One of the few things I remember agreeing with when I heard Ken Robinson talking about changing educational paradigms was his observation that diagnoses of ADHD (Attention Deficit Hyperactivity Disorder) fall as you travel across America from West to East.
Not the map Ken refers to, but something very similar.
He calls this modern epidemic the “plague of ADHD” and claims it is “fictitious”. He clarifies this by saying,
Don’t mistake me, I don’t mean to say there is no such thing as Attention Deficit Disorder. I’m not qualified to say if there is such a thing. I know that a great majority of psychologists and
paediatricians think there is such a thing, but it’s still a matter of debate. What I do know for a fact is it’s not an epidemic. These kids are being medicated as routinely as we had our tonsils taken out. And on the same whimsical basis and for the same reason – medical fashion.
I’ve written about some of my own experiences of teaching children with ADHD before. There are certainly some children who seem to choose when and where their ADHD will kick in. One of the first children diagnosed with ADHD I taught was Ricky. He was a delightful, hardworking boy and I had no idea of his condition (This was in the days before schools had SEN registers.) One day Ricky turned into a chair-flinging monster. He screamed and raged and stormed out. I was flabbergasted; what on earth had happened? What had I done to this normally mild-mannered lad? . “Don’t worry sir,” one Ricky’s friends told me, “He just forgot to take his pills today.” This was my first encounter with the extraordinary effects of Ritalin.
Clearly Ken is right to say that denying the existence of ADHD – or indeed the dramatic effects of medication – is foolish. But in an article published in Psychology Today, Dr Marylin Wedge asks why French children don’t suffer with ADHD. She says,
In the United States, at least 9% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?
Why indeed. Ken blames computer games, boring schools and standardised testing. I don’t know about you, but this sounds suspiciously simplistic and convenient. Dr Wedge says that US physicians see ADHD as a biological condition best treated with biological interventions. This could be an example of the Fundamental Attribution Error. French physicians tend to view ADHD as having contextual causes.
Instead of treating children’s focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child’s brain but in the child’s social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling.
Of course it’s a little bit more complicated than that as Dr Wedge outlines. Her book, A Disease Called Childhood: Why ADHD Became an American Epidemic is fascinating and well worth a read.
I read Dr Richard Saul’s ADHD Does Not Exist last year and in it he makes a compelling case for doubting the diagnosis and treatment of very many who have been labelled as having ADHD. Saul makes clear that the symptoms are all too real but the medicalisation of the condition has had severely negative consequences. He presents cases of children and adults who suffer with disorders which contain elements of attention deficit or hyperactivity and are then misdiagnosed. Sometimes the symptoms are normal. Sometimes they’re not. Sometimes they respond well to medical intervention. In the case of my student Ricky, the effects of medication seemed wholly positive, but generalising from a sample of one would clearly be foolish. Saul’s thesis is that, on average, medication is overwhelmingly unnecessary or counter-productive.
Maybe ADHD isn’t as straightforward as some would like to have us believe. The Centre for Disease Control (the boffins in the US who track the likes of Ebola and SARS) have monitored a 60% increase in the diagnosis of ADHD over the last decade. This is startling. Either the human genome is failing, leading to a bizarre increase in the number of prefrontal lobe related problems or some other factor is at play. My money is on the ‘other factor’. It might be worth considering who has a vested interest in the status quo, specifically pharmaceutical companies that make a lot of money out of ‘medicating’ kids with drugs such as Ritalin, but also self-professed ‘experts’ who give advice to the education sector, and wondering whether their advice is really in children’s best interests.
In her chapter in Seymour Fisher and Roger Greenberg’s The Limits of Biological Treatments for Psychological Distress (1989), Diane McGuinness refers to ADD as “the emperor’s new clothes.” She observes, “It is currently fashionable to treat approximately one third of all elementary school boys as an abnormal population because they are fidgety, inattentive, and unamenable to adult control.” She concludes, however, that “two decades of research have not provided any support for the validity of ADD” or hyperactivity. Neither clinical studies nor psychological testing has been able to identify such a group. The problem, according to McGuinness, is how to get professionals to give up such a vested interest in the use of this powerful label.
