Responding to Ignorance
I recently got an email that challenged the increased diagnosis of ADHD over the last two decades. It seemed to suggest that ADHD doesn't really exist or that it wouldn't be a problem if we would just, I don't know, transform our culture – you know, fix our schools, eliminate technology, that kind of thing. And it suggested that ADHD is over-diagnosed. I always get angry when people say things like that and generally don't bother responding, but this was from someone I generally respect. So I wrote back. This is what I wrote:
On the one hand, I agree. It would be wonderful if the world slowed down a bit to give us all a chance to catch our breath. It would be magical if children received more outdoor education, frequent breaks, and healthy food in schools - and if class sizes were significantly smaller, so many more children would be able to thrive.
But a blanket denial of ADHD - a complicated neurobiological disorder - is unfair to the families suffering and needing help and support. It disregards the very real challenges they face.
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If You Only Knew
Any parent who has suffered through a child taking two hours to complete 10 minutes of homework; struggled with a child's inability to sit for even two minutes at the family dinner table, despite a deep desire to do so; or has a child who is just unable to manage their emotions or impulsivity healthily, no matter how hard they try … that parent knows that ADHD is, in fact, very real. It can be painful, stressful, and devastating if it's not managed correctly.
As a parent of three children with ADHD, and an adult diagnosis for my husband and myself, I understand all too well the serious implications of what happens when ADHD goes undiagnosed, untreated, and unmanaged. It nearly destroyed my family and my marriage.
So...Is ADHD over-diagnosed? ADHD is appropriately diagnosed when an individual's challenges significantly interfere with more than one aspect of their life. It is not a character trait or a tendency. Instead, it is marked by an individual's inability to produce desired results, despite the intention (and sometimes the effort) to do so. As ADDers, we know what we're "supposed" to do, but we can't quite figure out how to get it done. From our perspective, it can be absolutely maddening.
Yes, there could be some cases where ADHD is incorrectly diagnosed (although, in all likelihood, there is as much of a problem with underdiagnosis, particularly in low-income communities). But paying too much attention to that problem without understanding what's really happening in the lives and brains of people with significant ADHD dismisses the serious challenges those families face. Those challenges and the dire results that come from NOT identifying and managing the challenges can be devastating to families and society.
As the co-founder of ImpactParents, a global support resource for parents of complex kids, I focus exclusively on helping parents learn how to manage those complexities, including ADHD – by activating the brain, parenting positively, shifting expectations, and using systems and structures. Specifically, we identify "activating the brain" as any measure parents might use to understand and address what is happening in their child's brain. Since ADHD is a neurobiological condition, some steps can improve the efficiency or effectiveness of the brain, such as exercise, nutrition, medication, brain training, sleep hygiene, or other options. I do not want to prescribe to parents the choices they make for their children. I do want parents to be aware of the importance of engaging the brain in effectively managing the impact of ADHD. Medication is one such option, and there are several others.
The good news is that people with ADHD can be creative, brilliant, and incredibly successful. But for these children to grow up to reach their full potential, they must learn to manage themselves. To do that, their parents must learn to understand what they are dealing with and help their children learn to manage themselves. Denial of their children's challenges does not serve anyone.
Yes, It's Complicated
Whether ADHD is over-diagnosed or underdiagnosed is a highly complex dilemma. Solutions for improving diagnosis and treatment require a comprehensive, collaborative approach that starts with acceptance and understanding.
- Rather than criticize parents for giving medication to their children, understand the challenges they face and the tough decisions they have to make.
- Support parents in taking a comprehensive approach to treatment and management of inattention, impulsivity, emotional intensity, hyperactivity, and chronic disorganization – without judgment.
- Most of all, show some compassion. The only thing worse than struggling with ADHD is having some stranger tell you there's nothing wrong with you in the first place, that you just need to "try harder."
Children do not want to struggle, to feel "stupid" and "bad." Parents do not want to feel guilty about making complex medical decisions for their children. Understanding and awareness are the keys to the successful management of ADHD. It starts by getting out of the muddy river of denial.