Logo for kidsinthehouse.com, a parenting site with 9,000 videosI wrote an article, ”Why I Believe Attention Deficit Disorder is a Myth,” for the website The Kids in the House:  The Ultimate Parenting Resource, on August 29, 2017.   The Kids in the House is a site that offers 9,000 videos from experts and parents (who are the real experts!) on a wide range of parenting topics.  You can also watch a video on ADHD on this site, ”How to Thrive with ADD and ADHD” where I am one of the panelists.

The title of my new book is The Myth of the ADHD Child, Revised Edition: 101 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels, or Coercion, and some people might get upset and think that I am saying that their disorder or their kids’ disorder simply doesn’t exist.  I say no such thing!  As a former special education teacher, I know that the symptoms associated with a diagnosis of ADHD—hyperactivity, distractibility, and/or impulsivity–are very real indeed!  So let me clarify what I mean when I say that ADHD is a myth.  I’m using the word ‘’myth’’ in its original sense of the term in Greek, which is mythos, meaning ‘’story.’’ So I’m talking about ADHD as if it were a story.  It’s a story that has been developed over the past three decades about why certain people are inattentive, fidgety, spacey, disorganized, impulsive and/or hyperactive.  The plain truth is that I don’t think it’s a very good story.  There are plenty of inconsistencies.  The main one, in my view, is the fact that professionals can’t seem to agree on how many kids have the disorder.  The DSM-5, which is the official manual of the American Psychiatric Association, says 5% of kids have ADHD.  The International Classification of Diseases, which is used instead of the DSM-5 in many parts of the world, uses an entirely different term – hyperkinetic disorder or HKD—and concludes that the prevalence is 1-3% of all kids.  The Centers for Disease Control in Atlanta, says 11%.  The prevalence also differs by state.  In Nevada 5.6% of all children are diagnosed with ADHD, while in Kentucky that number jumps to 18.7%.  That’s a lot of variation!

I think one of the reasons for the huge differences has to do with the fact that there is no objective diagnostic tool that can definitely say whether someone has ADHD or not.  Instead, the decision about who is ADHD relies mostly on subjective judgements.  The most commonly used tool—behavior rating scales—which are used in 90% of the diagnoses of ADHD, ask simple questions about behaviors, whether a child has sleep problems, whether he forgets his homework, and so forth.  The answers to these questions depend heavily on context.  A child might forget homework whenever he dislikes the assignment, or because the teacher gives the assignment at the start of the day instead of at the end, or because the dog ate his homework (sorry, just joking about this last one!).  The point is, that ADHD is a psychiatric diagnosis—that’s serious stuff—and to make this diagnosis hinge upon the subjective judgements of teachers and parents is very iffy to me.

Advocates of the ADHD story usually emphasize the gravity of the disorder by pointing out that there are thousands of studies indicating that ADHD is a brain-based disorder, probably of genetic origin.  I agree that there are brain differences between many kids diagnosed with ADHD and typically developing children, but the key word here is ‘’difference’’ not ‘’disorder.’’ Recent studies, for example, indicate that the brains of kids’ identified as having ADHD develop normally, but lag behind typically developing kids by two to three years.  This finding has huge implications for many of the other brain studies that have been done over the past twenty years especially those which have discovered problems in the executive functioning areas of the brain that govern planning, organization, inhibition, and goal-setting.  In kids diagnosed with ADHD, these areas of the brain (in the prefrontal cortex behind the forehead) are developmentally delayed and thus are apt to be less functional than so-called normal children.

Another issue related to brain studies is that these brain differences can be due to environmental effects such as early childhood trauma, adversity in the family, and even growing up in poverty (in fact several studies have suggested just that).  Advocates of the ADHD story also emphasize the genetic nature of ADHD, with the implication that this disorder is heritable and thus hard-wired into the DNA of ADHD-identified children.  Such arguments, however, ignore the fact that recent trends in genetics have focused increasing attention on how the environment can affect which genes are turned on and which are turned off (a phenomenon known as ‘’epigenesis’’).  In one study, a gene-environment interaction was noted where a child with a specific genetic mutation would develop behavior disorders under conditions of parental criticism.  That means if the child is in a family where the parents are supportive and helpful, this particular gene will not be expressed and the behaviors will not manifest themselves.

One final problem that I have with the ADHD story is that many kids with the diagnosis also have diagnoses with other mental disorders such as depression, autism, anxiety, and bipolar disorder—a situation referred to as ‘’co-morbidity.’’  In fact, one study in Denmark noted that 52% of all kids with an ADHD diagnosis had at least one other disorder.  The raises the following question in my mind:  if a child is both depressed and ADHD, where does the one disorder stop and the other one start?  How do we know for sure whether it’s not the depression alone which causes the inattention, impulsivity, and/or hyperactivity? These are also symptoms of depression in children.

