ADD/ADHD: A "Fake" Diagnosis?
by Tina Blue
December 18, 2002
Some time ago a reader wrote me to ask whether ADD/ADHD might be a fake diagnosis, one of those American fads, since they seem not to have it at all in Canada.
I just discovered your articles tonight. A friend recommended them. I have enjoyed reading them and am staying up past my bedtime to do so. :-) I agree with most of what I've read so far (in about 10 articles). However, one particular article has me wondering what your response is to the claim that ADHD and ADD only exist in the United States. I find it interesting that ADHD doesn't exist even in Canada. Is it really a diagnosis, or just an excuse for parents not to have to take responsibility for their active children?
My response is that it is definitely both.
In Dr. Lawrence Diller's excellent book Running on Ritalin, he discusses the way our unbalanced modern life creates circumstances that cause children to seem ADD/ADHD, even when they are not. In the book Driven to Distraction, respected ADD/ADHD researchers Dr. John Ratey and Dr. Edward Hallowell (who is himself ADHD) call ours an "ADDogenic society," because the sort of life we try to live in this country causes everyone to seem distracted and scatterbrained.
But I have ADHD myself, and anyone who knows me can tell that I am not quite like "regular" people. Frankly, I don't consider ADHD a disorder or a problem, but just a set of behavioral traits and a different way of processing information and acting on it. It does become a problem, though, in a society like ours, where any deviation from a very narrow set of acceptable behaviors and thought processes is not well tolerated.
ADD/ADHD researcher Thom Hartman points out that in a hunter-gatherer society, ADHD personality traits would be an advantage, not a disadvantage, and that is why such traits would have been conserved by evolution. In fact, the ADHD child is often compared to a wild monkey (another popular term is "house ape"), because the sort of behavior he exhibits is common among the young, and even the adults, of other primate species.
Because of our society's intolerance for difference of the sort that attends ADD/ADHD, a person with this set of traits might well find himself at a disadvantage in school, in his family, and in life generally. An inability to easily adjust to the demands of modern life produces a constant barrage of criticism and a perception of failure for many people with ADD/ADHD. So much negative feedback can produce all sorts of emotional and psychological baggage that makes life even more difficult for such people, thus exacerbating the problems created by ADD/ADHD. That is why treatment--behavioral, pharmaceutical, or both--ends up being necessary for many people, especially children who must stay on task and control their impulses all day in school. Sometimes psychological counseling is also needed to deal with emotional problems caused by constant criticism and perceived failure.
The fact that many other countries don't recognize ADD/ADHD doesn't mean it doesn't exist. Even in those countries where "no one" has ADD or ADHD, there are still words to describe the set of traits that characterize ADD, words that correspond to airhead, flibbertigibbet, space cadet, wool-gatherer, daydreamer, and all the other terms we use to label someone who just can't stay focused on what we think he should be focused on. And phrases like house ape, chandelier-swinger, wiggle-worm, maniac, wild man, wild animal, wild monkey, crazy kid, out of control, and ants in his pants are thrown at people, usually children, who are significantly more impulsive and physically agitated than most and who exhibit the behaviors and thought processes associated with ADHD.
But if the way people typically live in another country is more, well, reasonable than in the United States, then a child's (or an adult's) tendency to behave differently or to perceive and think differently might be more readily accommodated without blame or exasperation. On the other hand, some times and places are or have been even less forgiving than the United States is now of the sort of differences that characterize the person with ADD or ADHD. In such cases, the person who violates the norm is likely to be severely punished. In fact, it is almost certain that many ADD and ADHD children have been abused or even killed for failing to comply with the inflexible demands of their families or societies.
A lot of what is diagnosed and medicated in the U.S. as ADD or, especially, as ADHD is simply normal childhood behavior. But because we demand that children begin school so young, and because we expect them to sit still for long periods of time, remain quiet, and work at tedious, meaningless tasks (in other words,
abnormal childhood behavior), normal children seem to be terribly problematic. The little dickens just want to move around, talk to their peers, and play most of the time.
Of course, that's exactly what they are designed by nature to do, and it is also, for the most part, what they need to do for much of the day. But when they do such things, it can be mighty inconvenient for the frazzled adult who has to keep thirty of them contained and constrained for many hours a day, and who is also expected to cram a certain amount of academic knowledge and a certain set of skills into them at each stage of their progress through school. It's just so much easier to medicate them, since school these days is really more a matter of crowd control than anything else.
And then, of course, there is the fact that a lot of American kids are raised in daycares or by incompetent or neglectful parents, so that they are not well socialized by the time they enter school. A shocking number of American parents prefer not to spend the time and energy necessary to actually take care of their own kids and raise them properly. It's easier to dope them up with psychotropic medicines than to actually spend time and energy on them.
I did home daycare for 18 years, and a lot of the wild behavior I saw was simply a lack of discipline and socialization. But I also had kids who were undoubtedly ADHD. In "What About Ritalin," I write about two very poorly socialized sisters, H and C, who were incredibly difficult to take care of because they were so wild and so badly behaved. And yet there was a clear difference between them. H was just badly behaved. C was also ADHD, and the difference was obvious.
