Thursday, November 18, 2010

Pathologizing Childhood

From Peter Gray's blog, here are the official diagnostic criteria for  ADHD:


1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

Hyperactivity & Impulsivity

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often reacts as if "driven by a motor".
6. Often talks excessively.
7. Often blurts out answers before questions have been finished.
8. Often has trouble waiting one's turn.
9. Often interrupts or intrudes on others (e.g., butts into conversations or games).

Peter Gray asks "who is surprised that so many boys have been diagnosed as having ADHD?"

I don't really know about boys, but I can see that each of my daughters fits these criteria perfectly.  My older daughter is a  textbook case of "Inattention", and my younger daughter is a textbook case of "Hyperactivity & Impulsivity".   Actually, I'm amazed that, at least so far, nobody's tried to label either of my kids "ADHD".  Perhaps school personnel can predict my likely response?

And here's the Onion's take on it: More US Children Being Diagnosed with Youthful Tendency Disorder.


  1. PsychMom says:
    What about: Sits with legs on the back rest of a chair, or over arms of chair, or with head touching floor?
    Or: Goes down a flight of stairs without feet touching the ground.

    These lists just describe normal behaviour of young children. It's no wonder kids and school are like water and vinegar.

    My daughter physically cannot walk. I don't think I have ever seen her walk 10 steps in a row, without a leap, hop, skip, twirl, cartwheel or flat out lying on the ground for a moment, amongst those 10 steps.

    Even walking with her while she's holding my hand (which she insists upon often), my arm is never still...
    She's ill, if she's walking. And then, at the end of the 10 steps, she's flopped onto her bed and asleep.

  2. PsychMom, I added a link to a terrific Onion article above. I think you'll like it.

    I just ordered a balance cushion for younger dd to use at school. I notice she sits on one for speech therapy. It's supposed to be helpful for wiggly kids. Worth a try ...

  3. PsychMom says:

    I read the article...and I got sucked in at first...but then it got just too funny..

    I'll see if has the seat...often the American Amazon has way more stuff than the Canadian site has.

  4. Great series of posts this week, FedUpMom. I love the Onion story -- am linking to it on my blog, too.

  5. Even though most "normal" kids have these symptoms, to receive a diagnosis of ADHD, these symptoms should be extreme and interfering with day-to-day life. I'm guessing your daughters don't take over an hour to finish their dinner every night because they can't still or stay in one place long enough to eat more than one bite at a time. That's what is meant by "Often fidgets with hands or feet or squirms in seat" and "Often gets up from seat when remaining in seat is expected." I'm also guessing that your daughters don't scream and cry for thirty minutes, covering the page with tears, every time they are asked to write their name, or color a picture for school. That's what is meant by "Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework)." As with anything, it's all a matter of degree. Trust me, your school is not going to tell you your kids have ADHD. If they do, just say, "Let me talk to an MD and I'll get back to you."

    In the 90s, ADHD was supposedly this "fad" diagnosis--everybody had it. Then in the 2000s it became this derided diagnosis--bad parenting (or bad school or bad expectations) = unruly kid. Now we're in the indignant phase, where paranoid parents are convinced the school is just waiting to march perfectly normal kids down some line and force-feed them Ritalin.

    Some research shows that ADHD is over-diagnosed. But I doubt it's diagnosed very often in "normal" kids. It may be diagnosed in children with a multitude of behavioral issues caused by something other than ADHD (anxiety, lack of sleep, chaotic homelife, etc.), but it's really not very likely that the men in the while coats are marching to your door to aggressively and mistakenly diagnose and medicate your "normal" child.

    People naturally like to find reasons for things. If a child seems out of control, can't make/keep friends, gets in trouble in school day after day, sometimes we look for what we think might be causing it. You do the same thing when you assume your child is asking a lot of questions about "universal truths" because she was adopted. One of my kids does the exact same thing, and he was not adopted. It's just a normal personality trait of an inquisitive child.

  6. LAB, if you read the Peter Gray article, you'll find that currently about 1 in 8 boys has been diagnosed with ADHD. Doesn't that sound high to you?

    Actually, I have a daughter who can spend an hour eating dinner, and when she was younger she could easily cry for 30 minutes if I tried to make her do homework. That's how I got started campaigning against homework in the first place.

    You're right that my speculation about how adoption has influenced my daughter might not be correct. That's one of the great unknowables -- how much of what we see is because of the traumas of her early life, and how much is just who she is? We'll never know.

