After a variety of incarnations – Minimal Brain Damage – Attention Deficit Hyperactivity Disorder (ADHD) came on the radar in the 1970s in the US and exploded with its codification in DSM-III in 1980.
The general sense in most of the world in the 1980s – aside from a developing ADHD-mania in the US – was that it affected children, particularly boys, but that they grew out of it.
With growing acceptance of a role for stimulants, the marketing argument transformed the original clinical picture – all of a sudden left untreated those affected would go onto a life of crime, alcoholism, career failure, suicide, drug abuse and other nameless ills. There was a moral onus on doctors and others to pick the condition up and treat it with stimulants. And of course – its life long.
The stimulants by this point were controlled drugs. They had been restricted in the 1960s owing to growing evidence about their abuse and links to aggression and crime. But in pursuit of a disease entity and available on prescriptive only, suddenly drugs, which seemed dangerous enough to be made controlled drugs, started to be handed out to young children by the fist full.
On simple clinical grounds a case can be made for childhood ADHD. Most people looking at a very small number of young boys who are behaving like a bee in a jam jar would figure there’s something physical involved that a stimulant paradoxically seems to calm. But it was equally obvious some decades back that this is something that these boys grow out of. And it’s rare.
Beyond this there are a range of conditions that shade into disturbances of family situations. The difficulties a child is having may reflect disturbances in the home or perhaps issues at school. The images here come from a set – why every boy needs a mother.
It gets a lot trickier feeding stimulants into this kind of situation.
Operational criteria as in DSM-III are like a horoscope into which everyone can read what they want. They have become a vehicle for side-lining judgements, such as judgements that family dynamics might be important in a case. Now if someone figures they meet the criteria for a condition, they pretty well have as much right to claim they have whatever the condition is as anyone else has. People are no longer beholden to doctors or experts or even to common sense.
In the case of ADHD, it’s difficult to think of any other disorder in medicine which for instance changes sex in such a dramatic fashion during someone’s 20s. Up till the late teens there are or at least used to be four times more boys for every girl who met the criteria. In the twenties, its more common in women than men. This should be a pointer to the fact that there is more going on here than just little boys becoming big boys or girls coming in from the cold.
There are other diagnoses that could be brought into play that don’t feature in DSM III, IV or 5.
In Europe but not in the United States there was an appreciation of differences between extroverts and introverts. This is something that pretty well no-one in the US or linked to ADHD has any appreciation of.
Its not a matter of noise. Extraverts can be quiet and introverts chatty and noisy. The difference between them, Carl Gustav Jung thought when he coined the term, is that extraverts put their problems in front of others whereas introverts internalise them or try to solve them in their own head.
This means that introverts are more prone to obsessive and phobic problems – lying in their own bed at night scared about the ghosts that may be hiding beneath the bed. Extraverts are more likely to be hysterical. They will act out and have a stomach pain or something like that on the morning that they have to go into school for an exam.
Ask pretty well anyone who has siblings about the temperamental differences between the members of their family and you will pretty immediately in most cases get quick thumbnail sketches of extraversion and introversion.
These are not simply mental states. Using rating scales for personality, it’s possible to show that where you lie on an introversion-extraversion axis can predict how much anaesthetic it takes to put you to sleep. Extraverts need less, introverts need more. Extraverts become calmer on a stimulant, introverts become agitated. It applies to dogs and other animals as much as it does to humans.
In the US the mania for ADHD was complemented a decade later with a growing mania for paediatric bipolar disorder. There is pretty well no such thing as juvenile bipolar disorder – outside the US. But its difficult to stop a rolling bandwagon and apparently sober American physicians are pretty good at diagnosing juvenile bipolar disorder based on in utero activity.
Rather than ADHD or JBD being entities it’s at least as valid to see them as expressions of the fact that some of us are extraverted and others introverts. Some of us respond better to a stimulant others get more help from a sedative.
What has this got to do with adult ADHD?
When the ADHD concept began there was general recognition that children grow out of it. It clearly suited the interest of the pharmaceutical industry to spin the opposite story which is that actually there’s been an unrecognised adult ADHD all along. Many of us who have lost our jobs or ended up with broken marriages or other problems in life wouldn’t have had all these difficulties if our condition had been recognised and treated. Salvation fortunately had now arrived in the form of a stimulant or Lilly’s Strattera.
What’s not to like about this message?
