ADHD: Disorder or not?

The American Psychiatric Association has defined ADHD as a “developmental neurobiological condition defined by the presence of severe and pervasive symptoms of inattention, hyperactivity and impulsivity”. A child must show a variety of inattentive, impulsive and hyperactive behaviour over a period of six months which should be present in school and at home (Daley, D et al). In my opinion, the definition of ADHD laid out by the APA has been taken out of context. How do you know when a child is portraying a behaviour that defines ADHD? Society has come to define what they consider ADHD may look like. If a child is not paying attention in their homework and would rather be playing video games, it is considered a sign of ADHD (Daley, D et al). Or if a child does not like or understand math but has more of an artistic and creative mind, that also means the child has ADHD (Daley, D et al). It seems as if children are not allowed to be children anymore. I also think that society needs to adapt to our technological era since children are exposed to a fast paced environment of television, video games, and computer games. When a child is removed from that environment and forced to do work, they tend to lose focus because they are not accustomed to a slower paced atmosphere. For example, in Sean’s case, he is more artistically minded and does better in music than he does in math. This doesn’t necessarily mean that he has ADHD but that he might simply find those courses tedious compared to his other interests.

Many children that show the symptoms of ADHD also show performance deficiencies when engaging in social interactions as well as aggressive behaviour with other peers (King, S et al). The individual with ADHD has difficulties when taking turns, talks excessively, doesn’t listen when spoken to, interrupting others during conversation and classroom discussions (Daley, D et al). I think that the basis in which testing occurs for ADHD needs to be altered. At the moment, the diagnosis of ADHD is subjective and based on a list of behaviours. A teacher is given a list of nine categories and if a child demonstrates six of the nine categories, they are labelled as ADHD (Null. G et al). The most “powerful” symptom of ADHD as mentioned in the documentary is when a child fidgets with their hands, feet or squirms in their seat (Null. G et al). If a child is misdiagnosed as ADHD, it can lead to unnecessary use of health and education services as well as exposure to psychoactive medications (Null. G et al). In the documentary “The drugging of our children”, a child who has been misdiagnosed as ADHD took a higher dose of Ritalin as he grew older; he became addicted to the medication and went into relapse when he did not have access to it. Within the power points of health ethics, ADHD is also defined as a “made up disease”, in which the intake of mind altering drugs with children can increase blood pressure as well as heart rate. Through situations like these, we can tell how dangerous it can be to misdiagnose someone as ADHD. I think the diagnose of ADHD should be on the basis of exclusion and narrowing down the symptoms while comparing it to other illnesses and situations, instead of basing it on a list of behaviours that almost all children exhibit these days.

I think that parents, physicians as well as teacher’s are all responsible in the misdiagnosis of ADHD. As mentioned above, teachers decide whether or not a child needs medical attention while comparing to a list of behaviours that define ADHD. Elementary school teachers often have a class of twenty five to thirty students and it becomes difficult when some students are not cooperating like the rest of the class (Dang, M et al). At this point the teacher will speak to the parents and the school board will ask them to either place them on methylphenidates or transfer the child to a special needs school (Dang, M et al). This places pressure on the parents because they don’t want their child to go to a special needs school. Many parents are also in the working force so they want to be able to come home to a stress free environment hence they will take their children to the physician to test for ADHD. Many parents have long term dreams for their child and are willing to take any steps in order to achieve them.