    The difference is that I don't harm my daughter when I wonder how adoption has influenced her. But I could very easily harm her by putting her on psychotropic medications at a young age.

    If the diagnostic criteria for ADHD describe normal behavior, then they need to be rewritten. Do I think ADHD is being diagnosed in normal kids? Yes, absolutely. I also think "executive function disorder" is being diagnosed in normal kids.

  7. PsychMom adds:

    I tend to agree FedUpMom, that if the diagnostic criteria are so broad, it only follows that there will be an overdiagnosis. And because many people have claimed to be experts in the diagnosis and treatment of ADHD, they will interpret these behaviours as pathological.

    And teachers, who are stressed out with 25 to 30 kids to try to teach will only be reinforced to select out energetic children who are harder to manage, if they find that medications calm these kids down. It's human nature.

    And again, we're looking at the child as the problem, rather than the conditions the child find themselves in and what they are forced to cope with.

  8. PsychMom adds:

    I just wanted to say one more thing, expanding on my last comment. Kids are forced into coping with much more than they were 30 years ago, which is a reference point for most of us. We think that kids are alright with getting up at 6 or 7 in the morning, because we have to go to work. They "have" to be alright with it because it's the requirement. They have to be alright with staying out of their homes for 9 hours X 5 days a week. They have to be alright with daycare, babysitters, fast food, shopping in the evenings, parties almost every weekend, split up parents, and their extracurriculars too....etc etc...
    We demand an awful lot without really understanding if they can handle it. Maybe many kids can't.

  9. The problem is that illness, especially mental illness, is partly a social construct. The illnesses we worry about and diagnose, and in whom, say a lot about what's going on in our society.

    This goes back to my "Cultural Changes" post, but diagnosing mental illness in women and children has a long, tangled, and ugly history. People without power (women and children) behave in ways that people with power (men and adults) don't like. What do the people in power do about it?

    Well, one time-honored response is simple violence. It used to be considered appropriate for a man to slap a "hysterical" woman in the face, for instance. Violence against children is ubiquitous, and mostly legal in the U.S.

    In the '70's, "frigidity" in women was a much-discussed medical concern. It was also believed that all kinds of mental illnesses in children were caused by withholding mothers. Feminism put a large dent in this kind of thinking.

    Right now, we live in a society where school is more restrictive and high-stress than ever before, and many kids can't handle the pressure. Whose fault is that? Who needs to change?

    How will we look back on ADHD twenty years from now? Will it be an old diagnosis, gone the way of all those "frigid" women of the '70's?

  10. PsychMom says:

    I find generally (and maybe this is because of high stress levels) that our society is far less tolerant of "abnormality" than ever before. Police are very quick to stun and shoot people that don't quickly do what they're told, regardless of the level of threat. And schools too, have zero tolerance for lots of things in a way that is clearly overblown and extreme. And it's odd too, because on the one hand we are all about EVERYONE having a right to be heard in our free society, but if you say or do something that someone else is uncomfortable with...the reaction is huge.

  11. LAB -- If "that's what is meant by" those criteria, then why don't the criteria say that? Are the doctors going to have you there to translate for them? What evidence do you have that the criteria are being interpreted in that way? Really, one in eight boys have extreme and life-interfering symptoms of ADHD?

  12. Interesting discussion. Another "pathology" I'm hearing about more and more is "Auditory Processing Disorder." Does anyone know if there is research to suggest that this is a real disorder? (I know it has nothing to do with actual hearing.) A friend's son was diagnosed with it after it was determined that he was not reading at grade level. But from what I've heard, boys often read later than girls (and this boy was quite young when the diagnosis was made). The strange thing is that he appeared to outgrow his disorder, and was later deemed gifted. I'm wondering if he was just developing at his own pace, and his early reading problems had nothing to do with "auditory processing disorder." I mean, the Finns don't even begin to teach reading until age 7--I wonder if Finnish kids are diagnosed with "disorders" at the same rate as North American kids.

  13. All kids can display some of the characteristics of ADHD here and there. But like LAB says, true ADHD has these symptoms in the extreme. Believe me, I know, as both my boys have it, mostly leaning inattention. I'm only medicating one right now, I think my youngest is too young for medicine, or at least I don't want him to have it now. I was in denial, I was just like you, ADHD is the diagnosis du jour and they are trying to make kids into robots and for some reason adults now can't cope and need antidepressants. We are not pushover parents by any means so that theory is out, too. But if you could see my kids, who constantly need redirected, the medication truly helps my oldest. He was going into 2nd when he was diagnosed, I delayed giving him medicine, he definitely had trouble as the work was a little harder and needed more focus. He was so easily distracted he had to have his desk face a wall at times at school to keep his eyes on his work. Seems cruel, yes, but he couldn't have his desk in a group. I started him over Christmas break that year and it was a major difference. My youngest's inattention is even worse than when my oldest was at his age, but he's only in kindergarten and I'm insisting he not be on medicine so they'll have to deal with it. If you could even see these ADHD kids in a group of "normal" kids you see the difference. Sometimes it's really heartbreaking, which is how I'm feeling with my youngest right now.