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If you only read sources that question the validity of ADHD you will only arrive at one conclusion. If you go on to YouTube and search ‘Russell Barkley ADHD’ you will see a different POV from a world-renowned psychiatrist.
Similarly, extrapolating meaningful conclusions from one person’s classroom experience is hardly a rigorous examination of the issue.
Most experts seem to think that the prevalence in the populace is around 3-5%. Meaning that while the U.S. is significantly over-diagnosing France is similarly under-diagnosing (assuming the estimates are correct).
While some amphetamines are used to treat ADHD (though very rarely in the UK), Ritalin is not one of them. The chemical name of Ritalin is methylphenidate. Were it an amphetamine it would be called methamphetamine. There is such a drug which is known more commonly to street drug users as ‘Speed’. It’s not helpful for people with ADHD to confuse these two drugs.
Ritalin is a stimulant, however. Those with ADHD have underdeveloped areas of the brain, one of which is the area that governs self-control. ADHD treatments stimulate this area allowing suffers more control over their actions and behaviours thus giving the seemingly counter-intuative effect of calming them down, when the effect on those with a ‘normal’ brain would be to speed them up.
Maybe a little more research is required before writing an article with such a provocative and pejorative title.
Thanks for this. I didn’t know any of that stuff about methylphenidates – interesting. I have my doubts over this though: “Those with ADHD have underdeveloped areas of the brain, one of which is the area that governs self-control. ADHD treatments stimulate this area allowing suffers more control over their actions and behaviours thus giving the seemingly intuitive effect of calming them down, when the effect on those with a ‘normal’ brain would be to speed them up.” That sounds like a contested theory – do we really know what how Ritalin works? The best we can probably say is that it has an effect on a particular area on the brain which is associated with a certain set of process so we therefor think something is happening. I also doubt whether all those diagnosed with ADHA have the same underdeveloped part of the brain – have you any sources I could look at to verify this?
Strange though that you found my title pejorative: it was a question. Provocative is good. It provoked you to add to the sum of my knowledge of the world. The problem with much received wisdom is that certain vested interested feel very threatened when it’s questioned. This is a tremendous shame – answering tricky questions is a great way to add to the debate.
Unquestionably, some children are more physically active and distractable than others. I left university in the 1960s to work in the building trades, and didn’t slow down enough to complete a degree until 1993. Francis Fukuyama put it like this:
“ADHD isn’t a disease at all but rather just the tail end of the bell curve describing the distribution of perfectly normal behavior. Young human beings, and particularly young boys, were not designed by evolution to sit around at a desk for hours at a time paying attention to a teacher, but rather to run and play and do other physically active things. The fact that we increasingly demand they sit still in classrooms, or that parents and teachers have less time to spend with them on interesting tasks, is what creates the impression that there is a growing disease.”
A recent study (just been looking for the reference!) examined 1,000+ children who had to walk a fair distance to school (I think it was a mile), and none of them had ADHD.
Rosemary Tannock has advanced the theory that ADHD is more a cognitive problem than a behavioural one, and that limitations in working memory are a significant factor. I’ve taught basic literacy skills to upwards of a thousand SEN pupils, and I understood the cognitive load problem long before the term became fashionable. I’ve never had a lot of trouble with my ADHD pupils, none of whom were prescribed Ritalin. It is perfectly reasonable to suggest that constructivist classrooms exacerbate the problems of children with limited working memory, and hence ADHD. It may not be entirely coincidental that ADHD wasn’t invented until constructivist ideas started to influence teaching and learning.
Ritalin may be justified as crisis control, but there is very little evidence of the effects of long-term use, and almost no evidence of the complications that might result when taken along with other medications. The US Drug Enforcement Agency reported that
“Methylphenidate [the generic name for Ritalin] is a Schedule II central nervous system stimulant and shares many of the pharmacological effects of amphetamines, metamphetamine, and cocaine…Whereas the majority of children experience only minor side effects under medically supervised controlled conditions, there are a significant number of case reports documenting more severe abuse. These reports and scientific studies of abuse are routinely down-played, if referenced at all.”
