ADHD: Medical Problem, or Parenting Problem?

Posted on April 4, 2013


I am more convinced than ever that ADHD is over-diagnosed for the convenience of adults.

The headlines are not helping my bad attitude toward ADHD diagnoses.  On Monday, CBS News published a story titled “Report: 11 Percent of School-Aged Kids Diagnosed With ADHD.”   On the exact same day,  Medpage Today carried the headline, “Parent Training Tops Meds in ADHD.”   These two stories are convincing me, more than ever, that ADHD is 1) tremendously over-diagnosed to the point of abuse, and 2) this is because far too many adults – whether parents, teachers, or doctors – are actively looking for an excuse or crutch or easy fix for children’s behavior.  As Alan Schwartz’ scathing New York Times article shows, ADHD medications are far too often given simply for adult convenience.

I concede that other childhood ills – asthma, allergies, autism – have also been inexplicably on the rise, but ADHD is different, because often it can be helped with cognitive therapy alone, and because – as Dr. Alice Charach’s study has found – providing training for parents of ADHD children is actually more reliably effective than medicating the children.   Those two points – effectiveness of cognitive therapy, and effectiveness of parent training – tells me one big thing: for far too many cases, parenting is the key, not medications.

Check out some of the parent behavior training features:  rewarding good behavior… consequences for poor behavior… effective discipline strategies.  My goodness, how innovative!  We never would have thought of this back in… oh, wait.  We did.  I can remember a few disruptive, noisy kids from my elementary school days.  ADHD had not been invented yet, so the “treatment” was a trip to the Principal’s office, and maybe calling little Timmy’s parents.  Timmy would get “in trouble,” and would behave reasonably well after that, at least for a few weeks.  Yes, some kids were prone to be more disruptive than others, but then again, some kids were bad at math or sports or grammar.  It was just one of those things that the kid was expected to have to work harder at.  No excuses.  No medications.  And certainly not 11% of us!

Our language reflects our shifting attitudes as well.  The disruptive little Timmy of my day was “a difficult child,” “acting up in class,” “the class clown.”  The words we used put the onus for Timmy’s behavior on Timmy, he was expected to change it, and generally, he did – albeit with difficulty.  Today, we say that little Timmy “struggles,” “has difficulty paying attention,” and “has a disorder,” conveniently removing all responsibility from not only Timmy, but from his parents.  Sorry.  Can’t help it.  That’s just how he is.  You deal with it.  Medications become the treatment of choice.  They’re easy, and we feel like we’ve done something.

Now, decades later, we may be coming full cycle.  After years of increasing numbers of medicated kids, we are finally hearing that Timmy might be better off with strong parental involvement and making a concerted effort to control himself.

In an interview in Psychology Today, Dr. Mary Solanto talks about cognitive therapy for adult ADHD patients, although what she says holds true for kids as well:  “Just because a person has ADHD – or any other brain-based condition for that matter – does not mean s/he can’t learn new, more adaptive behaviors and cognitions…. the greater the effort… the greater the pay-off… Just like learning to play an instrument, or learning a new language, or developing a muscle, learning new habits of the mind requires continued practice.”

Well, you know – if you can be shown how to modify your behavior, and then modify it under your own willpower, then I do not accept that there was ever a true medical problem.  Disciplining one’s own mind, learning to direct and sustain one’s own attention, should be part of growing up, and teaching and requiring a child to do that is absolutely a parenting responsibility.  Just because some people are belatedly taught these skills by mental-health professionals does not make it a “disorder.”  It is, at the root of too many cases, a parenting failure.   Specifically, a failure to spend hours upon hours of time repeating expectations, instructions, enforcing discipline for the same things, over and over, and regularly tossing your kid out into the back yard for a couple of hours (this is actually an effective way to help rein in ADHD).  News flash: parenting is hard work, and some kids make it even harder.  That doesn’t entitle us to abdicate our responsibilities to a pill, at unknown expense to our kids’ normal development.

Now, to be clear:  I think ADHD is real.  But I also think it is rare and that the diagnosis is extremely abused, and I think it’s reprehensible to label kids and medicate them just because we’re tired of all the hassle that parenting brings.


Related articles:

So Are Tantrums a Disorder Now?

Your Parent’s Name, and Yours, is Adderall

Our Overmedicated, Unfit Youth