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Thursday, October 30, 2014

Is ADHD a Valid Disorder?

APA

Robert Furey and Colleen Furey, reviewers of The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance by Stephen P. Hinshaw and Richard M. Scheffler, describe the “ADHD explosion” in stark and alarming terms: in 2011, there were 2 million more children aged 4 to 17 in the United States with an ADHD diagnosis compared with 2003; an estimated one in nine youths (6.4 million) currently has an ADHD diagnosis; 19 percent of adolescent males in the United States have received the diagnosis at some point in their lives; an estimated 9 million U.S. adults have an ADHD diagnosis. The financial costs of ADHD can be measured in the hundreds of billions of dollars, including both cost of treatment services (direct costs) as well as “hidden” costs such as unemployment, underemployment, loss of productivity in the workplace, and costs incurred in the criminal justice system through higher rates of criminal behavior.

The diagnosis of ADHD, and its medication treatments, has not been without controversy—some say that ADHD doesn’t exist at all, that the symptoms can be better explained by other syndromes. Others maintain that ADHD exists, but it is overdiagnosed due to cursory assessments and failure to adequately distinguish it from other syndromes. There is also controversy about the medications used to treat ADHD—children are commonly treated with central nervous system stimulants, like Ritalin, that work on the neurotransmitter dopamine and carry potential for abuse.

What is your view of the ADHD explosion—is it “an epidemic of ADHD misdiagnosis” as recently characterized by neurologist Richard Saul (2014) (cited in the review, para. 7)? Is it a valid disorder? Is there need for concern about the safety and long-term impact of the stimulant medications used for treatment?

Read the Review
ReviewThe Economics of Inattention
By Robert Furey and Colleen Furey
      PsycCRITIQUES, 2014 Vol 59(40)

Comments

Andrew Stock

I worked with a child last year who could have easily have met the criteria for ADHD, but while I was sure there was something more going on with his family, they would not pursue family therapy. This year, his parents have separated, and his behaviour has changed dramatically. It seems fairly clear that he was shouldering the burden of an often toxic home environment, which was affecting his behavior and attention span at school.

If I had diagnosed him with ADHD, according to DSM-5, he would have a neurodevelopmental disorder - something must be fundamentally wrong with his brain. To me, this situation highlights the problem with diagnosing children based on these types of behavior, which is always the result of a large array of factors, with several of the most prominent ones located outside of the child.

This idea is backed by the finding that the only well-established psychosocial treatments (measured with "gold-standard" evaluations) for children diagnosed with ADHD are behavioral parent training and behavior modification in the classroom (Ollendick & King, 2004). In other words, these behaviors are most reliably alleviated by addressing the child's environment.

The lack of evidence of the long-term effectiveness of drugs for treating children diagnosed with ADHD further necessitates that we stop focusing on fixing these children and their "disorder". Alan Sroufe (2012), professor emeritus of psychology at the University of Minnesota, noted that:

“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of times, they neither improve school achievement nor reduce behavior problems . . . to date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships, or behavior problems, the very things we would want most to improve . . . The drugs can also have serious side effects, including stunting growth.”

Hyperactivity and inattention are real patterns of behavior that can make life hard for kids, especially in many of today's education systems. The problem with the construct of ADHD is how quickly and uncritically it has been reified into both a causal agent and a biological disorder, two unfounded yet pervasive understandings that I see creep into school and family environments on a regular basis.

References

Ollendick, T. H., & King, N. J. (2004). Empirically supported treatments for children and adolescents: Advances toward evidence-based practice. In P. M. Barrett & T. H. Ollendick (Eds.), Handbook of Interventions that Work with Children and Adolescents: Prevention and Treatment (pp. 3-25). New York, NY: Wiley.

Sroufe, A. (2012, January 28). Ritalin Gone Wrong. The New York Times. Retrieved from http://www.nytimes.com

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Editor of PsycCRITIQUES

Danny Wedding, PhD

Chair of Behavioral Sciences,
College of Medicine,
American University of Antigua

Associate Editors of PsycCRITIQUES

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