By David Joel Miller
What is Attention Deficit Hyperactivity Disorder (ADHD) and why is it on the rise?
ADHD appears to be everywhere. It is spreading faster than obesity. In my therapy practice, most of my adult clients tell me that they were diagnosed with ADHD at some time in the past. Most of them have children with an ADHD diagnosis. It is common for the young people who come to see me to have, as their first diagnosis, ADHD.
ADHD is now something everyone gets. Over a nine-year period, the number of girls diagnosed with ADHD increased 600% (Robinson et al., 2002.) It is no longer exclusively a diagnosis of children as adults and even senior citizens are receiving the diagnosis.
One author tells us that if the current trend continues, within 20 years, half of all children will be on an ADHD med (paraphrased from Shannon, 2009.)
Why is ADHD so common and what is fueling its spread?
To answer this question there a number of factors we need to look at. What is ADHD? Even more basic, what is Attention and what is hyperactivity? We also need to know is attention abilities something you are born with or does it develop over time? Are there things you can do to improve your attention or is this just the way you are? Are there alternatives to taking stimulant meds and do those alternatives really work?
The relationship with other mental emotional and behavioral disorders is also important. There is a lot of overlap between having ADHD and having Autism, depression, anxiety and substance use disorders.
There are also cultural factors in ADHD. Certain population groups are more likely to get the ADHD diagnosis than others. Who gets diagnosed also is affected dramatically by who does the “testing” and who gives out the diagnosis.
There has been a lot of research on ADHD and its treatment recently. As I am able to read that research I want to report back to you what I find out and how you may be able to apply these ideas to your life or the life of someone you care about.
From the day a child is born there is pressure to behave in certain ways. Some children are more active than others. Some from day one have better abilities to “pay attention” but genetics is not the whole story of why some people are diagnosed with ADHD and others are not.
Learning to pay attention.
Regardless of age, a person can learn skills to improve their ability to “pay attention.” We can also learn skills to reduce or increase out behavior. Let’s begin our review of the ADHD phenomenon.
ADHD is not one thing but several.
We professionals used to have two separate diagnoses for these issues, Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD.) If you go back farther in the psychiatric literature these issues had other names.
The idea was that some people, mainly children, were not good at “paying attention.” Mostly we thought that this was a lack of effort on their part and that they just needed to listen better. Most people with a predominantly inattentive issue did not cause anyone any problems and so did not get noticed until they were much older and came asking for help. Sometimes this inability to “pay attention” was written off as low intelligence or a learning disability. Sometimes those things were factors but often they were not.
We have studied attention a lot and it turns out there are a number of different skills that we call “paying attention” and that those skills develop with time and can be learned. More on the subject of what attention is and how it develops in upcoming posts.
Most ADHD diagnoses are about Behavior!
Most ADHD diagnoses come about because the child’s behavior is upsetting an adult. The child does not stay in their seat, talks too much and generally disrupts the classroom. Some parents tell us that their children are “hurricanes” and are always in motion. So if the child does not stay in one place, moves a lot and causes problems for adults, this gets them evaluated and probably diagnosed.
Hyperactivity is very situational. If a child runs all through the soccer practice and is fast at running around the track, they get A’s from the coach and may become track stars or pro soccer players. That same child who is never in their seat in the classroom will get in trouble and probably placed on meds.
To avoid this ADHD diagnosis the child needs to develop the ability to regulate his behavior. A whole lot of factors, like diet and opportunities for physical activity, can affect a child’s ability to sit still. When most people lived on farms and in rural communities there were more opportunities to “work off” that energy. Now, most people on planet earth live in cities and they stay inside a lot more.
Some of my clients have told me they are not allowed to go outside because of the gangs and the drive-bys. Their parents tell me they are scared to let the kids out of the house. One client has two bullets in him from drive-bys. Any questions why his kids never leave the house?
One theory is that ADHD, the hyperactivity part, is a failure of human evolution to keep up with our changing environment. This may also be true of the inattentive part as we will talk about in the future.
ADHD also coexists with depression and anxiety
Many children’s first diagnosis is ADHD. They are then placed on a stimulant medication to treat this hyperactivity on the premise that the behavior problems are caused an inability to “pay attention” meaning a failure to do what the adult says.
It does not stop there. Before long, because their behavior is causing adults problems, we change this diagnosis to “Disruptive Behavior Disorder.” Eventually, this may run the gamut of “bad child diagnoses” to Oppositional Defiant Disorder or even Conduct Disorder.
In the teen years or adulthood, we then discover that this person was depressed or had an anxiety disorder all this time.
One treatment for anxiety disorders in adults is to tell them to avoid caffeine or other stimulants. This is a conflict if they are taking stimulant meds for their “ADHD.”
I fully believe that there are children who warrant the diagnosis of Disruptive Behavior Disorder, Oppositional Defiant Disorder or even Conduct Disorder. They and the others in their lives need help. Just saying that we professionals and society need to be looking for depression and anxiety issues also.
So next stop would need to be this area of attention. What is the ability to “pay attention” how much are we born with and how does it develop.
The day you were born you had some ability to “pay attention.” In the next attention post, let’s look at this day-one ability and how your attention abilities change and develop over time.
Please think about how you learned to pay attention or what the barriers to that were.
Staying connected with David Joel Miller
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page or my Facebook author’s page, David Joel Miller. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.