. Even though parents make decisions based on what they think will benefit the child’s future, that doesn’t necessarily mean that the parent is always making the right decision (Ross. F.L). Decision making in health care must be based on good morals and practical reasoning. I agree that parental autonomy is extremely important when it comes to making decisions about children but parents also need to think of what benefits the child’s long term autonomy as well as present day autonomy (Ross. F.L). The American Academy of Paediatrics recommended that children should be able to have a say in decision making and be given a greater voice as they mature (Ross. F.L). A third party, such as physicians are told to resist the decision making process unless the decisions made are negligent and abusive (Ross. F.L). When children are able to make proper decisions about their life , then a physician is able to approve of it with the permission of the parents taking into account the child’s assent (Ross. F.L). Not only does this allow the physician to withhold their professional roles as medical practitioners but also respect the decisions of the child and the opinions of the parents. If we are to refer back to Sean’s case, he does not want to take Ritalin because he does not like the way it makes him feel but the parent’s insist on him continuing the medication because they don’t want any trouble from his school and want to keep a stress free home environment. In my opinion, the parents should ask Sean how he is feeling and if he is having any side effects. More priority should be given to the child since they are the ones taking part in the treatment and would be able to explain how they are feeling.
Any decisions made either by parents, teachers or physicians, should always look into the beneficence of the child. I strongly believe that we need to respect the child’s autonomy because he or she will be the one to suffer the consequences or gain benefits from a treatment (Ross. F.L). I agree that children are vulnerable and that as adults, we have the responsibility to care for them but we need to think about the implications our decision can have on the children (Ross. F.L). If we are to diagnose all children that may show behaviors that link to ADHD, then how will we define how children behave in general? This can viewed through Kant’s theory in which actions are taken to make it a universal law (Fisher,J). If one child depicts behaviour of ADHD, then another child with similar behaviour will also be diagnosed as ADHD. Hence, more children are being misdiagnosed for the sake of “universal law” and not for their autonomy or beneficence (Fisher,J). Even though I am against the concept of diagnosing children as ADHD, I do believe that it exists but within a spectrum that should define exactly what ADHD is. I understand that if certain behaviours are a link towards ADHD and the child is not treated, it can also cause great complications in the future (Null. G et al). As mentioned in the documentary, one child who had been under diagnosed as ADHD ended up hurting himself because he did not understand why he was different from others and how he couldn’t live up to the expectations of his parents (Null. G et al). This approach is taken through the eyes of utilitarianism (Fisher,J); parents make decision about their children because they want to minimize their child’s pain within society and expand their opportunities for them to achieve the best they can.

To conclude, ADHD is a subjective disorder in which the diagnosis has to be carefully evaluated. It is not ethically correct to identify children as ADHD by associating it with a list of behaviours that all children may display at one point or another. We need to be able to evaluate the consequences and benefits of diagnosing children as ADHD as well as research more into how children actually behave in general before prescribing medications that may affect them in the long term.

Much Thank to the following for their research:

Castel, A., Lee, S., Humphreys, K., & Moore, A. (2011). Memory capacity, selective control, and value-directed remembering in children with and without attention-deficit/hyperactivity disorder (ADHD).Neuropsychology, 25(1),15-24. Retrieved from EBSCOhost.

King, S., Waschbusch, D., Pelham, W., Frankland, B., Andrade, B., Jacques, S., & Corkum, P. (2009). Social information processing in elementary-school aged children with ADHD: medication effects and comparisons with typical children. Journal Of Abnormal Child Psychology, 37(4), 579-589. Retrieved from EBSCOhost on March 3.

Daley, D., & Birchwood, J. (2010). ADHD and academic performance: why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom?. Child: Care, Health And Development, 36(4), 455-464. Retrieved from EBSCOhost on March 3.

Dang, M., Warrington, D., Tung, T., Baker, D., & Pan, R. (2007). A school-based approach to early identification and management of students with ADHD. The Journal Of School Nursing: The Official Publication Of The National Association Of School Nurses, 23(1), 2-12. Retrieved from EBSCOhost on March 3.

Rey, JM., Sawyer, MG. (2003). Are Psychostimulant drugs being used appropriately to treat child and adolescent disorders. Br. J Psychiatry Journal, 182: 284-286. Retrieved from EBSCOhost.

Null, G & Louden, M. (Directors). (2005). The Drugging of Our Children [http://topdocumentaryfilms.com/the-drugging-of-our-children/].Gary Null & Associates.

Ross, F.L. (1997). Health Care Decisionmaking by Children. Is it in their best Interest? The Hastings Center Report, 27(6), 41-45. Retrieved from Webct on February 27.

Fisher, J (2009). Morality and Ethics. Biomedical Ethics: A Canadian Focus, 1.3(12-17). Retrieved on March 3.

Nicki, A (2011). Power points on Mental Health Ethics. Slide 23. Retrieved on March 3.