Today, People wear corrective eyewear so they see. They have surgery for cataracts and glaucoma. Diagnosing ADHD and treating it appropriately is just another advancement Medicine has made to help people live better lives. Your statements reflect ignorance of the disorder and if heeded would negatively impact millions. If advances hadn’t been made for kids to have tubes put in their ears, they might still need a tonsillectomy.
Please don’t try to influence people to suffer needlessly and return to the dark ages. Maybe you need to stick to your
Chosen field, which I guess isn’t mental health. CBigler, Ph.D., HSPP
Hi CBigler, Ph.D., HSPP
Maybe I’m being over sensitive, but your comment seems both dismissive and sneering – is this intentional? I’m not seeking to influence or persuade, merely to publicise dissenting opinions and ask awkward questions. You’re right to say I have no expertise in this and I’m rather surprised to stoop to engage with my little blog. Your evident ire and the fact that you’ve taken the time to tick me off strongly suggest a vested interest under threat.
There is a body of opinion within the field of mental health which very much considers the current situation to be the ‘dark ages’; perhaps you’d like to address some of your absolute certainty to physicians like Richard Saul whose chosen field very much is mental health?
I have ADHD and the drugs help me. period. The drugs help me and I don’t have ADHD. The drugs help me. Either way the drugs help me.
You’re aware of the placebo effect? https://en.wikipedia.org/wiki/Placebo
This isn’t to belittle you or your lived experience but personal anecdote is the opposite of science. You might be interested in this https://www.psychologytoday.com/blog/saving-normal/201603/keith-connors-father-adhd-regrets-its-current-misuse
It’s very hard to know how to respond to you David.
I was disgnosed with ADHD and that was by seeing a panel of psychiatrists and talking with them and filling in questionnaires and providing school reports.
The criticism of Richard Saul is that ADHD is over diagnosed and that children have other issues, such as lack of iron, etc. and I do have some sympathy with medical professionals on the frontline who have to assess “ADHD” symptoms and decide if there is a case for stimulants.
I went to a good school, but really struggled when concentration increases were required, in fact this was at the point of A levels= age 18. A levels required far greater “executive function” and I failed all my A-levels and have either left or been fired in all jobs I have had and attribute low self asteem throughout my to the condition I now call “ADHD”. My parents were saints and their love and patience really helped me get by. I have no way of judging how bad my symptoms were compared to my classmates but I would suspect based on the list of ADHD positive assessment criteria, I was one of the few in my school year to suffer from such issues with concentration to that degree. I had a fantastic time at school, I was academically doomed for my lack of concentration, but did like school for the sport (luckily I was great at rugby) and I was quite good looking so had joy with the opposite sex, who liked my exuberant personality. The problems start when you leave school, since you tend not to like the authority figures that were always picking on you and you rebel against organisation and convention because your brain works differently. I crave hi-stimuli inputs, the tasks of every day life / working life were much harder for me to manage and I survived by putting all my effort into keeping jobs that my lack of focus was ill-suited too…. I can honestly say I have only ever read one book. I am not thick, I just find them too boring and lose concentration and somehow never finish a book. When you fail so many times, in the end I gave up trying to read. I settle for high-stimuli TV / Movies instead. I am flirting with NLP to see if I just have self-limiting beliefs but I think it is DNA winning over nurture. I still think I play down in my mind just how difficult and impactful on my destiny all the incidents of over impulsiveness and poor concentration and extreme emotional sensitivity in social situations have been. The problems mount up slowly over time and I avoided facing up to them for a long time, by not moving out of the family home for example for a long time. I have huge feelings of disappointment in myself by having to seek psychiatric opinion on my suspected case of adult ADHD this year. At the age of 41, having been suddenly told about ADHD, I researched the symptoms and I acknowledged that I had potentially suffered from the condition all my life and I was astonished by some of the life stories that mirrored mine. So it was only this year I got the diagnosis. I am lucky I had a family with money and a good school and loving parents. I actually don’t necessary think they acknowledged some of the stuff I was going through. They just thought it was normal. I’d like to think more positively that the drug industry is a force for good. I know many disagree. It’s easy to pick on people who make money.
