There is more to ADHD than we assume

When Gillian Lynne was eight years old, she hardly paid attention in class and constantly fidgeted. She was thought to have a learning disorder and was sent to a specialist. The specialist left her for a minute, but as he left the room, he turned on the radio. As soon as he left, the girl was on her feet, dancing. Looking at her from outside, the doctor told her mother, “She’s not sick; she’s a dancer. Why don’t you take her to a dancing school?” Gillian Lynne grew up to be an acclaimed dancer and choreographer, best known for her work with Cats and Phantom of the Opera. Today we would label her as an ADHD child, tell her to calm down and medicate her.

Despite its prevalence, ADHD is quite a recent “disorder.” The earliest records date back to 1902 when Dr. George Frederic Still, a pediatrician, observed “deficiencies in volitional inhibition,” for which he recommended “good discipline” as treatment. Along the way, organic or biological pathology such as small lesions of the brain have been suspected causes of ADHD. Different versions of the disorder have been part of the Diagnostic and Statistical Manual of Mental Disorders (DSM) since the 1960s.

Western countries have witnessed an explosive increase in ADHD diagnoses. Between 1970 and 1990, the number of children diagnosed in the U.S. has doubled every seven years. As the evolution of our definition of the disorder proves, at the root of the dramatic rise in diagnosis of ADHD is the reductionist view that the product of complex interaction of multiple factors can be traced to a single cause — a physical abnormality or chemical imbalance. Medicalization of ADHD presents the option of medicating children with amphetamine-based psychostimulants as a “quick fix.” Since a one-word diagnosis is much easier than seeking answers to a multidimensional issue, ADHD is a tempting way to explain a child’s anomalous behavior.

Has the way we view our children’s behaviors changed? The emergence of ADHD coincides with modern medicalization and the recent ascendance of medicine’s cultural power. Though its authority and credibility stem from factual and logical “scientific” method, science harbors covert values and interests of the contemporary paradigm. Thus the trajectory of scientific and medical development can be situated within the context of social, cultural and political flux. Medicalization, the sociological phenomenon of explaining problems that are not evidently medical with medical knowledge, became especially prevalent in the 1970s when the authority of medicine pervaded all domains of life. Beginning in the 1980s, “deviant” behaviors — homosexuality, male chauvinism, drug addiction and various other behaviors — were defined as medical illnesses and the medical profession was licensed to provide some sort of treatment. As such, the omnipresent authority of medicine in our culture infiltrates our perspectives and lends its own lens to the way we view our children.

The healthcare system in the United States is one of the largest components of our economy. Pharmaceutical companies are so powerful that they influence prescribing habits of doctors. Diagnoses have become legal and financial tools to legitimize the economic system of psychiatric care, and its ideological impact has lead us to think about our children’s behaviors from a medical standpoint, labeling behaviors that do not fit into socially and medically acceptable framework.

Have our children’s behaviors actually changed? A large-scale change in genes limited to the Western countries in just a few generations is unfeasible. If so, then perhaps we should scrutinize the environmental and social causes of the shift in children’s behaviors and, more importantly, the way we perceive and classify children’s behaviors. Numerous environmental factors in the modern lifestyle could have contributed to the more frequent presentation of ADHD-like behavior in children. Ever-present visual and sensory stimuli can lead to a shorter attention span. Changed diet and exercise patterns, earlier exposure to alcohol, drugs and adult content, less time spent with family as more mothers enter the workforce and stress with family relations (e.g., higher divorce rates) all affect children psychologically and biochemically. The list goes on.

Also, our perception of the roles of parents has shifted significantly. There is a lesser degree of parental interference and discipline in tandem with more intervention from the state to protect children’s rights. On top of that, parents and educators recently have worshipped the banning of negative feedback. In the absence of negative feedback, it is feasible that children have weaker discipline and a less clear idea of what is acceptable behavior, which could contribute to children’s inattentiveness and impulsive behavior. All the while parents and the schools point fingers at each other for the lack of discipline in children when the responsibility to educate the child as a person lies with both parties.

How about the way we evaluate our children? With increased competition, standardized tests have become the ruler for a student’s learning ability and even the diagnosis of disability. Although we know that there are numerous types of intelligences and talents, we disproportionately support the skills and knowledge that are linked to performance on standardized tests. The fidgety and inattentive behaviors of children who are confined and driven away from expressing their creative outlets can be wrongly perceived as ADHD-like behavior. As in the example of Gillian Lynne, rather than classifying and labeling children with psychological disorders, educators should recognize individual talents. Perhaps it is not the children who are failing, but rather the education system that educates children out of creativity and natural passions. Let us remember that Thomas Edison, Winston Churchill and Leonardo Da Vinci all showed ADHD-like behavior in their youth. An ADHD diagnosis does not necessarily mean lagging behind; it can simply mean the child thinks differently from others, perhaps even brilliantly.

I am not saying ADHD as a whole is not real, but it is important to recognize that ADHD is not a disability. Instead, it is a disorder, a deviation from a set of socially constructed criteria that is prone to subjectivity. Before we conclude that a child lacks focus or volition, we should consider if we have failed in our responsibility to educate. Understanding that a child’s behavior is the product of various environmental factors rather than a singular biochemical imbalance or genetic condition, accepting that each child has unique talents and interests and helping them cultivate their individual talents will lead to a more fruitful society, one where children are considered creative and active rather than fidgety, inattentive or impulsive.

CORRECTION: The author's name was misspelled in the print edition. It has been corrected online.