Does ADHD Exist?

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.