First, let me begin by saying I am not an idiot. I clearly recognize that ADHD is a certified medical condition as defined by the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5). In addition, I recognize that the symptoms described in the DSM-5 are very real: things like ‘’fidgets’’ ‘’blurts out answers’’ ‘’is forgetful’’ ‘’has difficulty waiting their turn’’ and ‘’fails to follow through on tasks and instructions.’’ I’m not denying that these behaviors exist. But my question is: why do certain children (and teens and adults) act in these ways? Is it because of something called ADHD, or are there other, more complex and subtle reasons for these and other ADHD-related behaviors? I’m going to share 17 reasons why I think we should deeply question the legitimacy of the ADHD diagnosis.
- Our culture has changed radically over the past 50 years, with greater fragmentation of the family, different expectations for kids, a faster pace, and a more complex society, and ADHD symptoms are a global systemic response to these changes. This is basically a sociological explanation for ADHD symptoms. The problem is not in our kids but in the crazy society that has sprung up around them. By locating ADHD within an individual, it fails to account for the fact that we’re social beings and respond to changes in systems, in this case to contemporary Western culture. Children are the most vulnerable members of a society and are the ones that are most likely to respond negatively when the culture itself becomes problematic. In this case, don’t blame ADHD, blame our confusing, fragmented, complex, stressful society. The ADHD diagnosis in this context, represents a way of blaming the victim.
- Children and teens diagnosed with ADHD have normal brain development, but it lags behind typically developing individuals by two to three years. This is a developmental explanation for ADHD symptoms. Several research studies have confirmed the fact that this delay exists, and the last part of the brain to mature is the frontal lobes, the very area of the brain which most ADHD experts see as the main region implicated in ADHD. Simply maturing later than other kids is not a reason to give someone a medical diagnosis. Other research suggests that kids who enter kindergarten or first grade as the youngest in their class, are more likely to be diagnosed with ADHD and medicated. Again, we’re talking about a developmental delay here, not a medical disorder, and we should be using a developmental perspective rather than a medical one to help these kids (e.g. developmentally appropriate enrichment such as free play).
- Kids diagnosed with ADHD are responding to an increase in the pressure on kids to succeed in school. Over the past thirty years, our schools have increasingly focused on accountability using standardized testing and more ‘’rigorous’’ expectations for achievement. Not every kid can shrug off this increasing stress, and if you’re lagging behind developmentally by two or three years, it’s even more difficult. Teachers are often the de facto diagnosers of ADHD (even though it’s regarded as a medical disorder), and are more apt to see ADHD symptoms when the curriculum consists primarily of lecture and seat work. It shouldn’t be a medical disorder simply to have difficulty with what is an inappropriate way of teaching kids in the first place (education experts say kids need project-based learning, and active, experiential hands-on ways of learning new material). In fact, it’s makes a good deal of sense that many of these kids ARE becoming more restless, forgetful, disorganized and so forth in a classroom that stifles their vitality and inhibits their natural ways of learning.
- Boys are diagnosed with ADHD more than four times as often as females, and the main reason for this situation has to do with normal gender differences. It shouldn’t be a medical disorder to behave like a boy. In times past, people would regard ‘’all boy behavior’’ as a natural part of being a male: being rowdy, enjoying lots of action-packed moments, engaging in horseplay, and the like. In research studies, preschool boys are found to engage in more physical activity than girls, they prefer object play to interpersonal interaction, and they pay attention more to non-verbal sounds while girls respond better to verbal stimuli like the teacher’s voice. Thus, in the average elementary school classroom, the deck is stacked against boys, particularly since eighty-one percent of elementary and middle school teachers are women, who judge appropriate behavior in terms of their own gender bias.
- ADHD symptoms have increased in our culture due to the high consumption by youth of fast-paced multi-media stimulation. Our kids are now spending seven-and-a-half hours a day consuming media, compared with just a few minutes a day playing outside. Research studies are finding correlations between high media consumption in kids and attention and behavior difficulties. Consumption of mass media, including television, movies, video games, the Internet, and social media, has a direct impact upon the dopaminergic areas of the brain (dopamine being a neurotransmitter important in novelty-seeking, rewards, and motivation). These are the same regions that are regarded as dysfunctional in ADHD. The big question is: are they dysfunctional because of a medical disorder called ADHD, or because the brain is bombarded with seven-and-a-half hours of daily media stimulation?
- ADHD symptoms have arisen in our culture due to the decline in the amount of time children spend playing outdoors in free unstructured settings. Neuroscientists have seen direct links between frontal lobe damage in laboratory mice and an inability to play. Play stimulates the production of important brain chemicals and even assists in the building of new brain connections. Some thinkers believe that the frontal lobes themselves evolved over time due to playful behaviors and that playful behavior is an important factor driving human evolution. Yet our children have been playing less and less over the past thirty years . During this same time span, kindergartens have become increasingly academic with less time devoted to play-based activities. Recent research has indicates that when children diagnosed with ADHD play in outdoor settings, their symptoms decrease, and the wilder the environment, the more the symptoms go down. Let’s allow children more time to play, and then see how many of them are diagnosed with this purported medical disorder.