Oddly even though I am happy to be diagnosed now and take stimulant medication, I am not entirely sure that I would have wanted it at school, because it was such fun in many ways! But I do think my life may have been more successful and much better now had I got better qualifications. The missing link in this debate is – will these children live more fulfilling lives? If someone had diagnosed me age 15 I would have accepted it. I was already feeling different from others and picked on. People could always get an extreme reaction from me when the teased me and they could coerce me to be the class entertainment and I was also the airhead for not concentrating / being disorganised. That said people did like me but I struggled to build very close friendships because I was never good at working at relationships over time. Now that I am on medication, it has given me hope. It’s early days. I have been on medication for several months and currently looking for a new job, so it’s quite hard to put the medication to the test. What I can say, is that the drugs have not changed my life, since I have the emotional baggage of having lived with the condition. Had I had the pills earlier I may not have had that baggage. I do feel better and have been able to get more done. It’s a difficult situation, but if we could find a common denominator in these “adhd” brains, the better.
Dr Bigler–Medicine indeed has helped people lead better lives. It could not do so if received wisdom was set in stone. Your example about tonsillectomy (which I suffered many years ago) demonstrates the folly of doing so. However, your post implies that current practice should not be questioned, at least not by people outside your field. Yet the USDEA report I quoted was written by experts. Do you argue that they should be ignored? and if so, on what grounds?
In Britain we are fortunate to have doctors like James LeFanu, who has written a book which explains both the triumphs and failures of medicine. It makes for exhilarating reading, and it does not pretend that the profession is in possession of wisdom that ordinary mortals are too poorly informed to understand. He also admits that there are huge areas in which modern medicine is helpless. He understands that his profession is dynamic, and it would shrivel and die if it did not always question its assumptions.
On a side note, your comments about ADHD are interesting. Your key point here seems to be the odd phenomenon that such ‘conditions’ are differentially diagnosed and treated across cultures and societies.
While, I presume, Ritalin has been subjected to an RCT the issue is probably not with Ritalin itsself but with the diagnostic practices that encourage its use. That’s the point that needs addressing – not outrage that ADHD is somehow being ‘dissed’. As your own piece indicates, Ritalin works (and this has been established by clinical trial). The problem is the cultural practice of diagnosis and prescription which, as far as I know, has never been subjected to an RCT. Medical diagnosis relies on the classical presumption of ‘professional expertise’ which I believe is nowadays barely tenable (PhD notwishtsanding!) and has been under attack for over 30 years.
My side note therefore is that the case of ADHD is an example of the underlying fallacy of clinical trials as a method for evidence-based practice. You may prove a drug efficacious, but this does not provide a guide to how it should be used in any given case for, of course, diagnosis is a social and cultural practice more than it is ‘scientifically’ proven.
The same arguments apply, I think, to evidence-based approaches to teaching.
[The issue of the overprescription of medical opiates, particularly in the US (but also globally) provides similar examples of the same process at work. An RCT may demonstrate that certain drugs ‘work’ (opiates sure do kill pain!) but such ‘proof’ does not provide any guidance as to their prescriptive application. Diagnostic practices are based on quite different sorts of assumptions and conditions (wish fulfilment being one of them perhaps].
[http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse](http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse)
See also: http://www.socialsciencespace.com/2014/05/is-maximizing-the-impact-of-research-desirable/
Thank you for this – looking forward to exploring the links
I have absolutely no idea and this is not my field at all so I’m keeping my comment short. But it has been astonishing to me over the past ten years to see the huge growth in access to high sugar energy drinks for children that seem to be almost entirely unmonitored by parents. Monster, Red Bull, those concentrated Robinson’s bombs of sugar and so on. It may not entirely be coincidental, that these drinks and foods with high sugar levels are regulated more in countries (both in law and by parents) with lower reported cases of ADHD.
That’s a very interesting case of correlation Debra but it appears to one of the widely believed neuromyths point out by Paul Howard-Jones here: http://www.educationalneuroscience.org.uk/wordpress/wp-content/uploads/2016/01/Howard-Jones-Neuromyth-nature14.pdf
Whilst one must question the ‘fashion’ of diagnoses – bipolar diagnoses are much increased in my region, too – I think we need to be careful making comparison with French treatment of ADHD: they also treat autism as a contextual condition, leading to some awful treatments (ref. film ‘Le Mur’).
