Sick, injured or merely different? Rising ADHD cases fuel running battle among mental health experts
Those who can afford better care get a deeper probe. Sarkis spends at least an hour on initial diagnoses, in addition to the Conners exam that probes for underlying symptoms. But he knows most doctors don’t have that luxury. And he is well aware that false diagnoses often result.
It doesn’t help, Sarkis said, that the Centers for Disease Control Web page for ADHD flatly asserts that there is “no evidence” that ADHD can be caused by “eating too much sugar, watching too much television, parenting or social and environmental factors such as poverty or family chaos.”
While that statement may be technically true, Sarkis said, “The signals are all wrong.” The CDC website is aimed at parents and teachers who are looking for clues about how to interpret classroom misbehavior. Often these do have environmental or social causes, Sarkis says.
Real ADHD, in contrast, will be very evident very early in life, Sarkis says, and careful therapists spend a lot of time exploring early life. “I often ask how active the fetus was,” Sarkis said, noting that he sees a connection between prenatal hyperactivity and future ADHD. “More often than not I get a positive response,” he said. And both kids and adults with ADHD are extremely active in their sleep as well. “The sheets won’t stay on the bed,” he said.
But Sarkis watches closely for indicators of neglect, abuse or stress at home. He is particularly attuned to girls who were sexually abused. “When the brain is preoccupied trying to make sense of something like that, it can’t really concentrate on school work,” he said.
There is widespread agreement that casual ADHD diagnosis can alternately pathologize normal childhood and mask serious problems. The use of drugs in both cases has spawned a cultural meme, reflected in the lyrics of a recent song by British indie rock singer Paolo Nutini:
This kid’s too vibrant. (Give him some Ritalin.) Oh, he’s giggly. / He makes mischief. (Give him some Ritalin.) And he has to be told. / He can be disruptive. (Give him some Ritalin.) He can be antsy. / Oh, but let’s not forget, the kid’s only 5 years old.
The Centers for Disease Control offers a parallel rough list for parents who wonder about their child: “A child with ADHD might daydream a lot, forget or lose things a lot, squirm or fidget, talk too much, make careless mistakes or take unnecessary risks, have a hard time resisting temptation, have trouble taking turns, have difficulty getting along with others.”
This checklist, Greenberg notes, sounds suspiciously like anyone who ever attended grade school. He laments an economic decline that has destroyed skilled trades that used to be available to those who didn’t want to stare at books. His own teenage son would qualify as true ADHD, Greenberg said, and was “miserable” in the classroom before he switched to a technical school.
“The fact that these common traits turn up as criteria of a mental disorder says at least as much about the society that makes these demands, and the parents and teachers who fervently wish their children to meet them, as it says about the medical or pharmaceutical industry,” Greenberg said.
“There is no such thing as ADHD,” Greenberg said, again staking his outlier position. “Is it so important that everyone learn how to push paper as grown-ups? This is all about preparing children for the information society in a world full of electronic distractions.”
“I don’t disagree with all of that,” said Scott Kollins, now Conner’s successor as director of the ADHD program at Duke University. But unlike Greenberg, Kollins does view ADHD as a real condition that if undiagnosed can breed serious dysfunction, including anxiety and depression that lead to self-medication with drugs and alcohol.
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