The ADHD Blob Rolls
Over America and the World
Recently, I happened to catch an old cult classic moviefrom the 1950s called The Blob. It’s the story of a tiny gelatinous substancebrought to earth via a meteorite that begins to wreak havoc on a small town inAmerica, devouring everything in its path. As it rolls over people, the blobincorporates them into its mass and as it does so, it grows larger and larger.I won’t spoil the story by telling you how the movie ends (Hint: It has somethingto do with climate change), but I will say that while I was watching the film Ithought of America’s ADHD epidemic. The notion of there being an attentiondeficit disorder in the human mind began as a tiny blob of an idea when it wasfirst presented in a speech to the Canadian Psychological Association in 1972by its president, McGill University psychologist Virginia Douglas. Shesuggested that what at the time was being called hyperkinesis had more to dowith attention problems than with the behavior of hyperactivity. From there,the ADHD blob grew in size at cognitive science laboratories throughout the1970s (cognitive psychology having displaced behaviorism in the late 1960s asthe psychology field most likely to receive research funding from universities,foundations, and governmental agencies). In 1980, attention deficit disorderwas given official recognition as a psychiatric disorder in the United Statesby the American Psychiatric Association in their Diagnostic and StatisticalManual of Mental Disorders III (DSM-3).
Then, in the 1980s the ADHD blob gobbled up an entirevillage with the founding of Children and Adults withAttention-Deficit/Hyperactivity Disorder (CHADD), a parent advocacy group thatbegan lobbying the U.S. Congress to recognize what was then called ADD as alegally handicapping condition under federal disability laws. In the late 1980sand early 1990s the media began spreading the word about this new phenomenon ontalk shows, in feature articles, and through popular culture (in the 1992 movieWayne’s World, for example, Wayne frequently reminded his somewhat scatteredbuddy Garth to take his Ritalin).
Big drug companies, sensing an opportunity to make a hugeprofit from this new attention disorder, started to financially support CHADDand fund individual doctors, ADHD researchers, and professional organizations.In 1997, the federal Food and Drug Administration (FDA) relaxed itsrestrictions on selling drugs to consumers and began permitting ads for ADHDdrugs in women’s magazines, on television commercials, and through otherpublicity outlets, creating even broader exposure of ADHD to the publicconsciousness and creating an even greater demand for drugs to treat it.
In the 2000s, the ADHD blob rolled over a huge newcommunity as it extended its reach to include ADHD in adults, through Websites, blogs, social networking sites, chat rooms, and forums that discussedthe impact of ADHD on work, marriage, relationships, and general coping skills.Now, in the 2010s, the ADHD blob has overtaken and digested another largeregion, the world of early childhood, with kids as young as two years old beingidentified as having ADHD and medicated for their attention deficits. As I sitback and contemplate all that has gone on since 1972, I ask myself: Is thereanywhere the ADHD blob, now a gargantuan amorphous entity, has not yet visited?The answer: the rest of the world, where ADHD is spreading rapidly, with ratesrising as much as tenfold over the past few years in some countries.
Why I Call ADHD a Myth
Before I get any further into this chapter, there’s onething that I want to set straight. When I say that ADHD is a myth, I amdefinitely not saying that there are no restless, inattentive, hyperactive,impulsive, and/or disorganized children (and adults) in America and the rest ofthe world. I worked for several years as a special education teacher, andduring my tenure, I taught so many kids who displayed these traits that I beganto think that all children acted in this way. I have no illusions about themillions of restless, inattentive, and/or impulsive children out there in homesand classrooms across the country and the world who are exasperating parents,testing the patience of teachers, and creating havoc in families and schools atepidemic levels. The reason I need to stress this fact is that when I wrote thefirst edition of this book twenty years ago, many people (especially those whohad been diagnosed with ADHD or whose children had been diagnosed with ADHD)became apoplectic, thinking that I was saying that they or their kids had noproblems. I have received a fair number of angry letters and emails from peopleover the years who felt that I was insensitive to their issues, blind to theirsymptoms, and completely out to lunch with my proclamation that ADHD is a myth.Not wishing to repeat this unpleasant experience, I need to state here plainlywhat I mean when I say ADHD is a myth. I’m using the word myth in this book interms of its original meaning from the Greek word mythos, which means “story.”Over the course of the past forty-five years, a story has emerged to explainwhy some children are restless, inattentive, disorganized, hyperactive, and/orforgetful (among other behaviors). This story has been collectively told bymany different agents of society, including psychologists, psychiatrists,university researchers, educators, parents, the pharmaceutical industry, themedia, and those who have themselves received a diagnosis. Like any myth, it’sa story that has different versions, but overall there’s a general consistencyto the basic narrative.