All of these issues, to my mind, suggest that we should be critical in thinking about the validity of ADHD, and not rush to judgment in placing a label on a child and medicating him with a potentially hazardous medication (although medications can be helpful for some kids).  Yes, the symptoms are real, but is there really a ‘’thing’’ called ADHD that is responsible?  I have my doubts. (Note: all decisions regarding diagnoses and medications should be made in conjunction with your physician).

For more information about why I believe ADHD is a myth, plus 101 practical strategies to help kids with that diagnosis, get my book: The Myth of the ADHD Child, Revised Edition: 101 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels, or Coercion.

This article was brought to you by Thomas Armstrong, Ph.D. and www.institute4learning.com.

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60 Responses
  1. max

    does a dog have ADHD because it acts different to other dogs?

    some people are loud some quiet

    some big some small

    we are all different folks

    there is no medical test for ADHD it just an excuse

  2. I am very grateful I now know that all these struggles in my life are from ADHD. I very ambitious. I have had a lot of goals in life. But I have low coping skills. It took me 6 years to get my associates degree. I have been going to school for years and I do not have my bachelor’s degree. I love knowing things and learning. In high school I couldn’t concentrate so I would take notes without comprehending what I was writing with the plans to read my notes at home. I never would read them at home. At age 20 I never understood why I was in 2 car wrecks, the second one both cars were totalled. Before I got on ADHD meds I had to look at least 4 times booths ways before pulling through an intersection. Even after that I was still hesitant. Now I look once each way and feel confident pulling into the intersection. Before I would get many steps wrong putting something together. I often would have to take things apart and redo it even though I would read each step multiple times. I just put a chicken coup together no problems, no mistakes. I have had anxiety many times throughout my life and didn’t know that feeling was called anxiety. I practice mindfulness now. Before mindfulness videos caused me frustration or anger. My communication is immensely better now that I’m on strattera. There are many different kinds of meds for ADHD. Strattera is a non-controlled substance. Many people do not know the differences in ADHD meds. No one will ever convince me that ADHD doesn’t exist. It has been the best thing that has ever happened to me to find the source of my struggles. Now I have the tools and resources to be successful at my endeavors for the first time in my life.

  3. Thanks for sharing your experience of ADHD. It sounds like you’ve had quite a journey and found some good things along the way that helped. I have unipolar depression and take meds and meds (I mean medications and mindfulness meditation), both of which have helped me immensely. When I say ADHD doesn’t exist, I’m certainly not talking about the symptoms or inner and outer experiences that you’ve had, which are quite real. I’m arguing against ADHD as a construct – I want people to think more deeply about it and not just use it as simple answer to what are complex interdisciplinary questions. Anyway, thanks again!

  4. Nidia

    What is very funny to me is that, after speaking with many parents of children with ADHD (and I agree that we need to change the name, we don’t lack attention, we simply can’t channel it in the direction we would like) and myself being an adult with ADHD, we were ALL at one point strongly against medication. We demonized it because it was a drug, and big pharma is always up to no good- that is, until life fell apart before our very eyes.

    I always smile when people suggest healthy eating, good sleep habits, exercise , and meditation (and how frustrating meditation without movement it is for us- especially when your Ferrari-like mind feels trapped in a body that just won’t keep up)- because, which of us don’t already do all of those things?

    It took me decades to understand myself- why I could type an incredible paper on the philosophy of neoliberalism, but couldn’t so much as finish cleaning my bedroom because some other “new, shiny” task would pull me away, suck me into a world for a long time until my alarm brought me back, “Come back to your bedroom, where your body is currently, time to pick up your kids from school.” Why couldn’t I just be a mature, responsible adult? The world didn’t know this part if me, of course. They knew the mother of four who had finished college while running a small business, and who managed to have dinner on the table by 6pm. To the world, I was an overachiever, and I was! Out there, that is.

    In my home I was filled with shame. This shame always had me asking, “What if people knew? What if they knew I can’t do much as keep the floor clean? When I cook, it looks like a class of preschoolers took over my kitchen. I have countless times opened the freezer only to find folded laundry instead of ice, a bathroom cabinet only to find dishes, forgotten my appointment when on my way to said appointment.

    I decided even if I had ADHD, I didn’t want to open that can of worms. Medication? Nope. It was probably companies just trying to make their money.

