Many people these days are questioning whether or not Attention-deficit Hyperactivity Disorder (ADHD) is real. Some say that there is no disorder, rather it is young parents who do not know how to control children. Others say society has gotten soft and allowed children to run wild. Doctors, educators, and advocates have debated on the validity of the disorder for decades now. Who is right? Let’s take a closer look at the history, diagnostic criteria and signs of the disorder to see if ADHD is real or imagined.
Early history of ADHD can be traced back to the 1700s. A German doctor by the name of Weikard described similar ADHD symptoms in the 1770s (e.g., inattention, distractibility, overactive, impulsive). Signs and symptoms would continue to show up in writings and case notes of physicians through the centuries.
George Still would become a prominent figure of ADHD research and description in the early 1900s. His theory was one of deficits or defects in moral control. This theory of the cause of ADHD symptoms would later change to brain damage, and then to what was called “minimal brain dysfunction.”
By the the 1960s, the theory of minimal brain dysfunction was being abandoned for hyperactivity. However, it was still viewed as a brain dysfunction. Minimal brain dysfunction saw a resurgence in the 1970s with Wender’s theory. Douglass’s model of inattention and impulse control also emerged in the 1970s. Medication and behavior modification therapies also emerged, along with changes in law (PL 93-112 and PL 94-142).
The 1980s saw the creation of DSM-III and the creation of ADD. Subtypes were also created, with ADHD being created later in the decade. Assessments, theories and etiologies (e.g., environmental to social-ecological impact), and treatments continued to be developed and refined. Medication became increasingly more prevalent, leading many to worry over prescriptions and its affects on children.
We saw neuroimaging and genetic research emerge in the 1990s. We also saw more improvements in diagnostic materials, including diagnosing adult ADHD. Today, we continue to see improvements in diagnosis, treatments (other than medication and behavior modification), and in advocacy. There are now hundreds of studies to show what ADHD is, how it affects children and adults in various settings, and effective modes of in managing the disorder (which is now universally recognized). There is no longer one prevailing view on how to manage ADHD, and advocates are in abundance to teach about symptoms.
Diagnostic Material and Signs
I won’t list out the diagnostic criteria in this post. Instead, visit CDC.gov for diagnostic information and a printable checklist (it’s alright, I can wait; this post will still be here when you’re done).
The first thing you may notice is that there needs to be six (6) checked boxes in either inattention or hyperactivity for a diagnosis. Some of the items listed are quite vague and may be confusing or inaccurate for some with the disorder (I suspect we will see more precise language in latter additions of DSM). Contrary to some opinions out there (see more here), it is not a quick and easy five item list can be checked off in matter of seconds.
The second thing you will notice is that these checklist items must be present for at least six months, and have to be independent of any other medical condition with inattention and/or hyperactivity symptoms (e.g., anxiety disorder, mood disorder, hearing difficulties, sleep disorder). The symptoms must also be present in more than one setting (usually at home, work, and/or school). Therefore, unless you observe a person in more than one setting, you cannot say that the person has or does have ADHD.
ADHD has other signs of which many people–professionals included–may not be aware. Handwriting may be poor, social skills may need improvement and writing samples may show a lack of cohesive thought, order or detail. Impulse control–whether it be through word or deed–can also be signs of ADHD. If ADHD symptoms need to be observed in more than one setting, than the symptoms will affect more than one area of a person’s life (i.e., not just school work).
Not everyone with ADHD will have hyperactivity symptoms. It is possible to have the disorder without running around a room like a chicken without a head. Sometimes, the quiet kid in the class can have the disorder instead of the trouble maker.
Does ADHD Exist?
Yes, it does (sorry doubters). Many who dismiss the disorder do so because they think this is a new disability created by drug companies to get kids hooked on prescription drugs. While an argument can be made for over-medicating those with ADHD instead of trying other treatments, ADHD is clearly evident in research journals and medical case studies long before our current generation of children, and long before medications such as Ritalin.
Many others doubt the reality of ADHD due to publications of professionals claiming that the disorder does not exist. Even I fell for the propaganda at one time. However, when you look past the smoke screen of these authors, you will see that they may have a point of doctors rushing the process of diagnosis, or incorrect medication prescriptions, but the points against the existence of the disorder have no merit.
The more I have learned about ADHD, the more I wonder if I have it. Do I? Stay tuned for Part 2, where I go through the checklist for myself and discuss treatment strategies.