Read an Excerpt

The Myth of the ADHD Child

101 Ways to Improve Your Child's Behavior and Attention Span Without Drugs, Labels, Or Coercion

Penguin Random House

The ADHD Blob Rolls over America and the World

Recently I happened to catch an old cult classic movie from the 1950s called The Blob. It's the story of a tiny gelatinous substance brought to earth via a meteorite that begins to wreak havoc on a small town in America, devouring everything in its path. As it rolls over people, the blob incorporates them into its mass and as it does so, it grows larger and larger. I won't spoil the story by telling you how the movie ends (Hint: It has something to do with climate change), but I will say that while I was watching the film I thought of America's ADHD epidemic. The notion of there being an attention deficit disorder in the human mind began as a tiny blob of an idea when it was first presented in a speech to the Canadian Psychological Association in 1972 by its president, McGill University psychologist Virginia Douglas. She suggested that what at the time was being called hyperkinesis had more to do with attention problems than with the behavior of hyperactivity. From there, the ADHD blob grew in size at cognitive science laboratories throughout the 1970s (cognitive psychology having displaced behaviorism in the late 1960s as the psychology field most likely to receive research funding from universities, foundations, and governmental agencies). In 1980, attention deficit disorder was given official recognition as a psychiatric disorder in the United States by the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders HI (DSM-3).

Then, in the 1980s it gobbled up an entire village with the founding of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a parent advocacy group that began lobbying the U.S. Congress to recognize what was then called ADD as a legally handicapping condition under federal disability laws. In the late 1980s and early 1990s the media began spreading the word about this new phenomenon on talk shows, in feature articles, and through popular culture (in the 1992 movie Wayne's World, for example, Wayne frequently reminded his somewhat scattered buddy Garth to take his Ritalin).

Big drug companies, sensing an opportunity to make a huge profit from this new attention disorder, started to financially support CHADD and fund individual doctors, ADHD researchers, and professional organizations. In 1997, the federal Food and Drug Administration (FDA) relaxed its restrictions on selling drugs to consumers and began permitting ads for ADHD drugs in women's magazines, on television commercials, and through other publicity outlets, creating even broader exposure of ADHD to the public consciousness and creating an even greater demand for drugs for treat it.

In the 2000s, the ADHD blob rolled over a huge new community as it extended its reach to include ADHD in adults through Web sites, blogs, social networking sites, chat rooms, and forums that discussed the impact of ADHD on work, marriage, relationships, and general coping skills. Now, in the 2010s, the ADHD blob has overtaken and digested another large region, the world of early childhood, with kids as young as two years old being identified as having ADHD and medicated for their attention deficits. As I sit back and contemplate all that has gone on since 1972, I ask myself: Is there anywhere the ADHD blob, now a gargantuan amorphous entity, has not yet visited? The answer: the rest of the world, where ADHD is spreading rapidly, with rates rising as much as tenfold over the past few years in some countries.

Why I Call ADHD a Myth

Before I get any further into this chapter, there's one thing that I want to set straight. When I say that ADHD is a myth, I am definitely not saying that there are no restless, inattentive, hyperactive, impulsive, and/or disorganized children (and adults) in America and the rest of the world. I worked for several years as a special education teacher, and during my tenure, I taught so many kids who displayed these traits that I began to think that all children acted in this way. I have no illusions about the millions of restless, inattentive, and/or impulsive children out there in homes and classrooms across the country and the world who are exasperating parents, testing the patience of teachers, and creating havoc in families and schools at epidemic levels. The reason I need to stress this fact is that when I wrote the first edition of this book twenty years ago, many people (especially those who had been diagnosed with ADHD or whose children had been diagnosed with ADHD) became apoplectic, thinking that I was saying that they or their kids had no problems. I have received a fair number of angry letters and e-mails from people over the years who felt that I was insensitive to their issues, blind to their symptoms, and completely out to lunch with my proclamation that ADHD is a myth. Not wishing to repeat this unpleasant experience, I need to state here plainly what I mean when I say ADHD is a myth. I'm using the word myth in this book in terms of its original meaning from the Greek word mythos, which means "story." Over the course of the past forty-five years, a story has emerged to explain why some children are restless, inattentive, disorganized, hyperactive, and/or forgetful (among other behaviors). This story has been collectively told by many different agents of society, including psychologists, psychiatrists, university researchers, educators, parents, the pharmaceutical industry, the media, and those who have themselves received a diagnosis. Like any myth, it's a story that has different versions, but overall there's a general consistency to the basic narrative.

