Is ADHD a real disorder

When I was in school, ADHD hadn’t been invented. There were kids who didn’t pay attention for a good part of the day, or who couldn’t sit in their seats, but the first activity was called day-dreaming and the second “shpilkas” or “ants in your pants.” These problems were recognized but were considered “normal.” Though we were sometimes disorderly, the cause wasn’t labeled a disorder. It’s now an epidemic.

There were always plenty of kids, me included, who were day-dreamers. Mostly these were boys who would get bored after a while and would start to look around the room, or doodle, or gaze into space thinking of this or that. Perhaps I’d do some writing or math in the margin of a notebook while listening with one ear; perhaps I’d work on my handwriting, or I’d read something in another textbook. This was not called a disorder or even an attention deficit (AD), but rather day-dreaming, wool-gathering, napping, or just not paying attention. Sometimes teachers got annoyed, other times not. They went on teaching, but sometimes tossed chalk or erasers at us to get us to wake up. Kids like me took enough notes to do OK on tests and homework, though I was never at the top of the class in elementary or middle school. The report cards tended to say things like “he could do better if he really concentrated.”  It’s something that could apply to everyone.

Then there were the boys who would now be labeled HD, or “hyperactive disordered.” These were always boys: those who didn’t sit well in their chairs, or fidgeted, or were motor mouths and got up and walked about, or got into fights, or went to the bathroom; these were the class clowns, and the trouble makers — not me except for the fidgeting. Girls would fidget or talk too, and they’d pass notes to each other, but they didn’t get into fights, and they weren’t as disruptive. They tended to have great handwriting, and took lots of notes in class: every single word from the board, plus quite a bit more.

There are different measures of education, if you measure a fish's intelligence by the ability to climb a tree it will spend its life thinking it's stupid.

There are different measures of education, if you measure a fish’s skill level by the ability to climb a tree you’ll conclude the fish is ADD or worse.

Elementary and middle schools had activities to work out the excess energy that caused hyper-activity. We had dancing, shop, fire drills, art, some music, and sports. None of these helped all that much, but they did some good. I think the fire drills helped the most because we all went outside even in the winter, and eventually we calmed down without drugs. Sometimes a kid didn’t calm down, got worse, and did real damage; these kids were not called hyperactive disordered, but “bad kids” or “juvenile delinquents.” Nowadays, schools have far less art and music, and no shop or dancing. There are a lot more hyperactive kids, and the claim nowadays is that these hyperactive kids, violent or not, are disordered, ADHD, and should be given drugs. With drugs, the daydreamers take better notes, the nappers wake up, and the hyperactive kids calm down. Today about 30% of high-school seniors are given either a version of amphetamine, e.g. Adderall, or of Methylphenidate (Ritalin, etc.) The violent ones, the juvenile delinquents, are given stronger versions of the same drugs, e.g. methamphetamine, the drug at the heart of “breaking bad.”

Giving drugs to the kids seems to help the teacher a lot more than it helps the kids. According to a famous joke, giving the Ritalin to the teacher would be the best solution. When the kids are given drugs the disorderly boys (it’s usually given to boys) begin to act more like “goodie goodies”. They sit better and pay attention more; they take better notes and don’t interrupt, but I’m not sure they are learning more, or that the class is, or that they are socializing any better than before. The “goodie-goodies” in elementary school (mostly girls) did great in the early grades, but their good habits seemed to hold them back later. They worked too hard to please and tended to not notice, or pretended to not notice, when the teacher said nonsense. When it came time for independent or creative endeavors, their diligent acceptance of authority stood in the way of excellence.Venn diagram of ADHD

The hyperactive and daydreamers were more used to thinking for themselves, a prerequisite of leadership. The AD ones had gotten used to half-ignoring the teacher, and the HD ones were more openly opinionated and oppositional: obstreperous, in a word. Those bright enough to get by got more out of their education, perhaps because it was more theirs. To the extent that education was supposed to make you a leader and a thinker, the goodie-goodie behavior was a distraction and a disorder. This might be expected if education is supposed to be the lighting of a fire, not the filling of a pit. If everyone thinks the same, it’s a sign that few are thinking.

Map  of ADHD variation with location for US kids ages 6-18, Scrips Research.

Map of ADHD variation with location for US kids ages 6-18, Scrips Research. Boys are 2-3 times more often diagnosed as ADHD; diagnosis and medication increase with grade, peaking currently in early college.

