It should be noted that debate over ADHD within the research and medical communities has been mild and mostly concerned with nuances in the diagnosis and treatment paradigms. It is thus most important to separate legitimate concerns raised by scientific papers from abstract, distorted, or mendacious information from other sources. The exact etiology of ADHD is unknown, although neurotransmitter deficits, genetics, and perinatal complications have been implicated.
The dopamine hypothesis has thus driven much of the recent research into the causes of ADHD. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity over-activity. Roughly scientists from the international community created the consensus statement as a reference on the status of the scientific findings concerning this disorder.
All of the major medical associations and government health agencies recognize ADHD as a genuine disorder because the scientific evidence indicating it is so overwhelming. Advocates of the ADHD story usually emphasize the gravity of the disorder by pointing out that there are thousands of studies indicating that ADHD is a brain-based disorder, probably of genetic origin.
This finding has huge implications for many of the other brain studies that have been done over the past twenty years especially those which have discovered problems in the executive functioning areas of the brain that govern planning, organization, inhibition, and goal-setting.
In kids diagnosed with ADHD, these areas of the brain in the prefrontal cortex behind the forehead are developmentally delayed and thus are apt to be less functional than so-called normal children. Another issue related to brain studies is that these brain differences can be due to environmental effects such as early childhood trauma, adversity in the family, and even growing up in poverty in fact several studies have suggested just that.
In one study, a gene-environment interaction was noted where a child with a specific genetic mutation would develop behavior disorders under conditions of parental criticism. That means if the child is in a family where the parents are supportive and helpful, this particular gene will not be expressed and the behaviors will not manifest themselves.
The raises the following question in my mind: if a child is both depressed and ADHD, where does the one disorder stop and the other one start? These are the same regions that are regarded as dysfunctional in ADHD. The big question is: are they dysfunctional because of a medical disorder called ADHD, or because the brain is bombarded with seven-and-a-half hours of daily media stimulation? ADHD symptoms have arisen in our culture due to the decline in the amount of time children spend playing outdoors in free unstructured settings.
Neuroscientists have seen direct links between frontal lobe damage in laboratory mice and an inability to play. Play stimulates the production of important brain chemicals and even assists in the building of new brain connections.
Some thinkers believe that the frontal lobes themselves evolved over time due to playful behaviors and that playful behavior is an important factor driving human evolution. Yet our children have been playing less and less over the past thirty years.
During this same time span, kindergartens have become increasingly academic with less time devoted to play-based activities. Recent research has indicates that when children diagnosed with ADHD play in outdoor settings , their symptoms decrease, and the wilder the environment, the more the symptoms go down.
During the hunting and gathering era of prehistoric times, there were advantages to being able to move constantly in a nomadic tribe hyperactivity , being able to pay attention to any sudden stimulus distractibility , and being able to respond quickly with immediate action in response to that stimulus impulsivity.
Thus, the three main signals of ADHD were advantageous in hunting and gathering cultures. One factor that unites many kids identified as having ADHD is that they absolutely have a hard time with boredom. But is it a medical disorder to be intolerant of being bored? Our greatest creative artists have traits that are virtually identical with the warning signs of ADHD , only we use more positive words to describe them: spontaneous instead of impulsive, divergent rather than distractible, vital rather than hyperactive.
Research studies have indicated that individuals diagnosed with ADHD score higher on creativity tests and also in brain scan studies respond more intensely to novel experiences. Our culture needs creative people to fuel new discoveries and innovations. But if we regard creativity as a medical disorder and medicate it , then what does this portend to the continued development of a vital civilization?
S ome kids diagnosed with ADHD are simply responding normally to what are in fact adverse living conditions in the home. Research studies have linked greater levels of adversity in the home with an increased risk of being diagnosed with ADHD and medicated. But is it ADHD or is it instead depression, anxiety, or another emotional disorder that needs to be recognized and treated?
Rather than regarding certain individuals as mentally disordered, we are increasingly seeing them as reflections of human diversity. Just as we honor and celebrate biodiversity and cultural diversity, so too should we validate diversity in brains.
