The belief that ADHD, attention-deficit hyperactivity disorder, isn’t real is a serious threat to the timely treatment that can transform the lives of young people. Steven Kurtz, Ph.D., ABPP, describes why people are skeptical and how to effectively respond to this skepticism.
I write and speak often about the perils of untreated attention-deficit hyperactivity disorder: children dropping out of school, teen pregnancy, trouble with the law, drug abuse. While the evidence should be undeniable—the result of long-term studies of these kids—our warnings are often dismissed for a troubling reason. People deny that ADHD even exists.
This belief, that ADHD isn’t a real disorder, just an exaggerated response to difficult but typical children’s behavior, is a serious threat to the timely treatment that can transform the lives of young people. So we should take a look at why this happens, and how we can effectively respond to this skepticism.
Spectrum Skepticism: ADHD is Easy To Dismiss Because It's 'Dimensional'
ADHD dismissal is a result of the fact that the disorder is defined by a group of symptoms that occur to varying degrees in every child, adolescent, and adult. Hyperactivity, impulsivity, and inattention are all things that occur on a spectrum. This is a common argument against ADHD—it’s just “boys being boys.” But children with ADHD are at the severe end of the spectrum—severe enough that these symptoms seriously interfere with their lives on an everyday basis. They are essentially really nice kids, but they are dealing with a really big problem.
This is a problem with all psychiatric disorders that are what we call “dimensional”—defined by symptoms that are common in typical children but much more extreme, and more damaging, in these children. So, for instance, lots of kids have some social anxiety, but just being shy is not at all the same as being so paralyzed with fear that you are unable to speak in social situations like school (selective mutism). Having childhood fears is not at all the same as being obsessed with fears you have to perform endless rituals to control (obsessive-compulsive disorder). Similarly, being typically rambunctious is not the same as being so impulsive and hyperactive you are unable to follow instructions or complete tasks in a classroom.
It’s easier for people to perceive psychiatric disorders that aren’t dimensional, such as schizophrenia or manic depressive disorder—typical kids simply don’t have hallucinations, for instance, or manic episodes where they don’t sleep for three days. Those are pretty definitive symptoms.
Unfortunately, the more a symptom or behavior is dimensional, or on a spectrum, the harder it is for people to see the outliers as really impaired with a disorder. It’s hard to convince the public that it’s a really different order of magnitude. But we have numbers to prove this. Take a widely used ADHD rating scale, the SNAP. Typically developing kids without ADHD don’t get scored a 0 on these scales—as we noted above, everyone is somewhere on the spectrum; they get more like a 0.9. But kids with ADHD have been shown, in well-controlled studies, to score an average of 2.3 out of a possible 3 on the same rating scale—an almost threefold difference.
Why It's Important To Treat Kids With ADHD
It’s not a stretch to say that most people who deny that these are real issues are not the parents of these kids, who are seriously impaired in many if not all aspects of their lives—in their homes, their schools, and their communities.
But even parents themselves sometimes have trouble accepting a diagnosis of ADHD, for a different reason. When I probe, I find that it isn’t really the diagnosis they resist—they see the problem behaviors very clearly—rather the possibility of medication being recommended as part of their treatment. They don’t want to “drug” or be seen as “drugging” their children. The popular misconception that doctors are peddling scrips to normally developing kids has the effect of stigmatizing the diagnosis, even to the extent that parents who understand their child is suffering with a problem will avoid diagnosis—and the treatment it allows.
When parents of a child who has ADHD say to me, essentially, “I’m afraid of the diagnosis,” I urge them to see that not treating their child’s ADHD is the thing they should be afraid of. What’s important is to agree that ADHD behaviors are causing impairment, and to help the child before the disorder severely undermines his success in school, his friendships, his relationships with his family members, and his sense of who he is and what he can accomplish.
The Risks of Ignoring ADHD Are Serious
The diagnosis is a necessary tool; the behaviors are what count.
I often use height analogies as a comparison. I say, how inattentive do you have to be before you’re considered really inattentive? You’ve got to be the equivalent of 6' 3". Most of us, when we see somebody who’s 6' 3" coming down the street, we register, “that’s a tall person.” And the same is true of impulsiveness, inattentiveness, or hyperactivity. We’re not talking a little restless, a little distracted, occasionally wild. Kids we diagnose with ADHD are seriously impaired in these areas, and their parents are usually suffering, along with the children themselves.
We need to see ADHD as a condition like high blood pressure, or high cholesterol, or diabetes—something we wouldn’t think of dismissing. The risks of not treating ADHD are just as serious to the health and happiness of the child.
Steven Kurtz, Ph.D., ABPP, is one of the nation’s leading clinicians in the treatment of children’s behavioral problems and disorders, particularly ADHD and selective mutism. Dr. Kurtz is senior director, ADHD and Disruptive Behavior Disorders Center, and director, selective mutism program at the Child Mind Institute in Manhattan. He has appeared on NBC’s “Today,” CBS’s “The Early Show,” and PBS’s “Keeping Kids Healthy” as an expert addressing children’s mental health.
The Child Mind Institute is an NYC-based nonprofit organization dedicated to transforming mental health care for children everywhere. Visit childmind.org for a wealth of information related to your child with special needs, including strategies for dealing with diagnosis and behavior, symptoms and signs, practical tools, videos, and more.