Attention Deficit Hyperactivity Disorder, to use its full title, refers to a condition in which a child (or adult) displays excessive inattentiveness, hyperactivity and impulsivity. These symptoms can occur in varying combinations, giving us three subtypes of the condition, namely the inattentive, the combined, and the hyperactive-impulsive subtypes. Studies suggest a worldwide prevalence of around six percent of school-going children. It seems to affect boys more than girls. We refer to the condition as ADHD, whether or not there is hyperactivity present. The term ‘ADD’ doesn’t actually exist officially, although colloquially, it is often used to refer to children with the inattentive subtype of the condition.
But there is far more to it than that. There is ongoing controversy about the condition and its treatment, and scarcely a week goes by without a radio programme or television documentary stirring up further debate. In the following posts, I will be looking at key questions which seem to fuel the hype around ADHD.
Is it real?
Before we go any further, we have to deal with the claim that ADHD is not even a real entity, that it is nothing more than the invention of greedy pharmaceutical companies, who require a ‘disorder’ to justify the use of their drugs. Even within the medical profession, this claim is not without advocates. The term used by such critics is reification, which simply means artificially making an entity out of something which is not actually a real entity. In answering this claim, let us consider the wider field of medicine. On what grounds do we consider diabetes, asthma or hypertension to be genuine medical conditions?
Firstly, these disorders all have a recognisable, discrete cluster of symptoms and signs which occur with relative consistency from case to case. In diabetes, for example, excessive thirst and passing lots of urine are characteristic symptoms. Similarly, the symptoms of distractibility, short concentration span, procrastination, absentmindedness and poor impulse control are hallmark features of ADHD.
Secondly, the symptoms of medical conditions cause impairment to the individual concerned. In asthma, shortness of breath can affect exercise tolerance and sleep quality, and can even be life-threatening in severe cases. In ADHD, academic underachievement, social difficulties and low self-esteem are typical consequences.
Thirdly, medical disorders have biological underpinnings which can be consistently observed from case to case. In hypertension we find raised blood pressure readings, and under the microscope there are characteristic changes in blood vessels and other organs. In ADHD, there are specific genes which have been implicated in the transmission of the disorder from parent to child. Brain changes have also been reliably demonstrated. Not only are brain volumes smaller in those with the condition, but there seems to be a direct correlation between the number of ADHD symptoms and the thinness of the brain’s cortex (the outer layer of brain cells).
If you throw out ADHD, then you must throw out asthma, hypertension, diabetes and a slew of other accepted medical conditions…which is fine if you want to live on that planet. But for everyone else, let’s move on next week to the history of ADHD…