse. The diagnosis can be an easy-to-reach-for crutch."
The need to label is certainly powerful, especially in an era of heightened mental health awareness and there is little doubt that sometimes certain behaviours may be inappropriately medicalised. The 'symptoms' of ADHD interact and overlap with other conditions or learning problems and ADHD could be a very handy label to attach to someone.
Julian Elliott, Professor of Education at Durham University, thinks children are branded and “We are turning everything into a mental health problem. For many of these children they don’t have a mental disorder; it’s a question of conduct."
Matthew Smith (2012) believes the diagnostic threshold is now so low that it has led us to a place where we have pathologised naughtiness as a mental disorder requiring chemical intervention and 'treatment' with medication. He says, "All sorts of children, simply those that daydream and don't pay attention, could now be diagnosed with ADHD and placed on medication."
The Real Deal
To say that ADHD doesn’t exist meets with plenty of opposition as scientists have found that there is a strong genetic link with ADHD running in families.
Although there is “no characteristic brain abnormality associated with ADHD” and a “consistent genetic marker has not been found”, Barkley (2018) notes that there is a heritability chance of 57% for a child if a parent has ADHD. Matthews et al (2014) notes that brain scan studies show differences in the development of the brain of individuals with ADHD, such as cortical thinning in the frontal regions and reduced volume in the inferior frontal gyrus.
In their study, Williams et al (2010) found genetic evidence and suggested that “ADHD is not purely a social construct.”
Clearly, a child with ADHD could be a child who misbehaving and that is nothing special so it’s crucial to distinguish between ADHD and other conditions that have similar signs and symptoms such as disruptive behaviour disorders, learning disorders, tic disorders, anxiety, depression and difficult peer relationships. One professional alone is unlikely to have a full picture of a child’s personality and background so this task is enormous.
As teachers we might be asked “Do you think my son has ADHD?” but how many of us are qualified to answer that? But then how many professionals have got a clear idea about what ADHD is?
I have taught lots of children who have supposedly had ADHD. But to me their symptoms of inattentiveness, hyperactivity and impulsivity were not unique to ADHD. They had been 'diagnosed' although I was never really sure by whom. It seemed to be more of a joint teacher-parent construct from a previous year.
Children and adults diagnosed with ADHD do have real problems. But we need to question who has done the diagnosing and dig deeper. It’s worth remembering that a GP cannot formally diagnose someone with ADHD - they refer you to a specialist. Who that specialist is could dictate someone’s future learning path.
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About the author
John is an ex-primary school teacher and Ofsted inspector who has spent the last 20 years working in the education industry as a teacher, writer and editor. John’s specialist area is primary maths but he also loves teaching science and English. John has written a number of educational and children’s books, and contributed over 1,000 articles and features to various educational bodies. John is eTeach’s school leadership and Ofsted advice guru, sharing insights on best practice for motivating and enriching a school team, as well as sharing savvy career steps for headteachers and SLT.