THE ADHD MYTH

ADHD is a neurologically based disorder, most probably of genetic origin (although prenatal smoking and lead poisoning are also known to be contributing factors), which afflicts around 11 percent of America's children aged five to seventeen. Significantly more boys appear to have this disorder than girls (boys, 14 percent, girls, 6 percent), although girls who have evaded detection for years are increasingly being identified as having the version of ADHD that is referred to as "ADHD Inattentive Type." ADHD is characterized by three main features: hyperactivity (fidgeting, trouble playing quietly, always moving, leaving classroom seat, talking excessively), impulsivity (blurting out answers in class, interrupting others, having problems waiting turns), and/or inattention (forgetfulness, disorganization, losing 5 things, making careless mistakes, being easily distracted, daydreaming). Current thinking has identified three major groups of ADHD children, one group that appears more hyperactive and impulsive, another that seems more inattentive, and a third that has all three features. The symptoms must have lasted at least six months, have originated by the age of twelve, and have been observed in multiple settings (for example home and school).

There are no lab tests, biomarkers, or other objective methods available to diagnose this disorder. Assessment tools include parent, child, and teacher interviews, a thorough medical examination, and the use of specially designed behavior rating scales and performance tests. There is no known cure for ADHD, but it can be successfully treated in most instances using a psychostimulant medication such as Ritalin, Adderall, or Concerta. Other drugs have also been used as well, including antidepressants such as Wellbutrin, blood pressure medications such as clonidine, and norepinephrine reuptake inhibitors such as Strattera. Nondrug interventions include behavior modification, parent training, a structured classroom setting, and information given to parents and teachers on the proper way of handling ADHD behaviors at home and in school.

There is no known cause of ADHD, but current thinking has it as involving structural abnormalities in the brain and biochemical imbalances in areas of the brain that are responsible for attention, planning, and motor activity, including the striatum, the cerebellum, the limbic system, and the prefrontal cortex. Neurotransmitters that appear to be dysregulated in ADHD include dopamine and norepinephrine. Children who have been diagnosed with ADHD can experience significant school problems, suffer from low self-esteem, have difficulty relating to peers, and encounter problems in complying with rules at home leading to conflict with parents and siblings. Some kids with ADHD also have learning disabilities, conduct disorders (destructive and/or antisocial behaviors), Tourette's syndrome (a disorder characterized by uncontrollable motor or verbal tics), and/or mood disorders including depression and anxiety. While ADHD seems to disappear for some children around puberty, it can represent a lifelong disorder for up to 80 percent of those initially diagnosed.

Although this description of ADHD omits many fine points and details and although there are disagreements within the ADHD community in regard to some of these issues, I believe there is very little in my description that most ADHD experts would seriously dispute. I want to emphasize again, however, that this is a story. It may be supported by thousands of medical studies, as claimed by a 2002 International Consensus Statement on ADHD signed by over eighty of the leading authorities in the field, but it is still a story gleaned from those research findings. We should remember that in ancient times, myths were stories that people told to account for unexplained phenomena in their lives (for example, wars, storms, illness, and death). Here too we have an unexplained phenomenon: Millions of children in our culture are restless, inattentive, impulsive, and disorganized despite our best efforts to parent and educate them, and as in ancient times, we want to have a way of making sense of this situation. Naturally the storytelling elements used in the modern age (research, clinical data, epidemiological studies, and so on) are far more sophisticated than those used in ancient times (such as supernatural entities, magic, and divine revelation). Nonetheless, the intent is still the same: to provide a coherent narrative, easily understood by the average person, for why millions of children are not acting in the way that we suppose they should act.

As we'll see in the next chapter, my biggest problem with the ADHD myth is that it's just not a very good story. Yes, it looks good on the outside with the fine veneer of medical authority, scientific rigor, and governmental support. However, when one digs deeper into the story, inconsistencies start to appear, other interpretations of the same data begin to emerge, and alternative stories to account for the same restless, inattentive, and impulsive behaviors start to appear, especially when we include other fields of inquiry beyond psychiatry and clinical psychology, such as sociology, anthropology, evolutionary biology, economics, gender studies, media studies, developmental psychology, and family systems theory. In the next chapter, I discuss some very specific problems with the ADHD myth, and in subsequent chapters, I share a number of alternative interpretations or stories that can also account for the millions of restless, inattentive, and impulsive children in our homes and schools.