Its unquestionably the case that extraverts and introverts are likely to remain so throughout an adult life, although we usually get better at hiding it. No-one has ever suggested its possible to switch from one personality style to another. It may well be that some extraverts will be helped by a stimulant from time to time in some situations, where others would not be. But calling these things entities – like Adult ADHD creates a dangerous dynamic.
It suggests that the condition should be treated rather than introducing the person to a recognition of their personality style and inviting them to consider at much greater length what this means – know thyself. That what they have is a particular set of attributes (as we all have) which may be wonderfully suited to particular occupational or other social niches and not to others.
Seduction can often be spotted a mile away as well as the likelihood of it succeeding or not. In this case it was clear it would succeed.
A decade ago we invited colleagues in North Wales to answer a few simple questions – did they think there was any such thing as adult ADHD ? And did they expect to think there was such a thing a few years up the road?
The answers are HERE but in brief they said no there’s no such thing and yes in a few years time we will figure there is such a thing.
Looking at it the other way round – working back from Adult ADHDers – a group in Dunedin New Zealand that have been long known to have excellent childhood development records found no evidence that those being diagnosed with Adult ADHD had anything remotely resembling Childhood ADHD.
The trick for adults with difficulties – who then seek an ADHD diagnosis or get one thrust upon them – will often be as it is for all of us a case of recognising who we are and what we can bring to situations and where we best fit in rather than medicating ourselves with a group of drugs that cause dependence – see It’s alright Ma and ADHD Nation – and psychosis and aggression – oh and Parkinson’s disease, dementia and other problems. Now why wasn’t I told about that?
More next week.
If only we took time to get to know ourselves, to accept other lay people’s perceptions of us, to consider the effects that we have on others around us and to be HAPPY WITH WHO WE ARE, then the ADHD label would disappear.
Why are teachers so happy to accept the ADHD label? It’s because, in the eyes of far too many teachers, it means that they can throw the responsibility of that group of pupils onto someone else – be it the additional needs section, educational psychologist or behaviour therapists. It is rare to hear teachers consider the fact that it may be THEIR DUTY to cater for the additional needs of these pupils. Are they the youngest children in the class who find that concentration at the level expected by the ‘one size fits all’ education system is beyond them? Are they exceptionally bright children who are bored with the menial tasks they are asked to perform? THESE are questions that all teachers should be asking before they look outside the classroom for further explanations. If you take an ADHD ( so labelled) child out of a classroom and get down to the nitty gritty of what makes them tick, you will often find that it’s the classroom atmosphere that creates the problem. Why do we medicate the child who does not conform to class rules if, actually, just adapting the rules slightly to INCLUDE their needs will improve matters for ALL WITHIN THAT CLASSROOM? ( This runs true for all specific learning difficulties, by the way, not just for ADHD). How comfortable are we in situations where we feel out of our depths – or where we feel that we know more than the speaker about a certain subject? Not very, I guess and it leads to us becoming fidgety and unproductive in many cases.
Some children take far longer to grasp ‘life skills’ than do their classmates but by including them as part of the whole and encouraging the rest of the class to accept that we learn from each other, at our own rate, the most problematic of ADHD-type behaviours can be brought under control – self control rather than dictated control! the reason why more boys seem to suffer from ADHD is because our education system suits girls better than boys. Let boys do maths, science etc. with a lego set and all signs of problems can disappear. We can learn so much better if we move about, touch/feel things etc. and yet we insist that pupils sit at tables from a very young age! Communication is far more relaxed under real-life conditions rather than a ‘topic’ given for discussion around a table.
Girls who are considered to have possible ADHD symptoms often are the ‘tomboys’ – in other words, girls who have suffered in our education system simply because their learning style is more in-tune with their masculine rather than feminine side. Give a child a label and allow them to behave without guidelines because ‘they’re ADHD’ and that child will languish in their drugged stupor. Expect the same high standard from an ‘ADHD child’, with constant reminders and examples of the expected good behaviour and you will find a child who will rise above their label.
I really cannot comment on Adult ADHD, except to say that anyone who finds that a label that sticks and works in their favour and does not require extra effort from themselves to conform, will be clung to throughout their life. We’d all take the easy way out given half a chance I guess- but surely not with medication!
Mary H – have you read any of psychiatrist Samini Timini’s work on ADHD? He has been campaigning for decades about the misuse of the label and of the massive increase of the use of drugs given especially to children. Although he doesn’t discount drugs altogether His theme is that ADHD is a cultural concept much as you describe.
