Why I Believe that Attention Deficit Disorder is a Myth
When parents hear me say that attention deficit disorder is a myth, they sometimes become very upset. They think I'm saying that their kids aren't jumpy, distractible, forgetful, impulsive, or disorganized. That's not what I'm saying at all. It's quite obvious to me that our nation's children have probably never been so hyperactive. The question is, what accounts for this? Is it a medical disorder called ADD (or ADHD as it's sometimes called)? I think not. I think instead that what we've learned to call ADD is instead a number of things all jumbled up together under this simplistic label.
Kids can be hyperactive for any number of reasons: because they're anxious or depressed, because they're allergic to milk, because they're bored with school, because they have a different kind of mind and aren't being challenged, because they're over-stimulated from television and video games. I could go on. The point is that the ADD label makes it too easy to ignore what might be going on beneath the surface of things. "Oh, he has ADD? Whew! Glad we know what the problem is now." But perhaps we don't really know at all.
Although there is a great deal of support from the medical and scientific community for ADD, once one looks into the literature, things become less clear. Nobody can actually tell you, for example, how many kids have ADD. Though the literature traditionally says 3-5% of all children have ADD, I've seen statistics in textbooks that have ranged from .019% (in England where its far less common) to 10% and above. ADD is in the eyes of the beholder.
Many of the "tests" that are used to diagnose ADD are flawed. The behavior rating scales that ask parents to rate their kids on a scale from 1 to 5, for instance, in terms of hyperactivity, impulsivity and so forth, are very subjective and parents and teachers often don't agree on what they see in the same child. The continuous performance tests that are often used to diagnose for ADD are a joke. One of them is a box that sits on a table. The child is told that random numbers will appear in a screen on the box. They are instructed to press the button below the screen whenever a 9 is followed by a 1. What a stupid task! Yet on the basis of this, children are being diagnosed and having their medication levels adjusted.
As the textbooks themselves declare, "there is no blood test (or other objective test) to tell when a child has ADD." If this is so, then how do we really know for sure if he or she has it? I've seen studies showing that the symptoms of ADD disappear or lessen under several real life situations: when the child is doing things that interest him, when he's engaged in one-to-one interaction with someone he trusts, when he's being paid to do something, and when he can control the outcomes of his activities. If ADD can disappear under these conditions, then how can ADD really exist as a medical disorder?
Many parents tell me that they don't medicate their ADD-labeled children on weekends or holidays. Why? Because they're not in school and they have more opportunities to behave in active ways. If this is true, then it's clear to me that at least in those instances, we're using Ritalin and other drugs to control children in specific environments (i.e. restrictive classrooms). I realize that Ritalin is very effective and for some kids it can make a big difference in their lives. But it shouldn't be the first thing that parents and physicians turn to at the sign of problems. On Ritalin, research suggests that kids begin to attribute their actions to the pill, not to their own internal effort. Studies suggest that many child hate taking Ritalin, yet you don't see this reported anywhere in the ADD literature. For kids who have that wide-focus attention span (e.g. paying attention to lots of different things rather than one single stimulus), Ritalin can close them down to a fine point of attention, which is great for doing a math page, but can hamper more divergent forms of thinking associated with creativity.
Probably the thing that bothers me the most about this ADD phenomenon is its emphasis on negatives. We're talking here about disease and disorder; we're talking about a psychiatric illness. Do we really want to be handing these labels out so freely? In the 1950s, only a very few children were labeled as having these problems by the American Psychiatric Association, and they were grouped under the category: "organic brain syndromes." This was a serious category, that included kids who'd had accidents and illnesses (like encephalitis) that had dramatically impaired areas of the brain important for attention and behavior. However, over the past four decades, more and more children have been drawn into the behavior and attention disorder web, kids who back then might well have been regarded as "fireballs," or "daydreamers," or "bundles of energy," but would have been seen basically as normal (or even better than normal).
I'm very concerned that the literature on ADD has so much to say about what these kids can't do, and virtually nothing about what they can do. In my own informal research, I've seen countless examples of kids labeled ADD who are musicians, dancers, athletes, leaders, and creative in many other ways. Why don't we see these kids as basically healthy and creative individuals who may not function as well in certain kinds of environments (for example, the worksheet wasteland of many classrooms), but do great when given a chance to learn in their own way. Many kids labeled ADD in fact do great when they're fixing an automobile, or doing experiments in their nature lab, or performing in a theater piece. Many kids with behavior difficulties grow up to become great individuals. People like Thomas Edison, Winston Churchill, Sara Bernhardt, Louis Armstrong, and Albert Einstein. Why don't we start using models of growth to describe our highly energetic kids and throw this ADD disease label in the trash basket where it belongs?
For more information, read The Myth of the A.D.D. Child: 50 Ways to Improve Your Child's Behavior and Attention Span without Drugs, Labels, or Coercion (New York: Dutton, 1995) and visit Thomas Armstrong's website.
This article was first published in Sydney's Child (Australia), September, 1996. Reprinted with permission of the author. © Dr. Thomas Armstrong