- Children diagnosed with ADHD are ‘’hunters in a farmers world.’’ This metaphor, derived from ADHD expert and political commentator Thom Hartmann, helps us understand why the genes for ADHD are still in the gene pool. During the hunting and gathering era of prehistoric times, there were advantages to being able to move constantly in a nomadic tribe (hyperactivity), being able to pay attention to any sudden stimulus (distractibility), and being able to respond quickly with immediate action in response to that stimulus (impulsivity). Thus, the three main signals of ADHD were advantageous in hunting and gathering cultures. Transplated into the modern day classroom, these traits become disadvantageous, but that isn’t due to any kind of medical disorder, but rather by being in the wrong place at the wrong time (e.g. in a restricted classroom setting rather than roaming in the great outdoors).
- Children diagnosed with ADHD are ‘’novelty-seekers’’ who crave dynamic, creative, and exciting new experiences. One factor that unites many kids identified as having ADHD is that they absolutely have a hard time with boredom. But is it a medical disorder to be intolerant of being bored? Our greatest creative artists have traits that are virtually identical with the warning signs of ADHD, only we use more positive words to describe them: spontaneous instead of impulsive, divergent rather than distractible, vital rather than hyperactive. Research studies have indicated that individuals diagnosed with ADHD score higher on creativity tests and also in brain scan studies respond more intensely to novel experiences. Our culture needs creative people to fuel new discoveries and innovations. But if we regard creativity as a medical disorder (and medicate it), then what does this portend to the continued development of a vital civilization?
- Some kids diagnosed with ADHD are simply responding normally to what are in fact adverse living conditions in the home. If a child doesn’t feel safe at home due to parental conflict, violence in the neighborhood, or other adverse circumstances, they are certainly going to have trouble paying attention, and their frontal lobe function will shut down as they descend into fight or flight mode or into a state of chronic stress. Research studies have linked greater levels of adversity in the home with an increased risk of being diagnosed with ADHD and medicated. Many stress symptoms are identical, in fact, to those of ADHD, and researchers have seen a significant amount of cross-over (called ‘’co-morbidity’’) between ADHD and depression, anxiety, and other emotional disorders. But is it ADHD or is it instead depression, anxiety, or another emotional disorder that needs to be recognized and treated?
- Kids diagnosed with ADHD are different from so-called normal kids, but their differences are better accounted for as ‘’neurodiverse’’ than as ‘’medically disordered.’’ Over the past twenty years, a new paradigm has emerged to account for individual differences in human beings: neurodiversity. Rather than regarding certain individuals as mentally disordered, we are increasingly seeing them as reflections of human diversity. Just as we honor and celebrate biodiversity and cultural diversity, so too should we validate diversity in brains. We don’t say that a calla lily has ‘’petal deficit disorder’’ but instead value its uniqueness as a flower. We should do the same with kids displaying symptoms associated with ADHD. Research is increasingly revealing that the so-called disorder of ADHD has distinct strengths associated with it as well as challenges (including creativity and novelty-seeking). Rather than counseling kids to accept their disorder, we should be helping them learn strategic ways of maximizing their strengths and minimizing their difficulties.
- Many of the symptoms regarded as part of the ADHD diagnosis are in fact healthy behaviors which simply need a proper channel in order to be constructive. One of the diagnostic criteria for ADHD in the psychiatrist’s bible, the DSM-5, is ‘’Fidgets with or taps hands or feet, squirms in seat.’’ Remember that this is regarded as a ‘’warning sign’’ of a medical disorder. The problem is that experts are now beginning to understand that fidgeting is actually a positive behavior; that kids diagnosed with ADHD concentrate better if they’re allowed to fidget! The provision of ‘’wiggle furniture’’ ‘’bouncy bands’’ and other flexible seating that permits quiet fidgety behavior are examples of how this behavior can be constructively employed in the classroom and the home.
- The DSM-5 criteria used to diagnose ADHD are too highly subjective and general to be used in identifying something as serious as a medical disorder. I mentioned fidgeting above. Another criterion is ‘’talks excessively.’’ First of all, how do you define ‘’excessively’’ and secondly, what’s wrong with excessive talking? For some kids that’s their nature, and we should have a tolerance for those who like to share their thinking with others. Another criterion is ‘’Avoids/dislikes tasks requiring sustained mental effort.’’ Yet many of these kids put considerable effort into activities that interest them (e.g. lego structures, video games, a hobby). The key word here is interest. If a child isn’t interested in a topic, isn’t it understable that they wouldn’t want to put much mental effort into it? When is the last time you put considerable mental effort into a lecture you found boring or irrelevant?