This is not to say that there is no such disorder as ADHD, or no benefit from the drugs. My sense, though, is that the label is given too widely, and that the drugs are given too freely. Today drugs are pushed on virtually any kid who’s distracted, napping or hyperactive — to all the members of the big circles in the Venn diagram above, plus to athletes and others who feign ADD to get these, otherwise illegal, performance enhancing drugs. Currently, about 10% of US kids between 6 and 18 are diagnosed ADHD and given drugs, see figure. The numbers higher for boys than girls, higher in the US than abroad, and higher as the kids progress through school. It’s estimated that about 25% of US, 12th grade boys are given amphetamine or Ritalin and its homologs. My sense is that only a small fraction of these deserve drugs, only those with severe social problems, the violent or narcoleptic: those in the smaller circles of the Venn diagram. The test should not be that the kid’s behavior improves on them. Everyone’s attention improves when taking speed. ADHD appears more as an epidemic of overworked, undertrained, underfunded teachers, and a lack of outlets, not of disordered kids, or of real learning, and real learning is never pretty or easy (on all involved).

Robert Buxbaum, April 18, 2014. In general, I think people would be happier if they’d do more artmusicdance and shop, and if they’d embrace their inner weirdo. It would also help if doctors and teachers would use words rather than initials to describe people. It’s far better to be told you’re hyperactive, or that you’re not paying attention, then to be called ADD, HD, or ADHD. There’s far more room for gradation and improvement. I’m not an expert, just an observant observer.

11 thoughts on “Is ADHD a real disorder

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  4. michael

    adhd is not the pile of clichés you seem to think it is….. it has nothing to do with creativity or boredom or youthful exuberance…….or a grand plot by big pharma. nor is diagnosis an easy option for doctors, teachers and parents who are “just not up to the job”…, no, no. Believe me, its a real illness……By the way, your Venn diagram is just plain wrong: all these various conditions you have lumped together is just plain unscientific.

    (I contend these over-educated engineers would be better to lump the shear forces calculation in with bending moment calculations: they are not really as different as imagined by the PC crowd, and should no longer be treated with all these numerous way too many different equations. And then, of course, there is deflection: don’t get me started on deflection calculations: I suspect there is an abundant over- focus on deflection these days: it can safely be ignored for the most part ~ unless the grand piano keeps rolling to the centre of the room; then there MAY be a case for modest intervention)

    (in conclusion*, i think engineers would better to spend less time on the imagined nuances of the forces in beams and could save everybody a lot of cost and time if they would just calculate real forces with one simple gravity formula and forget all these slightly wild and imaginary variations – and I dont see buildings and bridges falling down all over the place ~ they should dance more, or take up art or guitar
    – just my 2 cents worth. i’m not an expert, just an observant observer)

    Any way, what was I saying? oh yeah
    In fact all these mental illness have different causes and symptoms: they are different neurological conditions, except for add and adhd which are probably just different stages of the same condition, (see according to below…)

    If you’re interested, look up Dr Russell Barkley on youtube and listen to his free 20 or 30 hours of lectures to fellow psychiatrists, students and to parents on what he thinks adhd really is…..after his 30 or 40 years of research.

    ADHD…… its tragic, its not really curable, but many grow out of it or figure out a work-around, and its under-diagnosed. And it is badly named.

    its a real eye opener.

    *evidence? wheres the evidence? you want evidence? why?

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  9. Karl

    Excellent post, Bux!

    The only thing missing is speculation about why this state of affairs has come to be. Could it be that the (not-so-secret) agenda of the pharmaceutical companies is to get us all dependent on/addicted to their product?

    Greetings from Germany!


    1. R.E. Buxbaum Post author

      Karl, Thanks for your comments. It’s great to hear from you. I appreciated your comments about japan about a decade back, prescient really. I’m sorry to say there are lots and lots of problems with our US schools, especially in Detroit where I am. There’s a lack of respect for the system all the way down (to a good degree desired). There’s an over-reliance on drugs from corporations and home grown. There’s an over reliance on academics in unemployable subjects like history and literature, and a lack of sports and vocational options. There’s a lack of good teachers — no one who’s good wants to teach in Detroit — and a wealth of crooked administrators who steal outright and claim it’s OK since they were appointed by elected officials. It’s a mess all around with lots of operatic villains and comic do-gooders, but few heroes. My aim with writing about ADHD was to dissuade parents from medicating their children for hating math or being bored in school: it’s normal, especially in bright, creative kids. I got 100 or so reads on the post so far, and take that as a success. What’s new with you? How did they treat bored or disruptive kids in E. Germany?

    2. Peter Trzos

      Karl- Schedule II drugs in America (those with a high potential for abuse, aka ritalin, adderall, etc) require a monthly doctor’s visit to renew their prescription; they don’t allow refills. Every kid that a doctor puts on one of those dangerous drugs generates 12 yearly visits and 12 copays for that child, which I’d imagine brings in about $1,200 of revenue. You can easily get rich by putting kids on horribly addictive drugs.


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