Sami T gave a useful interview in 2015 in the Independant to W Sutcliffe
‘ADHD Being Different is not an Illness’.
There’s a whole host of arrivals of ADHD from Ant McPartlin to Stephen Fry, whose diagnosis of ADHD led to Bi-polar diagnosis, to Rory Bremner, who are quite vocal about it and seem quite pleased that they have it … an incredibly intelligent friend of mine, an English lecturer, received a phone call from her young lad’s school. We think your son has ADHD…
This kid is neither introvert nor extrovert. Having spent a lot of time with him, he is fantastically funny, he comes out with jokes about life, even Trump jokes, he has a sense of real adventure and will cross lochs, lose his wellies in the process and come back muddy and bruised, but, laughing.
He is a true wonder with computer games and his favourite are Dinosaurs, where you build huge parks and have Dinosaurs ‘sedated’ if you think that’s a good idea and you can have food underground and up pop goats…
He doesn’t have ADHD. He is ten years old and far more interesting and intelligent than his teachers are. His detailed explanation of why he was ‘sedating’ his dinosaurs and they were lying dormant was, a classy piece of diction..
Someone like Ant, needed a label. I think his ability to return to show biz would have been hampered if some psych had not decided that ADHD would be a suitable acronym in which Ant could now present himself, as the new me.
These people are high achievers with an ADHD label
Some have positions in the ADHD network
Rory Bremner on what it’s like to have ADHD
If it didn’t exist, you would have to invent it?
“Note the placing of the single low word in [Dwight] Macdonald’s brilliantly high-flown definition of the academic prose that had already begun to jam the college libraries:
The amount of verbal pomposity, elaboration of the obvious, repetition, trivia, low-grade statistics, tedious factification, drudging recapitulations of the half-comprehended, and generally inane and laborious junk that one encounters suggests that the thinkers of earlier ages had one decisive advantage over those of today: they could draw on very little research.
My brother was living a selfish, unfocused, irresponsible life…o.k. if you don”t have kids. He did.
He blamed our mom, not our world-class alcoholic father, who barely knew our names.
He ‘borrowed’ $25,000 for a business scheme, never paying them a dime.
After school & an RN degree in his mid 30’s, he enjoyed kudos for choosing such a responsible, caring, in-demand profession….& being a MAN-in a ‘female’ profession. So brave!
And then someone lobbed ADHD over the fence and he attached himself to it like a barnacle; excusing his past disinterest in parenting &, as he was a ‘medical professional, was clearly a valid, sympathetic diagnosis.
No…he simply continued his selfish behaviors as a nurse, bouncing from job to job, finally proclaiming his professional niche as a jail nurse & school nurse with 2 failed marriages & 2 bankruptcies.
He was sliding by, weighing 400 lbs., receiving ‘sympathy’ for terrible weight-caused issues, an absentee dad, fighting child support….with an excuse…of ADHD.
This sounds harsh, like unfinished sibling business, & lots of judgement….yes….AND he ‘forgave’ himself for his wive’s & little girl’s pain with ADHD.
I love the picture, above, of that young mischievous boy who has covered himself with women’s sanitary napkins.
He is just exploring and learning about the world around him by making better use of those napkins.
He is just being himself!
Who knows? He may be the next scientists who goes on to do bigger and better things.
Every child has the potential ~This I believe : )
If we are happy with ourselves, it really does not matter what others think of us!
Mary, hit the nail on the head, with this one!
Within the educational context, labels are a reflection of some peoples limitations in recognizing that individuals come in the full spectrum of personalities.
Each one of us, have unique characters and abilities which should be treated with dignity and respect.
This will be the catalyst for us to grow into human beings, capable of offering the world the most beautiful, artistic, creative and ingenious things, life can offer.
Sadly, some children, feel self conscious when they are unable to keep up with their peers, emotionally, intellectually or physically.
For instance, if you place a sports orientated child into an environment where they are made to feel ‘dumb’ or are told they are ‘dumb’, they will believe this!
If you put a high achiever into a sport where they lack co-ordination/skill, they will feel incapable and inadequate.
Like a finely tuned orchestra, every child has their own way of playing music.
Every person has their own gift and when in the right environment they excel.
Some children already know this and it is not their lack of spirit or lack of sheer determination that prevents them from getting there. It may be other external factors that limit.
Example include: poverty, access to resources, lack of encouragement and support and rigid systems.
Every child needs the opportunity and privilege to be who they were destined to be.
Below is an inspiring video of famous failures.
How many of these famous people had ADHD?