- An underlying theme in many of the criteria used to diagnose ADHD is the need to be ‘’compliant,’’ which is an expectation from ADHD authorities who themselves have been overly compliant during their lives. Bruce E. Levine, a clinical psychologist, points out that the people who create psychiatric categories such as ADHD have had to go through years and years of training, wherein they were required to be compliant toward supervisors, professors, trainers, and other authorities. Thus, they approach life from the standpoint that compliance is a good and necessary attitude to have toward life (since it worked for them). But non-compliance has its good sides as well. The United States would have never become an independent country had it not been for a lot of non-compliant individuals (we call them Founding Fathers). Advances in science would never have occurred if not for the non-compliance of scientists who refused to accept the status quo.
- Many kids who are diagnosed as having ADHD simply have a different temperament than other kids. The ancients had a theory of personality which believed that human nature consisted of four basic temperaments: choleric, sanguine, melancholic, and phlegmatic. Many kids identified as ADHD tend to have the sanguine temperament (enthusiastic, active, social). Modern temperament theorists Stella Chess and Alexander Thomas had another way of categorizing individuals: as easy, difficult, and slow-to-warm-up. Many (if not most) kids diagnosed with ADHD would fall into the ‘’difficult’’ temperament, but the important point here is that it is not superior or inferior to the other temperaments; it’s simply different.
- ADHD does not reside ‘’within’’ the child, but rather emerges as a result of the interaction between the child and his or her parents, caregivers, and teachers. Temperament experts suggest that behavior problems arise not due to the temperament of a child but to the ‘’goodness’’ or ‘’poorness of fit’’ that the child has with his caregivers. Some parents and teachers have a way of being with a difficult child in a way that results in a harmonious relationship and an active healthy child. But many kids diagnosed with ADHD are regarded by parents or teachers as ‘’trouble-makers’’ or as possessing other negative characteristics, and this bias affects how caregivers or teachers interact with them. This exacerbates the child’s difficult behaviors, and may lead to an ADHD diagnosis. But the ‘’disorder’’ is in the relationship, not in the child.
- The rise in the power of the ‘’medical model’’ and multi-national drug companies has fueled the increase in ADHD diagnoses in the U.S. and increasingly elsewhere in the world. Over the past fifty years, there has been an increasing tendency to regard life problems as due to medical ailments. The concomitant rise in the scope and reach of powerful pharmaceutical companies, which actively promote through advertising the sales of ADHD drugs, creates a self-perpetuating system that seeks an ever-widening market for its products. Medical doctors often spend as little as fifteen minutes diagnosing ADHD (often using a simple checklist of behaviors) and are susceptible to pressure from parents to have their kids diagnosed as ADHD, sometimes to qualify for benefits such as extra time in which to complete standardized tests.
- The symptoms of ADHD can be caused by a number of other conditions. Neurologist Richard Saul has argued that what is regarded as ADHD could be any of a number of other factors, including vision problems, sleep disorders, mood disorders, hearing problems, giftedness, seizure disorders, learning disabilities, sensory processing disorder, Tourette’s syndrome, fetal alcohol syndrome, and several other conditions. The rush to diagnose ADHD runs the risk of failing to recognize these other issues, thus leaving them untreated.
As you can see, each one of the 17 points discussed above raises doubt about the legitimacy of the ADHD diagnosis in children and teens. But it’s the cumulative power of these arguments that really drives home the idea that ADHD is a highly flawed diagnosis. Let’s imagine that we start out with 100 kids – all of them diagnosed by medical doctors with ADHD. Then, let’s eliminate the kids whose problem is mainly a ‘’difficult temperament.’’ Let’s say that eliminates 20 kids and leaves us with 80 ADHD labeled children. Then let’s eliminate those kids who are ‘’latebloomers’’ (whose brains develop normally, but 2 or 3 years later than other kids). Now we’ve eliminated another 20 kids, leaving us with 60 ADHD-identified children. Then, let’s consider those kids who have developed symptoms because of their overconsumption of mass media. Take out another 20 kids, leaving us with 40 ADHD cases. Next, let’s eliminate 10 boys in the remainder of the group who are simply demonstrating ‘’all boy behavior’’. This leaves 30 kids diagnosed with ADHD. Now, let’s consider those remaining kids who aren’t getting enough outdoor play in their lives. Another 10 leave the group, and we’re left with 20 kids diagnosed with ADHD. Let’s say that of that group, 15 of them are responding to adverse living conditions at home. That leaves us with 5 kids. Of these 5 kids, three show signs of depression and anxiety that mimic the symptoms of ADHD. We’re left with two kids. And the symptoms of these two kids turn out to be an allergic reaction to their consumption of wheat and milk (bad reactions to certain foods can also trigger ADHD symptoms). That leaves us with . . . what? Zero kids with ADHD. And that’s why I do not believe ADHD is a legitimate medical disorder.
To see a video version of this post, click here. For more information on why I believe ADHD is not a legitimate medical disorder, plus 101 strategies to help kids who’ve been diagnosed as ADHD, see my book: Thomas Armstrong, The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels, or Coercion (Tarcher/Perigee).