ADHD: Has this diagnostic fad run its course?

The idea of Attention Deficit Hyperactivity Disorder (ADHD) as a credible diagnostic term has passed and it is time that we accept that and move on. Fads and disappointments are not new to the field of psychology nor is the need for people to get beyond them.

Phrenology, hysteria, eugenics, compulsory sterilizations, shock therapy, and Thalidomide all at one time had some grounding in hope and reason. For awhile, each of them captured the imagination, but over time each led to more pain than good, and for that reason they all got left behind.

Like diagnostic fads before it, ADHD has been in many ways a disorder of its time.

Previous diagnostic fads

Hysteria found expression in a Victorian-era society that vigorously attempted to constrain the lives of women. The eugenics movement addressed societal concerns of the early 20th century relating to burgeoning minority populations.

ADHD became a popular diagnosis in the 1980s as more parents went to work and the role of schools and teachers changed. If we look at the history of our culture and the ailments that have plagued it, is not difficult to see why people in positions of authority told women that they were weak, minorities that they were feeble-minded, and children that they had a psychological disorder: It was easier for them than addressing the difficult conditions that women, minorities, and children faced.

At one time, ADHD appeared to be a reasonable theory that might help people address genuine concerns. Raising children can be hard, especially when adults are tired, frustrated, overwhelmed, and riddled with self-doubt. Beyond that, children can be annoying; They fidget, they interrupt, they don’t pay attention, and they don’t always do what they are told.

The behaviors of children and the difficulties of adults often lead to guilt, worry, and a sense of wrong that concerned adults feel a responsibility to address. The creation of ADHD as a psychological disorder was in part an attempt to deal with some of the difficulties of raising children. Unfortunately, that attempt has fallen short and led to new problems in recent years.

On a diagnostic level, ADHD is problematic. After generations of research, there is still no test for ADHD, nor is there a standard diagnostic measure within the profession.

A huge – and lucrative – market

What started out as a theory articulated by professionals is now an urban legend. Parents, teachers, talk show hosts, friends, neighbors and even the person you’re standing next to in the grocery store each believe that they can diagnose and treat ADHD. This superfluity of focused misinformation has helped fuel a pharmacological intervention that would have seemed absurd two generations ago. As of 2006, 4.5 million kids have been diagnosed with ADHD, with nearly half taking medication. In 2008, the ADHD pharmaceutical market was worth $4 billion.

Another problem with our fixation on ADHD is that it is not working. Again, even after generations of research there is no evidence that suggests placing children on Schedule II drugs such as Ritalin, Adderall, or Vyvanse improves their intellectual abilities over an extended period, or that these drugs affect children with ADHD any differently than they affect any other child. A stimulant is a stimulant is a stimulant. What we do know is that the use of these drugs can be debilitating, addictive, and deadly.

And just this week, a Michigan State University study found that nearly one million children in America are potentially misdiagnosed with ADHD – in large part because they were the youngest and least mature in their kindergarten classes.

Maybe the greatest problem regarding ADHD as a diagnostic label is that our faith in that label has distracted us and kept us from looking for the better understandings we should be seeking. Stress and sleeplessness lead to inattention. Frustration leads to anger and rebellion. Depression leads to indifference and a lack of enthusiasm.

Probably one of the best ways to make sense of children and the rise of ADHD is for adults to focus on some basic questions. Don’t most adults become distracted when they are tired? Don’t most adults become fidgety when they are bored? Don’t most adults lose interest in their work when they don’t see any significance in what they are doing? And when adults wrestle with concerns relating to stress, sleeplessness, frustration, and depression, aren’t the responses often “get some rest,” “exercise” “start eating better,” and “try finding something you’re interested in”?

As adults, aren’t some of our most meaningful discussions about how to live a meaningful life? If that’s the case for adults, why don’t we put more emphasis on these sorts of answers for children? Wouldn’t more rest, better meals, more exercise, and a greater focus on helping children understand their interests serve most children well?

What we've learned

With ADHD, as with most failed efforts, even its failure is informative. In the case of ADHD we have learned that 1) prescribing Schedule II drugs to children en masse can have serious negative consequences, 2) that highly subjective diagnostic criteria can lead to serious concerns relating to the validity of a diagnosis, and 3) that ignoring the environment in which a person lives and basing a diagnosis solely on symptoms can lead to misdiagnoses and inappropriate treatment responses.

While these shortcomings do not provide answers in-and-of themselves, our recognition of these shortcomings should help set us in a better direction as we move forward.

How do we, as a culture, get past the ADHD bubble and some of the mischief it is causing? Pretty much the same way we have gotten past bubbles and mischief in the past: We broaden our view.

On a scientific level, we get past ADHD the same way we got past phrenology and eugenics; we demand that the theories that are being expounded be based in fact and verified by research. On a societal level, we take responsibility for the fact that the diagnostic labels we have accepted, and pharmacological interventions we have embraced, are harming children and that we have no right to ask children to bear those harms. On a personal level, we place the difficulties of childhood within the context of the life of each child, and within the nature of childhood itself. We make a commitment to helping children be their best selves, and above all, we do the best we can to make sure that we never use our positions of authority to harm anyone.

Stephen R. Herr, an assistant professor in the Department of Educational Studies, Leadership and Counseling at Murray State University, is the author of “Connected Thoughts: A Reinterpretation of the Reorganization of Antioch College in the 1920’s.”