From my experience, labels can be a useful mechanism for people to make money, often playing on parents guilt if something is not done to address it.
Labels can be self fulfilling prophecies when people believe in them to be true.
Have just watched the latest video on Mad In America where you, David, were interviewed. Towards the end there is mention of ADHD – and the stories that you both tell, from the childhood of people that you know, illustrate EXACTLY the point that I was (very clumsily) trying to get across in my comment yesterday. Brilliant – absolutely brilliant! ‘The Ugly Duckling’ was the story that I often used to illustrate the element of ‘all stages serve a purpose’ in young lives – unfortunately, we now only appreciate ‘the swan’ and lack the time to let the ‘ugly duckling’ develop naturally to the ‘beautiful swan’. We will pay heavily for our rush for perfection in my opinion.
Slightly off topic; but SSRI’s possibly implicated in another Murder/ Suicide.
He was depressed, went to his GP, said he had no intention of harming himself or others, was prescribed Citalopram, and then went on to kill his wife and himself.
There was another web page about this by “theTime”, about how he told his GP he was feeling depressed, but specifically stated that he had no intention of harming himself. His GP then prescribed Citalopram, and shortly afterwards he committed the murder/ suicide. For some reason it wont allow me to link that page.
This business of whether a person had/had not the intention of harming his/her self seems to me to be unfair. Very often, it is the way that the discussion with the patient progresses that will give the general intention, one way or the other.
For example, in A&E or out-of-hours doctor’s assessment, you will often find that they will take a very serious view of the condition presented by the patient. Fast forward an hour or so – an hour of waiting for a liaison person to come across from the psych. unit to assess matters – an hour when the patient’s condition, if it changes at all, will deteriorate – and yet the liaison person will manage to write something along the lines of :-
Named person has agreed to keep him/herself safe overnight.
Tomorrow they will contact their CMHT.
We will inform CMHT of named person’s condition as presented today. Get them to sign it and send them home – or at least out of A&E with no idea where they may actually end up.
Keep themselves safe? How on earth can they possibly agree to that when mood swings can mean a change of mind within seconds? It is rare for them to contact CMHT with a report too – it is left to the patient to do the contacting when they finally feel the energy to do so.
I am worried about my teenage grandson being over medicated by dr.s orders. He has many serous side effects in his brain, body and just being able to function normally every day! He is on 3 different medications that I know of. A great amount of lithium carbonate per day! Also guanfacine and divalprocx. He was diagnosed as being bipolar but I dont believe he is.
Hello Carla – sorry to read what you have said here – I imagine you have researched info on the web. I would definitely be filling in the questionnaire on ‘Rxisk Polypharmacy Index – Could You be Taking too Many Drugs? Where you can get help’ . You would have something concrete to use then. You say your grandson i is being over medicated by dr’s orders. Does that mean he is being prescribed them on just the advice of doctors? Just reading the side effects alone of any one of these drugs is worrying. Is it possible to ask for an appointment with a pharmacologist? Waiting and watching will increase your anxiety – you have the right to be a loving ‘interfering grandmother ‘ by doing whatyou can to protect him.
Sorry about your situation, Carla.
As a grandmother, it must be frightening to see what impact these medications are having on your beloved grandson.
If you can see that something is not right, all concerned, need to have an open discussion.
As you can see, from a lot of people’s comments on this forum, the medications can be dangerous and have devastating effects. (short term and long term), to the brain ~ no one knows which part of the brain can be impacted?
When one tries to come off something, cold turkey, the consequences could be dire.
I would not like to tell you what to do however, please don’t take what doctors say as gospel. They do not manufacture the medicines.
Please research the topic and guide them towards finding the facts.
There is a wealth of knowledge on this forum here that may help.
Carla, it might get confusing with both of us having the same name on this forum.
Do you have any suggestions on what we can do. My name is highlighted in blue.
Your name is highlighted in black. I will not worry about this one as I did not notice this before.
I hope things work out, for the best, for your grandson.
I would be worried, also.
I’m heading for an ADHD diagnosis….and I’m an adult.
The symptoms all fit, but I want to make a distinction – my behaviours are not abnormal, what is abnormal is the constant fog in my head, my appalling working memory and my lack of motivation to do anything, even things I enjoy. No, it’s not depression, I have hopes, dreams and plans…but I will never do anything about them.
I don’t want medication but what else is there? CBT? Don’t make me laugh!
ADHD people have issues with intent: we know what to do, we just can’t do it.