I am a primary school teacher and mother of three children. Before I had kids I ‘knew’ that ADHD was something which could be altered with behavioural interventions. There was, quite simply, no chance that I could have children with such a condition. It never entered my head.
But…I now have two children with ADHD. I have spent years tinkering with diet, exercise, bedtimes, house rules and reward charts, limiting – to virtually nothing – screen time, and reading and applying parenting guidance of various other positive types. Then I’d try to ignore all of this and be completely unphased by the crazy behaviour they presented and regular misery they experienced through their inappropriate behaviour at school, but when school calls you in regularly you feel obliged to keep trying. All to no avail. Only medication has helped.
The difference between them pre and post medication (we see it every morning,) is amazing and extremely positive. They are calm, warm happy people now, instead of the angry, rude frustrated boys they were previously. They are now liked by others and their progress in school has leapt up.
In short, ADHD may be overdiagnosed. I can see the temptation. But I feel sorry for those French children who have it, but must suffer because other people don’t want to believe medication may be needed. Why should they suffer unnecessarily?
Furthermore, other conditions may be being overdiagnosed because ADHD is not picked up. One of my sons has a diagnosis of autism too, but it was made before his ADHD medication was at its optimum dose (it’s standard to steadily increase the dose to optimum when first taken). A recent set of tests (done for some research he has been involved in,) suggest that he no longer reaches the criteria for a diagnosis of autism only a year later!
Perhaps we should look more closely at other conditions too. I’ve been teaching children with dyslexia and a small percentage of them present with ADHD like symptoms which are largely ignored by the professionals who diagnose them with dyslexia only (instead?). Yet we know there is an overlap between these conditions. Why do we not try the medication on more people? Think of the misery it may prevent for those who struggle with dyslexia and who also struggle to focus on the intervention they experience!
I appreciate that, while methylphedidate is regarded as extremely safe, there may be things we don’t know about it. But children with unresolved behavioural problems are at a greatly increased chance of many other risks such as depression and drug taking, and have poor chances of building positive relationships with others. I think we should give more sufferers a chance to try methylphenidate, not fewer.
It really does seem unfair that because this is a brain problem, people are scared of medication. They aren’t for other things. At least, not in the same way.
[…] ADHD […]
[…] risen from 92,000 in 1997 to 786,000 in 2012. Let’s put to one side the contented question of whether ADHD actually insists and think instead about why children have been prescribed the drug. In almost all cases it is to […]
This article is inflammatory, offensive and invalid. I find it interesting that those who doubt the validity of ADHD do not suffer any invisible lifelong disability themselves. If you put yourself in the shoes of someone with chronic severe ADHD and lived for just a day in them, you would no longer doubt the seriousness of ADHD. I am a 27 year old woman with chronic & debilitating ADHD who only got a diagnosis in my early 20s. Unfortunately the medical establishment has overlooked many girls & women with the condition. ADHD does not affect intelligence, it affects executive function. I am a bright woman who due to ADHD has never been able to drive. Due to overcompensating so hard at school, I was hospitalized for an eating disorder. Whilst at university, I was diagnosed with severe depression- which was in fact a by product of untreated ADHD. I have not been able to hold down a job and have attempted suicide. My core symptoms – present since childhood- have included restlessness, hyperactivity, impulsivity, inattention and distractibility. I am not able to remain seated for longer than 20 minutes. Without medical intervention, I would not be able to lead a normal life, if any kind of life at all. The fact that you dismiss the pain & suffering of those with severe ADHD is hugely short sighted and insensitive. If I had been treated earlier in life, it would have saved me pain & would have saved the healthcare system unnecessary costs (treating an eating disorder, suicide attempts etc)
Hi Anon – sorry to read your story but glad to hear you’ve been diagnosed and treated. Also sorry to hear you were offended.
I think your case goes to show that the condition very many children get labelled with is quite dissimilar to the experience you describe. The problem with the label ADHA is it just describes a set of symptoms and tell us nothing about causes. It seems likely that the symptoms we bundle under ‘ADHD’ not vary markedly in severity but stem from a range of different origins.