    My husband was one of those diagnosed "hyperactive" kids in the 70's who was on Ritalin at one point. One of his baby sisters was diagnosed with ADD in school and was on Ritalin. Neither are medicated now, but I can still recognize the ADD. My sister-in-law says she just learned to cope with it. From what I've read, ADHD can run in the family. My newest theory is that it's so prevalent today because those "hyperactive" kids are having babies.

    I have a friend who has kids with "Sensory Processing Disorder". Talk about a new diagnosis! But it is very real and her kids definitely have this problem. So much so, they are now being home-schooled.

    I don't know why all these new problems are coming up in recent times. Is it because we are finally diagnosing them or are they really new? What about the rise in autism? Is it something in our environment? Is it a mutation of sorts? Looking back, I remember a couple of kids that seemed hyper in grade school. I have no idea what their grades were, though. Makes me wonder if they would be diagnosed in modern times.

    The medicine actually calms my ADHD child. We usually give him a holiday off it on the weekends but there has been times when we had to give it to him then. We actually see the change happen and know when the medicine has kicked in and he becomes, what I would term, normal. He is able to complete things and stay focused. The medications are given not without concern about long term affects, though, as I'm still worried about it.

    Also wanted to say I loved the Onion article!

  14. ***
    My newest theory is that it's so prevalent today because those "hyperactive" kids are having babies.

    You mean "hyperactive" types didn't have babies in the past?

    The medicine actually calms my ADHD child.

    Ritalin has a calming, focusing effect for all kids. That's why there's a thriving black market for the stuff. Any child can do better at school, study harder, and get better grades with a dose of Ritalin.

    We usually give him a holiday off it on the weekends

    Well, if you can give your kid a holiday from his meds, how bad is his condition really? I mean, if he had diabetes, you wouldn't give him a holiday from his insulin. Your kid only needs his meds if certain kinds of demands are being made on him, right?

    Is he able to complete things and stay focused if it's something he's genuinely interested in?

  15. ***
    If you could even see these ADHD kids in a group of "normal" kids you see the difference.

    Believe me, my younger daughter has stood out from every group she's ever been in, due to her boisterous and noncompliant behavior. She's a legend in her own time!

  16. I came to this board through the Stop Homework site seeking seeking support about the problems we've had with homework, but ADHD is an additional factor with that issue. How can I even explain these issues with school work on this board if it is not believed it is a valid diagnoses to begin with? Unfortunately for kids who truly suffer with ADHD, their presentation isn't as obvious as those with autism or other more visible disorders. Many are quick to judge these kids as not caring and lazy or perhaps spoiled brats with ineffective parents. My kindergartner still cannot follow a two-step direction. I'm not going to go into further debate about this as it is worrisome enough as is.

    I've taken action on the homework issue, have written a letter to the teacher and have had a sit-down with the principal. Would have liked to have had some feedback on this situation. In addition to that, I've had some real concerns with the math program, Everyday Mathematics.

    An article explaining ADHD's behavioral patterns:

    The national organization:

  17. Anonymous, I hope you will continue to read and comment on this blog. I would be very interested in continuing our conversation.

    We may have to agree to disagree on some issues.

    I am absolutely not trying to judge you or your kids.

  18. Our local PBS aired this documentary:

    If it airs locally, I highly recommend watching to increase understanding ADHD.

    I suspect some parents of true ADHD children might come across your blog seeking help or support because the issue of homework is even worse with them. I imagine the posts that opine ADHD as a phantom diagnosis would be very discouraging to read as it has been for me. These opinions on ADHD weren't evident on the Stop Homework blog.

    Thank you.

  19. Maybe we need to work out a deal with parents of ADHD children who want to write in about their homework or other school-related issues. If you want to put the whole ADHD business aside, that's fine.

    Just start your comment with a statement like "I don't want to discuss the ADHD diagnosis", and then we'll discuss the other issues you want to bring up.

    Would that work?