Is The Solution To ADHD To Stop Treating It Like A Disease?

A few months ago a great meme came through my Facebook news feed. In several graphic frames, it showed people with serious physical injuries being treated ther same way as people with serious mental health problems. Characters asked the injured: "have you tried not having a broken arm?" They told people with bleeding wounds to "just snap out of it." I thought it was a great satire on how we disbelieve that mental illness is real. It's especially hard when the mental condition causes behaviors that make trouble for carers and loved ones.

Amongst children, we could look to ADHD for a disease that fits that bill. 

ADHD, or Attention Deficit Hyperactivity Disorder, is a mental condition that causes restlessness and fidgeting. And if that were all, we'd hear a lot less about it. In fact, it blows big holes in a person's ability to concentrate, leaving them easily bored or distracted in a way that's not related to motivation or emotion: a kid with ADHD can know the answers, want to do well and flunk the test anyway. 

Can't They Just Snap Out Of It?

Just like a person with depression or addiction can't just pull themselves together, people with ADHD can't just not have it.

In the US, the Diagniostic definition and the treatment guidelines for ADHD come from the DSM, the Diagnostic and Statistical Manual of Mental Disorders. The DSM states that ADHD is a biological problem: if you have ADHD, there's something wrong with your brain. It locates the problem physically inside of you, and the preferred treatment is drug therapy like Ritalin. Ritalin is a central nervous system stimulant that's designed to ramp up dopamine activity in the prefrontal cortex, the physical location of the planning and executive function activities in the human brain. If you have ADHD, you have low dopaminic activity, so you take Ritalin and you should now be fine. 

That Doesn't Appear To Be Working

For one thing there's a thriving kid-level black market in Ritalin. For another, Ritalin itself comes with a whole host of problems including increased risk of future drug dependency (the manufacturer calls Ritalin a drug of dependency). 

Shocking? 

Here's what else Ritalin and Adderall manufacturers say about their products: They can cause sudden death in children with undiagnosed cardiac conditions, they can cause facial tics, weight loss and sleeping troubles, they can trigger hallucinations and psychotic or manic episodes, they can cause the development of new bipolar conditions in children who never previously had them, half of all children prescribed these drugs develop symptoms of obsessive-compulsive disorder within the first year of use, and they can cause thoughts of self-harm or suicide. 

READ Why French Kids Don't Develop ADHD

And the worst of all? Twenty percent of American boys are prescribed these drugs.

Everyone knows ADHD doesn't have a "cure" and people with the condition can't just snap out of it. 

What If We're Treating The Solution And Making The Problem Worse?

The standard view of ADHD doesn't go unchallenged. Not every psychologist believes ADHD is a biological effect that's located in a child's brain.

One such dissenting voice is that of Marilyn Wedge, PhD, author of A Disease Called Childhood: How ADHD Became An American Epidemic. In an article for Psychology Today earlier this year, Dr Wedge raised the question: Why don't French kids have a similar ADHD rate to American kids?

After all, both are highly industrialized, adavanced societies with similar economies and similar lifestyles. Sure, American kids eat more junk food (and yes, there are people who think junk food causes ADHD and they could well have a point) but otherwise, Jack and Jaques are living pretty similar lives. 

In very different cultures.

The French medical establishment doesn't use the DSM. It uses the French equivalent, the CFTMEA, or Classification Francais de Troubles Mentaux de L'Enfant et L'Adolescent. Where the DSM lists ADHD as a biologically-caused condition, the CFTMEA says the roots are in the child's unhappiness and the recommended treatment is a combination of psychotherapy and family counselling. 

The result? Fewer children with ADHD. Exactly what the difference is is open to question: Dr Wedge uses her article to suggest that ADHD is largely an American probelm, while studies show that "the epidemiology of ADHD in French children is similar" to that seen in other countries. (Source: Journal of Attention Disorders.) The rate of incidence was found to be about the same, in that study. Other sources claim to have found a bigger difference. 

The key stat for us, though, is this one: In France, 0.5 percent of kids are diagnosed and medicated for ADHD. (Source: Care2.com.)

As well as drugging fewer children, the French use a tighter set of diagnostic criteria, so they catch fewer cases that are on the borderline of the definition. The opposite approach in the US has led to a phenomenon journalist Ryan D'Agostino called "the drugging of the American boy." (Source: Esquire magazine.)

And the worst thing about the way we treat ADHD is that we treat what we can see. And the fidgeting, messing around, refusal to sit still and other aspects of the condition that catch doctors', teachers', and parents' eyes (and are part of the reason boys are diagnosed with ADHD three times as often) might not be symptoms of the condition. They might be coping strategies.

A small study of teens and preteens recently showed that children with ADHD were more likely to succeed at cognitive tasks if they were allowed to fidget. (Source: New Scientist)

In other words, the "excess" physical activity seen in kids with ADHD might not be a result of reduced brain function; it might be a coping mechanism, one that should be encouraged.

Even more importantly, it's the vigor of the movements themselves, rather than their frequency, that seems to be positively corellated with improved test scores. Maybe that goes some way toward explaining the higher incidence of ADHD in boys? After all, boys are socially permitted to make vigorous movements and the form of ADHD most commonly diagnosed in boys involves this fiudgeting and twitching. The form most commonly diagnosed in girls involves physical lethargy — and worse cognitive impairment.

READ How Can You Tell If An Adult Has ADHD?

It beats Ritalin.