The first mother to arrive at my office last Tuesday brought me a copy of the latest New York Times article regarding ADHD. She said she was both hurt and angry, as the newspaper heavily suggested that most ADHD results from problems with the educational system. She added, "It took me a while to accept ADHD is real (considering what everyone says about it), and if I had seen this article a few months ago, it would have made me doubt myself again." After reading the Times, she felt she might have skipped getting her son evaluated for ADHD, instead blaming herself and the school system for his academic difficulties.
Meanwhile, her son is thriving this year after diagnosis. "It makes me sad to think of all the parents who might be misled by the article. It seems so reasonable on the surface," she said. Since October was National ADHD Awareness Month, I thought I'd respond online to this common experience for parents and individuals living with ADHD.
ADHD is a medical disorder, not caused by parents or by our increasingly busy modern world. The genetic influence of ADHD has been shown close to that of height: If two tall people with ADHD put their child up for adoption, he (or she) will likely grow up to be tall and have ADHD. Suggesting otherwise alienates people who either have ADHD or are deciding about seeking help.
ADHD does not affect only attention but a part of the brain responsible for self-regulation and management as a whole. Individuals with ADHD may struggle at home, at school and in social relationships. Studies have linked ADHD to car accidents, obesity, sleep problems, and many other daily struggles. Parents of children with ADHD report higher stress levels, anxiety, depression, and marital problems. The cost of treating other medical conditions (such as asthma or diabetes) dramatically rises when an individual has ADHD, making it a public-health concern that we address it well.
Doubt about ADHD continues in spite of accumulating evidence about its medical basis. So much in print and online fans flames of distrust around global problems such as misdiagnosis and medication misuse. In reality, we have to separate the needs of individuals who have ADHD from societal concerns about people without ADHD ending up diagnosed or abusing prescription medications.
First , there is a difference between diagnostic rate and the actual occurrence of any disorder. Worldwide studies have shown that the actual rate of ADHD is around 4 to 8 percent. If somewhere the rate is far lower, ADHD is probably under-diagnosed. Anywhere the rate is significantly higher suggests misdiagnosis is rampant and needs addressing... but that doesn't change the fact that around 1 in 15 children actually have ADHD and would benefit from compassionate, objective care.
As for medication, no single intervention changes everything, so strong ADHD management typically draws from a wide range of supports. Parent training, behavioral therapy, educational interventions, discussion of better sleep habits, exercise, the practice of mindfulness and many other options all have potential roles. However, nothing studied to date changes core symptoms of ADHD (such as poor focus or impulsivity) more effectively than medication, another frequently biased area of public discussion.
Personally, I'm neither for nor against medication. Clearly, it is always best not to prescribe a medication when it can be avoided for anything. I also feel people should know the basics before making any decisions: Medications require meticulous adjusting over time to get right and they do not work for everyone, but used appropriately they can be hugely beneficial and without side effects. The fact that medication can be abused by people without ADHD must be addressed but should not affect decision making for an individual who actually has ADHD.
For the benefit of everyone, we need to balance discussion about the impact of ADHD (which is real) from separate concerns about over-diagnosis or medication abuse (which are also real). People end up doubting themselves ("This is all my fault!") and their family members ("They just have to work harder!") and miss out on opportunities to change a lifelong path through intervention. Instead of sowing seeds of doubt and pointing fingers of blame, individuals with ADHD need compassionate and open-minded support along with ongoing discussion about how to further progress in this complex field.
For more by Mark Bertin, M.D., click here.
For more on ADHD, click here.