Mythology 101


ADHD MYTHOLOGY

 

This is another new section I am adding to our A.D.D. Clinic website.  This paper is being written in mid-July, 2011, and discusses many, or maybe even most, of the “myths” about ADHD.  This common, brain / neurobiological condition may be the least understood troubling condition in our field. 

 

FREQUENCY

 

When I say “common,” I am referring to recent studies in modern nations where research about the “epidemiology” (frequency in the general population) has been thorough and repeated many times with the same results.  Worldwide, about 7-9% of all boys have ADHD, and about 5% of all girls have ADHD.  This condition usually remains problematic all through adult life; it does not magically “go away” at puberty or at full physical / mental maturity.  At least 5-7% of all adult men worldwide have ADHD, and at least 3-5% of mature women also have ADHD.

 

CHANGES OVER THE LIFE CYCLE

 

Very young children, ages 2 – 6, typically have primarily the “Hyperactive” form of ADHD.  They are not required to pay and sustain attention for very long when they are this young.  I was one of the exceptions, since I entered Kindergarten (Kdg) at age 4.  I presume I was driving my mother “up the wall” and she was eager to get rid of me for about 4 hours every day.  She insisted she enrolled me in Kdg early since I was reading 2nd and 3rd grade – level kids' books from age 3 on.  Since no one in middle class America had TVs or video games in 1943, and the radio had almost all war news, there was very little else to do except chase my little brother around the house and scream and yell.

 

I am quite sure most very young children entering Kdg a bit early are now as intimidated and frozen scared as I was then, surrounded by older children in a one-room old schoolhouse attended by kids grades Kdg – 6. I tried to keep quiet and do my work as best I could, but my hand refused to transcribe onto paper ideas coming from my brain, so I was always punished for “poor penmanship.”  Now I know this is very common for boys who have ADHD.  Girls, even at 4, are almost always more fully developed in motor skills like writing compared to boys.  Most boys who have ADHD cannot write truly “properly” legibly until they are 8 – 10 years old.  When I was growing up, illegible writing was considered disrespectful to the teacher, and “paddling” (being publicly spanked whilst lying on the teacher's desk) was the universally accepted remedy.

 

Paddling didn't help me write more properly, and all manner of punishments used over the past century to try to make boys who have ADHD write better have consistently failed.

I am rambling through this narrative to try to make two points:  1) Many children who have perfectly standard ADHD do not exhibit hyperactivity in every setting;  2) Some children who have ADHD and are also very advanced in academics compared with same-age peers do not exhibit any significant symptoms of ADHD in school until they are challenged to or beyond the maximum of their innate abilities and actually have to truly “study” and organize and complete complex written assignments.

 

Many of you are fully aware our current Diagnostic Manuals state “Symptoms of this condition are causing impairment in at least two settings by or before age 7.”  All serious authorities in our field now know this is not true, and I believe this erroneous comment will be eliminated in our future (2013, maybe 2014) manuals.  Most girls have only the Inattentive Form of this condition, and their problems are not detected until Middle School or High School, or in very bright girls, college.  Some boys have a similar story, although most boys who have ADHD manifest problems with overactivity in some settings...but not always in school.

 

Problematic overactivity and impulsivity usually improve and may no longer be evident at all by mid-puberty.  This is where the myth ADHD “goes away” by or after puberty came from.  However, by these ages (roughly 12-15) the  attention and organization – related facets of ADHD become more troublesome.  The basic neurobiology of ADHD is “hard-wired” into our brains, and these two (and other) difficulties typically get worse as the adolescent grows and turns into an adult. 

 

WHAT CAUSES ADHD?

 

Parental DNA in genes are almost always the primary cause.  Old sayings like “The apple doesn't fall far from the tree” and “Like father, like son” are quite true in most cases.  It is uncommon for me to diagnose a child as having ADHD without noticing the same condition affecting one or both parents, one or more grandparents, aunts, uncles, and cousins, etc.  This is a classically familial condition, although the family environment exerts some influence over the nature and severity of the symptoms.  Very disorganized and stressed families tend to make many  standard ADHD problems worse, while very well organized and highly functioning families usually have the impact of reducing the severity of the symptoms.  *** There are frequent exceptions to these overall observations. 

 

A classical myth about ADHD is the notion maternal smoking and/or substance abuse “causes” this condition.  That may be true in some cases.  However, young women who grow up and become pregnant,  but then continue to use nicotine or street drugs, very commonly themselves have a history suggesting they carry the genes for ADHD, so we often cannot be sure a child's symptoms are attributable to an adverse effect of even nasty street substances like methamphetamine.

 

Further, bear in mind every child also carries his/her father's DNA, so another factor may be the child is behaving just like his father did at that age.  Many grandparents notice this pattern early in the infant's development.  So this remains, for many children and families, a dilemma we can't solve with current scientific techniques.

 

In some of the most problematic cases the mother is not really sure who the father is, having had multiple sexual encounters prior to noticing she is pregnant.  DNA  testing in as many as 30% of contested child custody cases have led to the - SURPRISE ! - discovery another man was the the child's biological father. 

 

MYTHICAL CAUSES OF ADHD

 

    There is no known style or form of parenting which can generate ADHD in an innately normal infant or child.  Some folks, especially older generation European professors of Pediatrics and Psychiatry have clung to that antiquated notion despite thousands of professional papers documenting genetic etiology published worldwide.

 

     There are no “toxic substances” in our environment known to cause ADHD except lead.  This dates back to an earlier era when tenement houses and apartments in older cities used lead-based paint and a few children licked or ate the chipped off pieces of dry paint.  In the 60s and early 70s we usually checked lead levels in children who appeared to have ADHD.

 

    There are no strange substances in modern diets able to cause ADHD.  Sugar, preservatives, and coloring agents have been repeatedly studied over the past 50 years and consistently found to be innocent.

 

      Boredom at school presumably due to not being challenged with interesting work may make some children occasionally restless and inattentive for a while, but boredom does not cause ADHD. Actually, kids who have ADHD typically become very bored very quickly due to their short attention span and distaste for some tasks.  Give them a new video game or a new set of Legos and even the most impaired ADHD kids can stay focused for a long time, but that is because they have something new and different which interests them.


      So I am suggesting here, in a sense, we should change the name of this condition to Attention Inconsistency Disorders:  AIDS.  For some strange reason many people reject this name.  Almost all children, even those who have relatively severe ADHD, can sit and play very interesting new games for a long, long time...so long as they get to choose what to play or do. 

 

Some people believe our fast-moving, high-pressure, modern type  of society generates ADHD.  There is no scientific evidence there is any basis for these ideas.  ADHD has been diagnosed at about the same frequency in every kind of society or culture.  In fact, most children and adults who have ADHD thrive on fast-paced multi-tasking activities when they have control of what to do.  “Assignments” by anyone else generates resistance and failure to complete the task(s).