We should do the same with kids displaying symptoms associated with ADHD. Research is increasingly revealing that the so-called disorder of ADHD has distinct strengths associated with it as well as challenges including creativity and novelty-seeking. Rather than counseling kids to accept their disorder, we should be helping them learn strategic ways of maximizing their strengths and minimizing their difficulties. Many of the symptoms regarded as part of the ADHD diagnosis are in fact healthy behaviors which simply need a proper channel in order to be constructive.
The DSM-5 criteria used to diagnose ADHD are too highly subjective and general to be used in identifying something as serious as a medical disorder. I mentioned fidgeting above. The key word here is interest. When is the last time you put considerable mental effort into a lecture you found boring or irrelevant?
Bruce E. Levine, a clinical psychologist, points out that the people who create psychiatric categories such as ADHD have had to go through years and years of training, wherein they were required to be compliant toward supervisors, professors, trainers, and other authorities.
Thus, they approach life from the standpoint that compliance is a good and necessary attitude to have toward life since it worked for them. But non-compliance has its good sides as well.
The United States would have never become an independent country had it not been for a lot of non-compliant individuals we call them Founding Fathers. Advances in science would never have occurred if not for the non-compliance of scientists who refused to accept the status quo. The good of the child, in contrast, is something entirely different. Even in the unusual event in which the child is the one who wants to improve his ability to focus during the boring lessons — even then, he would need to train over a long time, with patience and consistency, without the use of artificial external substances, precisely like a soccer player.
Giving Ritalin in order to heal this fracture is equivalent to giving medication to suppress sexual desire to a homosexual adolescent in order to adapt him to the demands of the environment, as is the case in certain communities that think it is unnatural to be gay! This will perhaps work for a while, but, the moment we remove the bandage, we will return precisely to the original situation, if not to a worse one.
Soccer is played for 90 minutes and life itself for a bit longer. In order to facilitate a healthy, happy life for the child with the trait we call ADHD, it is not advisable to extinguish his curiosity and natural creativity and to try to get him to be like everyone else in the class. True, I too want my child to develop grit and determination, which will help him to get through the challenges of life, but will medicinal treatment develop the longed-for grit? As opposed to the case of adults who choose to consume Ritalin, the pressure exerted on children to take medication reflects a broken medical-social reality in which we violate the basic medical ethic: First, do no harm.
Part III. Change the language. Luckily, we have a precedent. In the s, homosexuality was removed from the DSM, and today there is no one in the psychiatric-medical establishment who sees in homosexuality a psychiatric disorder, and there is no physician who dares openly to prescribe a medication treatment within the problematic framework of conversion treatments.
Now comes the turn of ADHD, which also fails to meet the four Ds criteria, certainly when we keep a distance between the neurological phenomenon and the external demands of the educational system. The time has come to remove ADHD from the psychiatric diagnostic manual.
Very few parents give their child Ritalin during weekends or summer breaks. Only when the new school year begins does he become sick again. It is a seasonal illness. Change our educational perspective. The existing educational model is based primarily on linguistic-verbal intelligence and on logical-mathematical intelligence, while many ADHD children are blessed with other types of intelligences, such as naturalistic intelligence or bodily-kinesthetic intelligence.
Some of the diagnosed individuals, and especially those who were awarded the letter H, the honorary degree of hyperactivity, are also characterized by a personal charisma, entrepreneurship and creativity, and even leadership abilities.
A college professor is not superior to a garage manager, a startup entrepreneur or a riding instructor on a horse ranch. Except for psychiatric categories of clearly marginal populations whose members suffer from severe developmental disabilities or low-functioning autism, the educational starting assumption should be that children have variegated abilities and personality traits. One might be shy and mathematically talented, and another might have difficulties with verbal-based subjects but is energetic and a social leader.
Educational success, then, cannot be measured anymore according to the percentage of students who go on to study at Ivy League colleges. Along with the crucial need to reduce the number of children per class, we must find new ways to change educational programs into experiential activities, and to match them to the multiple types of intelligence and personality traits of children.
Stop being afraid.
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