Is ADD/ADHD Really a Disorder?

In a comment on one of my articles on ADD/ADHD, a reader took issue with my use of the words "syndrome" and "condition" to refer to ADD/ADHD. She says she prefers to refer to the "ADD-type personality."

The truth is, I agree with her. In fact, I am appalled that many texts categorize ADD/ADHD under "mental illness" or "psychiatric disorders." Though I have ADHD, I assure you that I am not in any way mentally ill, nor do I think anyone who knows me would classify me as having a psychiatric disorder.

What I have is a different way of perceiving and processing information, as well as a pattern of behavioral traits that do not conform to the most narrow range of "normal" or "acceptable" behaviors. I am unusually energetic and capable of multitasking of a sort that would make most people dizzy. I also have little tolerance for the minutiae of bookkeeping and record-collecting that pervades modern existence, so I run into problems because of my tendency to be slapdash about such things.

But I don't think the problem is necessarily in me. I'm inclined to think way too much bookkeeping and record-collecting is required of everyone in our society, and I suspect that there's something akin to insanity involved in most people's willingness to carry such a burden of mindless busywork without rebelling against it.

Whatever psychological disorders I find in people I tutor or teach who also have ADD/ADHD have inevitably been caused by externally imposed pressures and by being stigmatized in school or in the workplace. Many people with ADD/ADHD suffer from anxiety, low self-esteem, and depression, and often even from substance abuse problems stemming from these conditions--but in every case I have encountered, these psychological problems were the consequence of years of negative feedback from others, not inherent in their ADD/ADHD "condition."

The demands of modern life are not a good fit for the ADD/ADHD personality. Frankly, I don't believe they are a good fit for anyone. (For more on this topic, see my article "Slow Down--You're Moving Too Fast!") But the impact of such demands and stresses on the ADD/ADHD personality are decidedly more pronounced and disruptive to normal functioning.

In his book Running on Ritalin (N.Y.: Bantam Books, 1998), Dr. Lawrence Diller, a pediatrician, writes that rather than focusing on a supposed "chemical imbalance" in a person's brain, we should lay more blame on the "living imbalance" that fragments the lives of both children and adults and that creates such terrible difficulties for those whose perceptual and behavioral patterns are not well-suited to the demands and pressures we are all subjected to.

There is a tendency today to require conformity to a remarkably narrow range of sanctioned behaviors. As in Aldous Huxley's Brave New World, we are alarmed by those who think or act differently, for their differences are seen as disruptive.

When sleepy infants and toddlers are dragged out of bed at an ungodly hour and hustled to get ready for daycare so their exhausted and frazzled parents can get to work on time, and when those children must spend long hours--most of their waking hours, really--in daycare or preschool, which many find overstimulating and stressful, even when they enjoy it, then we must expect that some of them will have trouble adjusting to the way their lives have been arranged.

Furthermore, we start making demands for narrowly focused task-oriented behavior at a much earlier age these days, and that by itself is going to produce manifestations of what Dr. Edward Hallowell refers to in his book Driven to Distraction
(N.Y.: Pantheon Books, 1994) as "pseudo-ADD"--ADD-like
behaviors that are created by intolerable environmental conditions.

To make matters worse, we have virtually done away with those paths to financial and social success that do not require an individual to make it through many years of intense academic study, so that people whose temperament and gifts are not suited to long hours of sitting still and studying are relegated to the discard pile--or are pressured into trying to make it through college and professional training anyway.

Since many people with ADD/ADHD are also gifted and energetic, they may find ways to get by, even to seem unusually successful--but the personal cost is always high.

The ADD/ADHD personality type has certain very real advantages,* and it is easy to see that in some environments it might prove highly adaptive, which is no doubt why evolution has conserved these traits. It is only maladaptive--i.e., a "condition," a "syndrome," or a "disorder"--when there is a serious mismatch between the demands of the environment and the perceptual and behavioral patterns of the individual.

I believe that at present there is such a mismatch, and that for most of us who have the ADD/ADHD personality type it is difficult, sometimes even impossible, to meet the demands of modern life and to tolerate the stresses those demands create for us.

If an energetic six-year-old is allowed to run around and climb, as his body is meant to do, his high energy level will seem admirable, not problematic. But if he is expected to sit still, focus at length on tasks that are often boring and meaningless (at least to him), to keep strangely quiet, and to ignore the fact that a lot of potential playmates are crowded into the same room with him, then his behavior is likely to seem disruptive.

And when he is admonished to conform to rules of "acceptable" behavior, but still does not sit motionless, keep quiet, and stay on task, then his behavior--which is really far more normal for a very young primate than the behavior required of him--is likely to be seen as willful and disobedient or, in our more psychologized era, as symptomatic of a "deficit," a "condition," or a "syndrome"--even, as many manuals and listings consider it, a "mental illness" or a "psychiatric disorder."

In some cultures a man who is quick to rage and to kill an enemy at the slightest provocation would be considered admirable, a role model for young boys to emulate. A man who is gentle, forgiving, and empathetic would be considered weak and useless.

In our society, the raging homicidal warrior would be considered a dangerous sociopath, whereas the kind, understanding, gentle man would come very close to the ideal in many well-respected professions.

Yet within certain professional subcultures, the gentle man would be reviled as a milquetoast and a failure, while his more predatory and ruthless colleagues would excite admiration.

My point, of course, is that there is a very wide range of human behaviors and personality types, and those that are adaptive in one sort of environment may be seriously maladaptive in another.

In my article "Learning Disabilities, Learning Differences, and Giftedness" I point out that so-called learning disabilities generally, and ADD/ADHD specifically, are quite often associated with a high level of giftedness. It's too bad that our society cannot find a more humane way of dealing with children and adults who march to the (often much faster) beat of a different drum and of making use of their often considerable talents and gifts.

But since very little is done to acknowledge and to accommodate differences in the way people perceive, learn, and work, we must deal with the fact that those of us who have the ADD/ADHD personality type are in many ways not well-adapted to our social environment. As far as the rest of society is concerned we do have a "condition" or a "disorder."