Why the ADHD Myth Is Not a Very Good Story

A good story has certain essential elements in it. It should have a compelling beginning, a strong middle, and a convincing and conclusive ending. The ADHD story, on the other hand, has a feeble beginning, a confusing middle, and an ending that appears wildly out of control. ADHD historians often like to situate the beginnings of the disorder in a 1845 German storybook of morality tales for children called Struwwelpeter (Shock-Headed Peter). The book contains a poem titled "Fidgety Phillip" about a child who wiggles, giggles, tips his chair, and can't sit still. This description would fit many young children alive on the planet today. Finally, he pulls off the tablecloth (with the food still on the table) and hides or is trapped underneath it. Again, we're talking about an incident that could happen (and probably has happened) to many families at one point or another in their lives. The book of poems from which this story was taken also includes vignettes of a child with poor grooming habits, a boy who won't eat his soup, and a boy who goes outside during a storm with an umbrella and is sent flying through the air. What are the current disabilities for which these particular poems provide historical beginnings?

The History of ADHD: A Bad Novel in the Making?

The second foundational event occurring at the beginning of the ADHD story concerns a British doctor named George Still. In a series of three lectures to the Royal College of Physicians in 1902 London, Still spoke about children who possessed a "morbid defect of moral control" not accountable to "feeble-mindedness" or medical illness. To use this as one of the key plot points for the beginning of a story about a disorder now said to afflict over six million children in the United States alone is, and I say this as someone who has written fiction myself, a weak literary move. Still was talking about only a very few children (he cites around twenty in his lectures), not 10 percent of all children worldwide. The children in his case studies behaved in ways not even remotely similar to the American Psychiatric Association's DSM-5 criteria for ADHD. Still's patients defecated in bed, stole, and lied; one even went up to two kids in the playground and "banged" their heads together causing them great pain (perhaps this was Moe from the Three Stooges when he was just a child). Finally, Still attributes the behaviors of these children to a "moral defect," constructing a cause that is absent from today's neurobiological thinking about the origins of ADHD (although he does claim to be able to identify moral defects by the size of the children's heads!). To use a single fictional child in a poem and twenty children from medical case files to serve as the beginning of a story affecting the lives of millions of children and adults worldwide is, in my opinion, to build a narrative structure on quicksand.

From its humble and irrelevant beginning, we advance to the middle of the story, when things start to get a bit confusing and a little crazy. After World War I, children who had survived the worldwide encephalitis epidemic and apparently displayed symptoms looking like ADHD were said to be suffering from "post-encephalitic behavior disorder." In the 1930s, two German physicians, Franz Kramer and Hans Pollnow, referred to children with ADHD-like symptoms as having "hyperkinetic disease of infancy." Based on cases of children who had shown these symptoms after suffering from actual brain damage, doctors in the 1940s began to use the term minimal brain damaged to describe children who acted this way. In the 1960s, many scientists became dissatisfied with this term because of the absence of any detectable brain damage, so they coined a new term to describe these kids: minimal brain dysfunction, or MBD. In 1968, with the publication of the second edition of the psychiatric bible, The Diagnostic and Statistical Manual of Mental Disorders, the term hyperkinetic reaction of childhood became the correct nomenclature to use in describing and diagnosing this disorder. Even with all these name changes, the number of children considered to be suffering from whatever term happened to be used at the time, was very small.

Then we come to 1972 and Virginia Douglas's seminal speech on attention deficits, which led to the third edition of the DSM in 1980, and the establishment of "attention deficit disorder" (ADD) "with and without hyperactivity" as a psychiatric disorder. Finally, we have a protagonist in the story and a name that will survive in one form or another up to the present day, although the naming process will look a little like a scammer's shell game. In the revision to the third edition of DSM in 1987, this disorder was renamed "attention deficit hyperactivity disorder." In 1994, the DSM-4 divided this disorder into three components: ADHD predominantly inattentive type, ADHD predominantly hyperactive-impulsive type, and ADHD combined type. The current edition of the manual, the DSM-5, kept this distinction but extended it to adults and changed the maximum age of onset of the disorder from seven to twelve.

---

Excerpted from The Myth of the ADHD Child by Thomas Armstrong. Copyright © 2017 Thomas Armstrong. Excerpted by permission of Penguin Random House.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---