    Fast forward to 10 years later. My child’s teacher notes he excels at math and science, as long as they don’t include reading. Because you see, he can see words and he can hear them when read out loud, but they mean nothing. They form no concepts, there is no visual of the meaning of those words. There is just a cloud where these concepts should be forming. He is also getting older, and his impulsivity has gotten to the point where he almost got hit by a car- for the fourth time- at 9 years old. I realized and almost accepted that I may not see my child grow up to adulthood.

    I already feed him a very healthy diet (the kid has a six pack, for goodness’ sakes). He exercises a lot, and is the star athlete on any team we have ever put him in. We also have three other children, but definitely notice there are stark differences not in personality, but in his cognition. He seems to forget A LOT. Went to his room to grab socks, came back with his guitar barefoot. Went back for socks, came back with his latest STEM project. Third time’s a charm.

    I eventually picked up the phone and called my brother who got taken off medication during his teen years and was now nearing 30. He told me “don’t do that to him. Don’t keep him away from something that could potentially save his life.” I was baffled, but it rang true. I was desperate to keep my kid alive, I would do anything.

    Ritalin has not only kept him from running his bike into oncoming traffic. He now ENJOYS reading. He is pretty charming, so his friendships are very special and solid. The kid will sit with you and discuss politics, religions, world issues, or his latest engineering project. This was always in him. Ritalin has allowed him to enjoy life and thoughts that last more than a few seconds.

    I am now on medication too. I am able to keep my house (mostly) organized. My brain doesn’t feel trapped. I even sleep better, and my narcolepsy doesn’t get in the way either. My kids, all 9 and under, have noted “mommy you listen to us now! Not like before you wouldn’t pay attention to us.” My husband asked me why I “have become so patient and content.” It’s because my mind is here, now, with those around me. And I love feeling like I am here with them, and for them.

    My thoughts are still unorganized, but they don’t race anymore. It’s evident in the way I can now finish tasks, big and small. I also remember to turn off my stove. In short, medication was my last resort, but looking back, I wish it hadn’t been. It would have saved me years of depression, self-loathing, and of nearly burning down my house a few times. It has saved our lives, as it often does for people with ADHD, who are more prone to deaths caused by accidents.

  5. Nidia

    Jack Sheehan, I totally agree that this is only a construct in that “ADHD” is the divergence, when in reality it is the way we have structured schools, work, and other social rules to fit one type of brain. ADHD is like the fish being judged by its ability to climb a tree, as Einstein once put it.

    ADHD can definitely be a superpower (just ask Einstein, Disney, Beethoven, Bill Gates, Simone Biles, etc), but that superpower can be turned into an essentialist flaw if that’s what society wants to deem it. For those who find the way to navigate this world with their superpower it can be uplifting. For most of us, though, it can be crippling especially if society wants to see you as lazy (rather than creative), hyper (rather than energetic), unorganized (rather than as a multi-tasker), loud (instead of as a leader), and divergent (rather than innovative).

    I think it is the point if this article but it sort of misses actually educating uneducated people. Unfortunately anything that dismisses or minimizes the minority, the misunderstood, or the consistently silenced in any environment, it can have catastrophic consequences.

    The article would have been a great opportunity to spread purposeful information about ADHD if people with ADHD were consulted and given a voice, but unfortunately this is often the case then people who do not experience something speak for the people who do experience it. It becomes reckless.

    Anyway, good luck to all of you fellow people struggling (and being super-exceptional at the same time) with ADHD!

  6. Nidia

    I have to say, I completely misread the article the first time around. I just re-read and noticed I completely missed the point.

    Most of us with ADHD don’t see it as a disorder (at least that’s my hope) in and of itself. We see it as a disorder mostly as a construct, just like with race (something real only because of the effects of its being a construct). I think we recognize the magnificence of our brains as much as we recognize the struggles.

    Great article, though I must say for some of us medication has helped us survive what most feel are “simple” every-day tasks (remembering to turn off a stove before leaving the home, for example). I make sure to remind my son that his achievements are not that of his “assistant” (Ritalin). We discuss medication not as something we need to “fix us,” but as a great tool.

    Just like the accountant doesn’t owe her achievements to Quickbooks, nor an injured person owe their merits to the crutch (and it definitely doesn’t help them “cheat” or get advantages over others), our “assistants” don’t “fix” us, because we are imperfectly perfect! (Aside from the difficulties of the construct, that is).

  7. I’m not against medication. I understand completely what you’re saying, having taken for the past thirty years antidepressants for a mood disorder, but I also use my non-medication tools like meditation, diet, exercise, yoga, and therapy. Used with the medications, they form a synergistic ”team” that is more powerful as a whole than the sum of its parts.

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