Attention deficit hyperactivity disorder is not without its share of controversies, often leaving professionals and parents trying to sort through the multitude of varying opinions. On one hand, some experts maintain it's possible children too hastily receive an ADHD diagnosis and the drugs to go along with it. Parents themselves may be hesitant having their child on ADHD medications, especially if they are very young.
And in a move that's sure to raise eyebrows, one author, a neurologist, goes so far as to suggest the neurodevelopmental disorder is not real. His thoughts have helped fuel the debate.
Dr. Daniel F. Connor, a psychiatry professor at the University of Connecticut School of Medicine in Farmington, hit on the varying schools of thought around ADHD in a 2011 article, writing that although scientific evidence of ADHD exists, "the general public appears confused about ADHD: Is it a medical illness, a psychiatric syndrome, a mental disorder, a behavioral health disorder, a behavioral problem, a motivational problem, or a school-based learning and socialization problem?" He continues, "Doubt and confusion as to where this disorder fits into the general spectrum of illness further feeds the general perception that ADHD is a socially constructed disorder rather than a valid neurobiological disorder. This increases the public's concern that ADHD is overdiagnosed and stimulants are overprescribed."
But Amanda Morin, parent advocate, former teacher and expert at Understood.org, a nonprofit organization dedicated to helping parents whose children struggle with learning and attention issues, wants to reassure parents. "ADHD can be a controversial issue, and that can be confusing for parents who may already be feeling challenged by managing a new diagnosis and making very personal treatment decisions," she says. "It's so important to inform yourself about current research, know what's myth and what's not, to work with a doctor you have a good rapport with and to trust your own instincts. You know your child best."
Here then, is a closer look at these sometimes controversial aspects behind ADHD.
Investigative journalist and author of the 2016 book "ADHD Nation,” Alan Schwarz, mentions doctors who were “merely prescribing with little thought into whether a kid really had ADHD or not,” ultimately concluding that “ADHD itself is not an epidemic” but rather “ADHD misdiagnosis is an epidemic.”
There’s a fine line between parental desires to help their child and, as Schwarz says, the “completely predictable” and “massive financial incentive” that often permeates the pharmaceutical industry.
He talks of researchers being paid upwards of seven figures to conduct studies, all of which have a similar alluring thread to both doctors and parents: They feel the drugs work, have hardly any side effects and should be used because ADHD is a widespread issue. In turn, Schwarz maintains that a wave of comfort washes over parents who, thanks to ADHD drugs for their children, can rest easier. With impulsive or inattentive behaviors kept at bay, parents, he says, feel safe with the knowledge their child won’t be “doomed to academic and social failure, crash their car, get venereal disease and more.”
The Problem of Overmedicating
“I believe we are overmedicating our kids,” says Peter Shankman, founder of FasterThanNormal.com, a website and podcast designed to reevaluate the ADHD conversation. He’s also a successful entrepreneur, keynote speaker and author with ADHD. “I don't think meds are inherently evil, but I think we're using them as a first line of defense, and not a last resort, and that's a problem.”
Survey data of children aged 4 to 17 years presented by the Centers for Disease Control and Prevention supports the potentially problematic nature of this situation. The findings reveal that fewer than 1 in 3 children with ADHD received both medication treatment and behavior therapy, the preferred treatment approach for children older than 6, according to the American Academy of Pediatrics' clinical practice guidelines. When it came to younger children, just half of preschoolers with ADHD were getting behavior therapy, despite the fact that it’s the recommended method for this age group. Adding to the alarming nature of this data is the fact that approximately half of preschoolers with ADHD were on ADHD medication, and 1 in 4 were treated only with medication.
Schwarz says it’s crucial to help children, “rather than reflexively giving them a diagnosis of what is generally described as a serious, lifelong brain disorder.” Becoming more mindful of a child’s problems, he says, recognizing when they’re anxious, being bullied or experiencing sleep deprivation is essential.
Shankman’s suggestions? Forego “pumping kids full of amphetamines,” he says, and instead let children engage in physical activities such as running around outside before school. Proper nutrition is also imperative. He encourages people to fuel children with healthy options like protein and water instead of sugary, processed products. He makes these recommendations because they’re methods which have personally served him well. “The majority of what I do to combat my ADHD isn’t medication – rather, it’s physical and mental. I won't go to a meeting without exercising beforehand, even if that's running up five flights of stairs or doing jumping jacks before walking in.”
Is ADHD Real?
Neurologist Richard Saul is also concerned about the haste with which ADHD diagnoses are made and the expediency with which medications for the disorder seem to be doled out.
However, Saul takes this notion a controversial step further. He’s the author of “ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder,” and in a Time magazine opinion piece, wrote that ADHD is “an easy catchall phrase that saves time for doctors to boot.”
He draws on his decades of work with patients, noting that nearly two dozen conditions can lead to ADHD symptoms – iron deficiency, undiagnosed vision and hearing problems and substance abuse among them. Saul explains that most anyone with such issues will likely meet the ADHD criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, or DSM – the American Psychiatric Association’s classification and diagnosis standard – causing him to state that ADHD “does not exist.”
The notion of “does not exist” not only seems insensitive, Shankman says, but void of the scientific reality many professionals embrace. For Shankman, he emphatically declares that “ADHD is completely real,” adding that his brain “doesn't create as much dopamine, adrenaline, or serotonin” as a person without ADHD.
The ADHD Brain, Causes
Dr. Manju Banerjee is the vice president of educational research and innovation at Vermont’s Landmark College, a private, not-for-profit two- and four-year college that exclusively serves students with learning differences, including ADHD, autism spectrum disorder and dyslexia. She explains that a “neurotransmitter implicated in ADHD is dopamine,” the chemical produced in the brain in response to emotions pertaining to reward and pleasure.
However, she adds “so many factors go into a diagnosis.” Other ADHD risk factors can include, but are not limited to, brain injury, low birth weight, exposure to lead and genetics. Of genetics specifically, she notes that new discoveries, while interesting, are still at the early stages and have not reached “a diagnostic level at this point.”
Dr. Russell A. Barkley, clinical professor of psychiatry, Medical University of South Carolina, says “most of the causes of ADHD are genetic or neurological – or both,” noting that environmental agents or events can also be a factor by interacting with ADHD “risk genes to lead to its occurrence.”
He too, wants to make it clear that ADHD does exist. “As for ADHD being a myth, such ideas are perpetrated by those who either manifest a stunning ignorance of the science of ADHD or more likely are intentional efforts to mislead the public, such as by fringe political or religious groups.” Barkley points to the thousands of scientific papers on the topic to further illustrate that it’s real.
Questions surrounding whether ADHD medications are too hastily prescribed, what factors are involved in assessing its causes, potential misdiagnoses and even whether the disorder truly exists are likely to persist.
“Parents and doctors must be taught that just because a child has a difficult time paying attention or sitting still in school does not, ipso facto, have a potentially lifetime brain disorder,” Schwarz says. “It's complicated,” he says, reinforcing that figuring out what’s best for each child simply “takes time.”