Many ADHD children can be incredibly hard to handle, and many American parents are far too weak and tentative about disciplining their children. Often the uncontrollable behavior of an ADHD child is more a matter of poor parenting than of inherent brain function.
But bystanders who have no experience of dealing with an ADHD child should not be too quick to criticize the parenting skills of those who must deal with such a child. With all the environmental toxins pregnant women and children are exposed to these days, I would not be surprised to learn that at least some of the more uncontrollable children in our midst really have been affected by such toxins, just as a child with fetal alcohol syndrome has been affected by the specific toxin that his mother ingested while he was in utero.
I do know many parents who use their child's ADHD diagnosis as an excuse for their inability to assert themselves as parents, and they also inadvertently train their child to use ADHD as an excuse for doing whatever he feels like doing, regardless of the consequences. But I also know some parents who, despite doing everything "right" still end up with a child who simply cannot be made to behave.
It is important to understand that ADHD, even real ADHD, is not an excuse for antisocial behavior. There are not that many kids who are so disturbed that they cannot be socialized and taught to behave. More kids end up in BD (behavioral disorder) classrooms than need to, simply because no one has bothered to socialize them properly. In my daycare, I had kids who were just impossible at home and in school, but who were as good as gold for me, because I know what it takes to maintain discipline with a chandelier-swinger, having been one myself.
I also had one little boy, a brilliant child, who seemed to have ADHD, but I knew for a fact that he didn't. He was just spoiled rotten. (I wrote about him in "The Moon Follows Me Wherever I Go" on my "Who's Minding the Children" website.) That child is now a calm, polite twelve-year-old bookworm. Although many people mistakenly assumed he had ADHD when he was younger, no one who met him now would ever make that mistake.
On the other hand, even while raising 33 children (plus my own two) over a period of 18 years, I never found one, with or without ADHD, who was really uncontrollable. A couple came pretty close (see my stories about L and C in "What About Ritalin"), but even they were responsive to consistently applied behavioral modification techniques. C was eight when she came to me, and completely unsocialized (as well as ADHD), so the three years I took care of her were only enough to get started in undoing the damage her early training had done, especially since she was still being "trained" to be badly behaved during every minute she spent at home with her family. As for L, he was with me only sporadically, and only for a short while, so I did not have that much opportunity to modify his behavior. But even C and L behaved better for me than for anyone else, so I do believe that given enough time--especially if the socializing process had not been undermined by the children's home life--I would have seen even more improvement in their behavior.
Those two kids did end up on Ritalin, and for both of them Ritalin was a real blessing. But I think that many children who are medicated for ADD/ADHD either do not have it, or if they do, would not actually need medication if the adults in their lives (parents, teachers, babysitters, daycare providers) were more effective at disciplining and socializing them--and if the kids did not have to spend so much of their lives cooped up inside at school, at daycare, or in front of a TV or video game.
The main reason why we need the ADD/ADHD diagnosis is that we have set up school, daycare, and home situations so that they are very unhealthy for all children, but they are absolutely disastrous for kids with ADHD. Such children are especially troubled by the demand to sit in one place, not talking to their classmates, and staying on task with boring, meaningless assignments. As a result, they are often punished and stigmatized, at home and in school. (I write about this in "Is ADD/ADHD Really a 'Disorder'?" and "Learning Disabilities, Learning Differences, and Giftedness.")
I was an abused child at home. At school, I was such a high-performing student that I was recognized and admired by my teachers, but I also spent a large part of my time standing in the hallway for talking out of turn, and in the principal's office for not being able to sit still in my seat.
But in "The Advantages of Being a Flea Hopping Through the Pages of an Encyclopedia," I describe some of the very real advantages of having ADHD. ADHD is also often associated with a very high level of giftedness, and as someone who regularly teaches and tutors people with ADHD, I can tell you that some of the most dynamic, intelligent and talented people I have known have ADHD.
But Americans do have a tendency to jump onto faddish bandwagons, and it is typical in this country to take everything too far. We use the ADD/ADHD diagnosis as a catchall, stuffing all sorts of children into it when they don't need to be pathologized or medicated, but just need to have a little sanity restored to their lives.
There was no ADHD diagnosis in the U.S. until the 20th century. Kids who fit the profile weren't called ADHD, they were just beaten until they behaved. I wasn't called ADHD, either--I was just yelled at all the time and beaten for being too wild (see
"ADHD and the Abused Child"). Some children really are more jittery, wild, and distractible than most.
If we had lives that fit what we were evolved for, such kids would probably be dynamic leaders, not pains in the neck. But since our lives--especially in the U.S.--require that we perform like productive machines, and since women (and sometimes men) are trapped alone in homes, schools, and daycares with children who are bored silly and therefore endlessly demanding, the child with the ADHD personality will seem to be misbehaving, even as he acts much more like a normal, healthy young primate than the "good" boy or girl who only does what he or she is told and who never speaks or acts out of turn.
We pathologize everything in this country. ADHD is not really a disorder. But in this society, because an ADHD adult or child finds it so much harder to adapt to the demands of work, home, and school, we treat it as a disorder, and that is obviously better than beating the kids for noncompliance--though perhaps only slightly better.