ADHD: Overdiagnosed?

In category ADHD & Autism

As part of a series OVER-DIAGNOSIS EPIDEMIC on theconversation.edu.au,
Rae Thomas, Research Fellow at Bond University has written Moving the diagnostic goalposts: medicalising ADHD

It’s worth reading, as are the comments.

I remember when ADD and then ADHD became the popular diagnosis of the 1980’s. Since then Asperger’s Syndrome has taken some of its marketshare but both theories grow in general acceptance and number of children diagnosed.

The two disorders have much in common – subjective criteria to label children who don’t fit the prescribed box. There seems to be an overlap, or “co-morbidity”. Children diagnosed with either can progress to that wonderful disorder ODD (Oppositional Defiance Disorder). Both theories have the effect of placing the problem within the child and thereby avoid the need to examine the physical environment or the actions and expectations of other people.

Yet, when you think about change and evolution, people and children don’t change quickly. Environments do. Here are three changes that I believe are behind the rise in children diagnosed with ADHD.

Perhaps it’s unreasonable to expect all children to “stay on task” with so many distractions around.

Spending some time in a primary school classroom can be instructive. Those of us old enough to remember rows of desks, little to look at other than the blackboard, the clock and out the window belong to a different era. By comparison, today’s classroom is cluttered, noisy and often confusing. I don’t know how anyone could concentrate in one. Perhaps it’s unreasonable to expect all children to “stay on task” with so many distractions around.

Conversations are dominated by “No” and “Don’t touch” which really means don’t be curious… not even in your own home.

Many modern homes are not much better. When my children were young, we adapted. Anything within reach was at risk of being damaged and you just accepted that risk – or moved things out of the way. No more indoor plants, chemicals were locked away, precious and sharp things were moved higher and usually hidden from view. In that environment, children learn to take care of things in a relaxed environment. Yet, I have visited homes where the young children who live there are confronted daily with arrays of buttons and fragile ornaments which they are told not to touch. Conversations are dominated by “No” and “Don’t touch” which really means don’t be curious… not even in your own home.

Modern society demands more conformity. There’s a certain irony that in our increasingly multicultural society, more subtle demands for comformity are rising. This plays out particularly in the pressure on children to fit into school life, join team sports, make friends, be popular and be normal.

Failure to conform within arbitrary definitions of normal requires explanation and treatment. The ADHD explanation saves us from looking critically at the child’s social and physical environment by placing the problem firmly within the child.

use of peer pressure to manage the behaviour of children who don’t feel a valued part of the group can push them further out and create explosive situations

Now that corporal punishment is banned in schools, peer pressure is used as a major tool of behaviour management. Theories behind behaviour management assume that children identify as part of the group and want to remain part of that peer group, and therefore peer pressure can motivate them to conform to expectations. However, use of peer pressure to manage the behaviour of children who don’t feel a valued part of the group can push them further out and create explosive situations.

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