The ADHD Myth
ADHD is a neurologically based disorder, most probably ofgenetic origin (although prenatal smoking and lead poisoning are also known tobe contributing factors), which afflicts around 11 percent of America’schildren aged five to seventeen. Significantly more boys appear to have thisdisorder than girls (boys, 14 percent, girls, 6 percent), although girls whohave evaded detection for years are increasingly being identified as having theversion of ADHD that is referred to as “ADHD Inattentive Type.” ADHD ischaracterized by three main features: hyperactivity (fidgeting, trouble playingquietly, always moving, leaving classroom seat, talking excessively),impulsivity (blurting out answers in class, interrupting others, havingproblems waiting turns), and/or inattention (forgetfulness, disorganization,losing things, making careless mistakes, being easily distracted, daydreaming).Current thinking has identified three major groups of ADHD children, one groupthat appears more hyperactive and impulsive, another that seems moreinattentive, and a third that has all three features. The symptoms must havelasted at least six months, have originated by the age of twelve, and have beenobserved in multiple settings (for example, home and school).
There are no lab tests, biomarkers, or other objectivemethods available to diagnose this disorder. Assessment tools include parent,child, and teacher interviews; a thorough medical examination; and the use ofspecially designed behavior rating scales and performance tests. There is noknown cure for ADHD, but it can be successfully treated in most instances usinga psychostimulant medication such as Ritalin, Adderall, or Concerta. Other drugshave also been used as well, including antidepressants such as Wellbutrin,blood pressure medications such as clonidine, and norepinephrine reuptakeinhibitors such as Strattera. Nondrug interventions include behaviormodification, parent training, a structured classroom setting, and informationgiven to parents and teachers on the proper way of handling ADHD behaviors athome and in school.
There is no known cause of ADHD, but current thinking hasit as involving structural abnormalities in the brain and biochemicalimbalances in areas of the brain that are responsible for attention, planning,and motor activity, including the striatum, the cerebellum, the limbic system,and the prefrontal cortex. Neurotransmitters that appear to be dysregulated inADHD include dopamine and norepinephrine.
Children who have been diagnosed with ADHD can experiencesignificant school problems, suffer from low self-esteem, have difficultyrelating to peers, and encounter problems in complying with rules at homeleading to conflict with parents and siblings. Some kids with ADHD also havelearning disabilities, conduct disorders (destructive and/or antisocialbehaviors), Tourette’s syndrome (a disorder characterized by uncontrollablemotor or verbal tics), and/or mood disorders including depression and anxiety.While ADHD seems to disappear for some children around puberty, it canrepresent a lifelong disorder for up to 80 percent of those initiallydiagnosed.
Although this description of ADHD omits many fine pointsand details and although there are disagreements within the ADHD community inregard to some of these issues, I believe there is very little in mydescription that most ADHD experts would seriously dispute. I want to emphasizeagain, however, that this is a story. It may be supported by thousands ofmedical studies, as claimed by a 2002 International Consensus Statement on ADHDsigned by more than eighty of the leading authorities in the field, but it isstill a story gleaned from those research findings. We should remember that inancient times, myths were stories that people told to account for unexplainedphenomena in their lives (for example, wars, storms, illness, and death). Heretoo we have an unexplained phenomenon: Millions of children in our culture arerestless, inattentive, impulsive, and disorganized despite our best efforts toparent and educate them, and as in ancient times, we want to have a way ofmaking sense of this situation. Naturally the storytelling elements used in themodern age (research, clinical data, epidemiological studies, and so on) arefar more sophisticated than those used in ancient times (such as supernaturalentities, magic, and divine revelation). Nonetheless, the intent is still thesame: to provide a coherent narrative, easily understood by the average person,for why millions of children are not acting in the way that we suppose theyshould act.
