ADHD: Disorder or Difference?

The word “disorder” conjures up images of illness, disease and serious disabilities.  All parents want to see their child as the smartest, most capable and best liked boy or girl on the block.  So why would they want to have a label attached to them that often coveys just the opposite–such as slow learner, under-achiever or Attention Deficit Hyperactivity Disorder?

What a difference one word can make.  Suppose we changed the last D in ADHD from “disorder” to “difference.”  We could then say that a child with ADHD has some significant differences in his cognitive ability, emotional sensitivity and activity level when compared to other children.  This difference is probably inherited.  His “skill set” is different from 95% of the children in his class.

Unfortunately, the environment in which he spends most of his time is geared toward the other 95%.  However, we then could look at helping him to adapt successfully to this environment, using his own set of strengths rather than helping him to  with this environment due to his weaknesses.  We then might say that this child may need psychostimulants and/or psychological intervention to enable him to concentrate on boring tasks and control spontaneity in a highly regimented environment.

The above in some ways reflects the ongoing debate about whether ADHD is a valid mental health condition that requires appropriate medical and psychological intervention OR that ADHD is a mythical disease state, manufactured by the medical community in order to make huge profits and is promoted by educational bureaucrats and abusive parents desiring to tranquilize unruly kids. I believe that, as a society, we have created a monster with ADHD. We perceive it as a diagnosis that will forever change or even taint the course of our child’s life. And we are no longer surprised by the number of school-age children who are now diagnosed with ADHD. In fact, we have come to regard it as a norm, and it has fueled our perception that medicating our children can solve all their problems—and ours.

The facts, as in most debates, point to the truth being somewhere in the middle of these perceptions.  ADHD is a condition worthy of future study to provide answers to scientific questions that will result in more accurate diagnosis and more effective methods of treatment. In the meantime, ADHD left untreated leads to a higher likelihood of depression, suicide and substance abuse later in life.  ADHD appropriately treated leads to a higher likelihood of success in life because it can help the child properly channel his increased sensitivity, creativity and high energy.

On a more personal level, as a parent of a son who was diagnosed with ADHD at the age of five, I can identify with parents who may lean toward either the denial or victim mentality.  When my wife and I were concerned about our son’s behavior and emotional well-being, the last thing I thought of was that he had ADHD.  Sometimes, I was probably a bit on the overprotective side.  But on the whole, once our whole family accepted that he was a child with an attention deficit hyperactivity difference who needed medication, along with psychological support (provided by us at home), the situation turned around completely.  He responded well to the medication, and the crisis of emotional turmoil was over.  Over the years, we continued to provide consistent structure (as best we could) and encouragement as well as teaching him how to relax, learn necessary social skills and how to “stop and think.”  It all paid off.  He has been off medication since middle school.  He graduated with honors from a highly regarded university and is now pursuing a successful career in TV and film.  He has a great sense of humor and lots of friends.

I encourage parents not be afraid of the diagnosis, give it undue weight and importance or use the label as a crutch for your child. Instead, I believe we need to accept it as the first step in turning a difficult situation around to a positive direction.  Helping a child with ADHD succeed requires a team approach that often needs to continue over many years.  That team includes the family, health professionals, teachers and, of course, the child.  Children may need medication, but treatment guidelines indicate that psychological interventions are also important.  In some cases, psychological interventions may be sufficient to bring about desired results. In other cases, they address symptoms medication alone does not help and may also actually reduce the dosage of medication necessary to achieve desired results.

Effective psychological interventions include parent education, behavior modification, home-school contracts, cognitive behavioral therapy, social skills training, relaxation training and mental exercises to improve cognitive functioning.   Recent research indicates that many or all of these interventions may be most effective when implemented at home with the parents and the child working as a team.  Not only does this approach appear to improve the short-term effectiveness of the interventions, it also results in positive parenting techniques and an open and supportive parent/child relationship that becomes a way of life that is consistent and enduring over time.

So, ADHD can be perceived as a label to be dreaded, used as an excuse to avoid difficult situations or it can be perceived as the identification of the problem underlying a child’s difficulties at home and at school which can be successfully addressed.  On the one hand, it is a curse. On the other, it is an opportunity to make things better. The basic tenet of cognitive behavioral therapy is that how we think determines how we feel, which then determines how we behave.  If we want to change how we feel and how we behave as the result of those feelings, we need to change how we think.   ADHD: Think of it as an opportunity.

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