I’ve just been in to meet with my son Michael’s head of year, two teachers and Special Needs co-ordinator. None of them seemed to think that excluding my ADHDer from sport yesterday was not the best way forward when they also wanted to talk about his challenging behaviour in class. As they went on and on about how he liked to “challenge the rules”, and his mis-behavioural points, I wanted to say that – like a Golden Retriever dog that always brings back the ball – he wasn’t going to change. And I couldn’t help thinking – “well you have the power, if you don’t want to argue the toss over the rules with him – just don’t engage’.
More worryingly for me, is that he doesn’t have the choice to challenge his exclusion once again from extra-curricular activities. Last term he was made to sit in a library while others were outside playing games, because he was deemed a “risk” (to himself? to others?). Despite the fact that he had a giant black eye from a friend hitting him in the face during hockey after school (we are used to Michael being accident prone and didn’t complain) this time Michael was the culprit. Except Michael was excluded from hockey club for hitting another boy with the hockey stick.
Doctors are getting themselves in a right twist. In response to the previous post on the New York Times piece, Behavioural Neurologist Dr Richard Saul in Chicago has waded in, puffing his provocatively titled book called “ADHD does not Exist” (ironically reviewed by Belinda Luscombe on the same site as one of the Top Ten ADHD books here ). Dr Saul’s stance argued on the Time Magazine’s website here has a particular beef with the new diagnostic manual for mental health (DSM V), which awards ADHD to anyone displaying a minimum of five out of 18 possible symptoms.
His views will no doubt curry favour with Daily Mail readers, who do see this massive upsurge in ADHD diagnosis and medication as a problem, and also with those who feel that taking medication for ADHD is in some way “cheating” in life – whether offering extra focus at school or in the workplace (something that is shown to be not the case in the more level-headed recent Time Magazine piece by Denise Foley in another piece . Foley points out that even with meds, the attention of an ADHD child is still below the par of a “normal” child in school).
When a piece like this comes out in the NY Times it doesn’t always help the cause of seeing ADHD as a real issue, that people struggle with daily, and that those that are affected by it do deserve help. We don’t tell the short-sighted to try and manage without glasses, so why assume that the ADHDer has to settle down to difficult daily tasks without medication (or drugs, as the piece annoyingly calls them)?
First, is the author, a professor of Clinical Psychiatry Richard A. Friedman right to call it a disease? Not really. It confuses what it is, and it is already confusing enough – as disorders go. Disease is something one contracts, or that one gets over or rid of – like malaria or typhoid. Because ADHD is neurodevelopmental, ie the brain can develop and grow out of it, or at least many of the symptoms can be helped, it is better seen as a bundle of traits or a different brain wiring than a disease. You can’t give ADHD to anyone else after all, only your offspring because of the genetic link.
Secondly, are novelty-seeking jobs really a natural cure? Or small classes in school? Not really, not when inattention means that that adult or child will underachieve in any environment, unless some accommodation can be made to assist them to keep on task and pay attention – medication, coaching, teacher’s tricks. They aren’t going to learn or perform well in any environment, if they can’t stay focussed.
Finally – the jump in diagnoses does seem scary when you put it into percentages, but it is obvious really. Neuroscience is new science – a generation ago, people were just told to shape up, mental health was seen as a shameful area of the medical profession, people were stuck in psychiatric institutions and the key was thrown away.
Given the genetic component of the condition, if a child has a positive diagnosis – it doesn’t take very long until one of the parents looks back at the difficulties in their life, and realises that they may have ADHD, too, ad that it’s just they were branded naughty, wrong, undisciplined, or are reading this in jail (expert Dr Ned Hallowell estimates that 20% of the US prison population have it – much of it undiagnosed). This then leads them to seek a diagnosis and medication (some of which is not apparently that different from caffeine – another Dr Ned observation) which then leads to what the author calls an “epidemic”.
Remember, in the UK, up until 2006, after the age of 18 it wasn’t even possible to get further medication for ADHD because it was deemed to have disappeared overnight, and adult ADHD did not even exist. Of course, if you take this as the base point, statistics and percentages are going to go off the Richter scale as people come forward to ask for help.
So, before suggesting that all ADHDers find a natural “cure” by following the path of our most famous UK ADHDer Sir Richard Branson, and become entrepreneurs ( hopefully without too much of the novelty-seeking risk taking associated with the condition, complete with pilots dying in test runs to space), let’s look at what the new brain science is teaching us about this complex condition first. The more we learn about it, and the better we treat it and support those that have it (think of those unnecessarily locked up prisoners, who might have take a different course if not branded “wrong”, disobedient or dangerous at an early age) the better we might harness their human potential.
Only then will we have something approaching a natural “cure”.
Better Late than Never 