As we’ll see in the next chapter, my biggest problem withthe ADHD myth is that it’s just not a very good story. Yes, it looks good onthe outside with the fine veneer of medical authority, scientific rigor, andgovernmental support. However, when one digs deeper into the story,inconsistencies start to appear, other interpretations of the same data beginto emerge, and alternative stories to account for the same restless,inattentive, and impulsive behaviors start to appear, especially when weinclude other fields of inquiry beyond neuroscience, psychiatry, and clinicalpsychology, such as sociology, anthropology, evolutionary biology, economics,gender studies, media studies, developmental psychology, and family systemstheory. In the next chapter, I discuss some very specific problems with theADHD myth, and in subsequent chapters, I share a number of alternativeinterpretations or stories that can also account for the millions of restless,inattentive, and impulsive children in our homes and schools.
Why the ADHD Myth
Is Not a Very Good Story
A good story has certain essential elements in it. Itshould have a compelling beginning, a strong middle, and a convincing andconclusive ending. The ADHD story, on the other hand, has a feeble beginning, aconfusing middle, and an ending that appears wildly out of control. ADHDhistorians often like to situate the beginnings of the disorder in an 1845German storybook of morality tales for children called Struwwelpeter(Shock-Headed Peter). The book contains a poem titled “Fidgety Phillip” about achild who wiggles, giggles, tips his chair, and can’t sit still. Thisdescription would fit many young children alive on the planet today. Finally,he pulls off the tablecloth (with the food still on the table) and hides or istrapped underneath it. Again, we’re talking about an incident that could happen(and probably has happened) to many families at one point or another in theirlives. The book of poems from which this story was taken also includesvignettes of a child with poor grooming habits, a boy who won’t eat his soup,and a boy who goes outside during a storm with an umbrella and is sent flyingthrough the air. What are the current disabilities for which these particularpoems provide historical beginnings?
The History of ADHD: A Bad Novel in the Making?
The second foundational event occurring at the beginningof the ADHD story concerns a British doctor named George Still. In a series ofthree lectures to the Royal College of Physicians in 1902 London, Still spokeabout children who possessed a “morbid defect of moral control” not accountableto “feeble-mindedness” or medical illness. To use this as one of the key plotpoints for the beginning of a story about a disorder now said to afflict morethan six million children in the United States alone is, and I say this assomeone who has written fiction myself, a weak literary move. Still was talkingabout only a very few children (he cites around twenty in his lectures), not 10percent of all children worldwide. The children in his case studies behaved inways not even remotely similar to the American Psychiatric Association’s DSM-5criteria for ADHD. Still’s patients defecated in bed, stole, and lied; one evenwent up to two kids in the playground and “banged” their heads together inThree Stooges fashion, causing them great pain. Finally, Still attributes thebehaviors of these children to a “moral defect,” constructing a cause that isabsent from today’s neurobiological thinking about the origins of ADHD(although he does claim to be able to identify moral defects by the size of thechildren’s heads!). To use a single fictional child in a poem, and twentychildren from medical case files to serve as the beginning of a story affectingthe lives of millions of children and adults worldwide is, in my opinion, tobuild a narrative structure on quicksand.
From its humble and irrelevant beginning, we advance tothe middle of the story, when things start to get a bit confusing and a littlecrazy. After World War I, children who had survived the worldwide encephalitisepidemic and apparently displayed symptoms looking like ADHD were said to besuffering from “post-encephalitic behavior disorder.” In the 1930s, two Germanphysicians, Franz Kramer and Hans Pollnow, referred to children with ADHD-likesymptoms as having “hyperkinetic disease of infancy.” Based on cases ofchildren who had shown these symptoms after suffering from actual brain damage,doctors in the 1940s began to use the term minimal brain damaged to describechildren who acted this way. In the 1960s, many scientists became dissatisfiedwith this term because of the absence of any detectable brain damage, so theycoined a new term to describe these kids’ situation: minimal brain dysfunction,or MBD. In 1968, with the publication of the second edition of the psychiatricbible, The Diagnostic and Statistical Manual of Mental Disorders, the termhyperkinetic reaction of childhood became the correct nomenclature to use indescribing and diagnosing this disorder. Even with all these name changes, thenumber of children considered to be suffering from whatever term happened to beused at the time was very small.