Some 30 years ago when I started practicing, children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) were rare. These were children who were really extremely out of control. Nowadays, many children who are ‘diagnosed’ with ADHD can easily be taken on a family outing. The bandwidth of the criteria regarding ADHD has dramatically widened. In the 1980s the name ADHD was introduced in the third edition of the Diagnostical and Statistical Manual for Mental Disorders (DSM).
Today one out of four children is supposed to have a behavioral disorder, ranging from ADHD to light forms of autism. To label these problems a disorder is creating a much bigger problem. The phenomenon lies deeper and isn’t solved with medication.
Basically children need attention, love, ground rules and structure. This doesn’t mean that the parents are to blame, but that (for example) ADHD is a development problem and not a medical condition. Because of the surplus of stimuli and speed we live in an ADHD-world so we mustn’t be surprised that we produce ADHD-children.
Problem children usually have more than one problem at the same time. The big question is where these problems stem from! The wrong way to react is done in threefold. The first is to label a complex issue as a ‘disorder’ and subsequently partition it into ADHD, conduct disorder, non-verbal learning disorder, oppositional defiant disorder, etc. Secondly each of those disorders is separately pseudo-medicalized, as if it’s a brain condition that can be determined in a neurological or even in a genetical way. And finally all problems are taken out of their context and totally attributed to the child.
Society, social-economic context, school, parents, family, are not taken into consideration. ADHD is then nothing more than tallying up some symptoms of the child and voila, there is your diagnosis.
Instead of pseudo-medicalization, it’s better to give the sum of all the problems a name like ‘developmental problem’. British researchers have conducted a study about ADHD in the USA and in the UK (Hart, N. &Benassaya, L. (2009) Social deprivation or brain dysfunction?). They thoroughly interviewed more than 10,000 families and it showed that ADHD has a strong correlation with social problems.
Compared with children without ADHD, children with ADHD have much more to deal with poverty and family problems (like divorce, financial problems, serious illnesses in the family, psychiatric problems with a parent, and judicial problems). This indicates that there is a connection between the context in which a child grows up and lively, boisterous and inattentive behavior.
Most people think that ADHD is a neurological problem that should be treated with medication. This is complete nonsense. ADHD is what the abbreviation says: a shortage of attention and a surplus of activity. This is purely a descriptive terminology and it is now defined as an illness. But there is no scientific basis for that. There is no scientific study that can show why we should treat ADHD as a disease.
It’s quite possible that in Ancient Greece the impulsive and dashing Alcibiades (one of Socrates’ pupils) would fit neatly in the ADHD description of the DSM-5, but that doesn’t mean that he was suffering from the millennia old ‘illness ADHD’. It only indicates that the description of ADHD in the DSM-5 is now completely out of proportion. Thirty years ago ADHD hardly existed. Nowadays teachers advise parents to think about giving Ritalin to their child when it’s showing naughty, rebellious and boisterous behavior in class that they find difficult to handle. The teacher acting as a psychiatrist! “The child has ADHD” as if it’s a brain disorder! And a short visit to a psychiatrist will usually confirm this belief.
The DSM-5 is an arbitrary classification system with no psychological or psychiatric use. Despite the term ‘statistical’ in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM is written as an extension of the pharmaceutical industry.
There is no solid theoretical foundation, nor a clinical pragmatic practice. The pharmaceutical industry used its influence to dramatically extend the criteria for ADHD in 2000 and again in 2013 with the introduction of the DSM-5. This means more medication and is extremely profitable for them.
The diagnostic criteria for ADHD are very vague (why not five or seven symptoms instead of six, does ‘often’ means once a day or once a week/month, what is forgetful, etc., etc.). As a consequence there is a huge variety by different assessors in interpreting the criteria. Even worse, there are two equally comparable classification systems, the DSM-5 and the International Classification of Diseases, 10th edition (ICD-10). When children are diagnosed for ADHD with the ICD-10, then there are HALF as much ‘ADHD children’ than with the DSM-5. This shows how arbitrary this diagnosis is.
A competent parental guidance counselor or child psychologist should be the first choice. She/he can determine causes of the individual child’s behavior and give tips concerning a structured life style, parental advice or teacher training.