What Is ADHD, and Why Do People Say It Doesn't Exist?

Written by Dr. Steven Kurtz

This story is part of Speak Up for Kids, an annual public education program held during National Children's Mental Health Awareness Week (May 6-12, 2012).

ADHD is the most common of all childhood psychiatric disorders, but one that is widely misunderstood.

That's because the three key features of ADHD—hyperactivity, inattention and impulsivity—are behaviors all children exhibit to some degree.

Of course all children are rambunctious, distracted and impulsive at times, but kids with ADHD are much more so than their peers—on parent and teacher rating scales used to measure these behaviors, they average three times the typical frequency of these interfering behaviors. They also exhibit these behaviors both at home and at school, so it gets in the way of so many parts of their lives.

Perhaps most important, in children with ADHD these behaviors are so frequent and so intense that they are causing them serious distress. These children typically are unable to settle down and concentrate well enough to succeed in school. They are unable to follow rules, so they often can't play well with other kids or participate in team sports. They find themselves in trouble a lot, taking dangerous risks, and in conflict with their families. These are kids who are not only "in motion" a lot of the time, they're frustrated because they're out of sync with those around them and can't do what other kids can do.

Adding to the challenges in diagnosing and helping kids with ADHD is that it's common to blame parents for the kids' out-of-control behavior—and for giving them medication to control it.

When Parents magazine and the Child Mind Institute surveyed Parents' readers about ADHD, we found that a majority (62%) think ADHD is being overdiagnosed just because children have behavior issues. A whopping 72% said doctors are too quick to put kids on medication for ADHD rather than look for other solutions, and 74% said kids are being put on medication for a "quick and easy fix."

Stimulant medications, prescribed by a knowledgeable clinician, don't sedate kids; they bring their activity level, attention, and impulse control into the normal range for typical children. Given the right dosage and formula medicines level the playing field for these kids, allowing them to be successful in school, interact more effectively with friends, and have happier and healthier relationships with their families.

Studies show there's an 80% chance that a child with ADHD will respond really well to medication. (There are also non-stimulant medications that help some kids who don't respond well to stimulants.) It takes a knowledgeable clinician and careful monitoring—including observation by parents and teachers—to find the best fit of medicine and dosage, balancing benefits and risks, for each child. This, in combination with behavioral therapies such as Parent-Child Interaction Therapy to help manage disruptive behaviors, affords kids the best chance of having success at simply being kids.

But the belief that ADHD isn't a real disorder—and that medication is just an exaggerated response to difficult but typical children's behavior—is a serious threat to the timely treatment that can transform the lives of young people. Parents wait an average of two years— two precious years of child development— before they seek professional help. So we should take a look at why this happens, where this skepticism comes from.

First, it comes from the fact that ADHD is what we call "dimensional"—defined by symptoms that are common in typical children but much more extreme, and more damaging in these children. Being typically rambunctious is not the same as being so impulsive and hyperactive you are consistently unable to follow instructions from teachers or parents. Being typically distracted is not the same as being unable to finish a project, a game, even a meal.

It's not a stretch to say that most people who deny that these are real issues are not the parents of these kids, who are seriously impaired in so many aspects of their lives.

But parents themselves sometimes resist a diagnosis of ADHD for a different reason—not because they don’t see the child struggling, but because they don't want to "drug" their children. The popular misconception that doctors are peddling scrips to normally developing kids has the effect of stigmatizing the diagnosis, even when parents see their child suffering.

When parents of a child who has ADHD say to me, essentially, "I'm afraid of the diagnosis," I urge them to see that NOT treating their child's ADHD is the thing they should be afraid of. What's important is to agree that ADHD behaviors are causing impairment, and to help the child before the disorder severely undermines his success in school, his friendships, his relationship with his family, and his sense of who he is and what he can accomplish.

We need to see ADHD as a condition like high blood pressure, or high cholesterol or diabetes—something we wouldn't think of dismissing. The risks of not treating ADHD are just as serious to the health and happiness of the child.

Steven Kurtz, PhD, ABPP, is Senior Director of the ADHD and Disruptive Behavior Disorders Center at the Child Mind Institute and Director of the Selective Mutism Program. Dr. Kurtz is one of the nation’s leading clinicians in the treatment of children’s behavioral problems and disorders, particularly ADHD, and the social anxiety disorder selective mutism.

Child Mind Institute's Speak Up for Kids is an annual public education program held during National Children's Mental Health Awareness Week (May 6-12, 2012) aimed at ending the stigma, lack of awareness, and misinformation that cause children to miss out on treatment that can change their lives.

Read more articles about children's mental health here.