Hi team.
I realize post last week was mostly tongue-in-cheek, and it's a shame it all resulted in an after-school special. However, I'm going to take the liberty of responding to the post at face-value because I feel it NEEDS a respectful rebuttal.
I'll begin with an attempt to paraphrase the key point:
'There's no such thing as adhd. The only problem is that people are bitches of various types and no longer discipline their kids.'
Personally, I agree with the following: a lot of kids aren't given enough structure these days, the adhd label is over-applied, and that some parents/ individuals use the label as a crutch and as an reason to abrogate personal responsibility.
That being said, a certain percentage of kids really DO have significant, diagnosable neurological issues relating to attention and executive function, regardless of the actual underlying 'cause'. Some percentage of kids have probably always had these issues. I think the major difference between now and 'the good old days' is that they used to stay more in line because otherwise people would hit them with things like rulers and belts. I feel like in some ways, all we've done is replace the direct threat of violence with dope. I'm not really sure which is preferable.
If the incidence of adhd *is* on the rise (with crap like this, it's really hard to tell), poor parenting could be a contributing factor. But so could things like environmental changes, diet, fad diagnosis, the opportunistic behavior of big Pharma, and the grooming of shorter and shorter attention spans via electronic media.
Another possibility is that the level of attention *expected* from children has risen over the years (longer school hours, complexity and amount of material, etc), to the point where more and more kids are falling behind the cut. Maybe you put something like that together with more lenient parenting styles, and you could have a big problem.
With issues like this, it is very difficult to pick everything apart, and focusing on a single aspect and making inflammatory blanket statements about it really misses the point. I think that jumping straight to a simple explanation for a complex issue and sticking to it usually obscures more than it explains (e.g., virtually all political campaigning).
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Right now I work 2 days a week in an elementary school with children who have cognitive and language-based deficits. As a clinician who actually works children who have issues like these, and has met and heard about a number of their parents, I would like to make the following point about explicitly labeling deficits:
Diagnostic labels are both good and bad for the same reason; giving a complex combination of fuzzy internal factors a single name make them feel easier to understand and externalize. As in, "It's not just 'me', it's my x."
On the bad side of things, people can use 'X' as way to excuse all personal failings, a reason not to change or improve their situation, and also as a reason for everyone else to give them special allowances or treatment:
"I may not be lifting a finger to help him myself, but my child has X, so it's the responsibility of the school system to pay 50 grand a year to send them to this special school."
On the good side, explicitly labeling something that's otherwise just 'them' can help put things in perspective, help the person stop beating themselves up, and be the basis for figuring out ways to compensate for whatever the deficit is and grow. Without that level of separation given by *accurate* diagnoses and labels, its difficult to get that process going.
The following is in response to Guy's comments about intelligence:
When you said that a lot of kids who are 'just stupid' now claim they have ADHD, something like the inverse used to be true. Before people started talking specifically about attention and executive function problems, anyone who had those issues WAS 'just stupid', or 'just lazy'. That was the only way they had to describe it. Your comments seem to imply that that you think of intelligence as a single capacity, that in general you either have it or you don't. There's a Lot of research that shows it's more complicated that that. Remind me to write about the Theory of Multiple intelligences in a future post.
Sure, some of those 'just stupid' kids you mention are below average on a whole list of cognitive capacities, and they're going to have problems throughout life no matter what you call them. But if all you have is a 'Stupid' category, a bunch of the kids you have to lump in there are actually good at a lot of things, or even really really good at 1 or 2 things. They're just *not* good at the 2 or 3 things everyone usually quantifies to set an arbitrary standard for intelligence. If you tell that set of talented kids that don't fit the standard that they're stupid, unfortunately most of them are going to believe you. And I truly believe that when that happens, society (yes, society) loses out on a lot of what they would have offered.
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This blog is a joint venture. We all get to decide what and how we choose write. That being said, I feel like a basic level of respect in what we write and how we respond to one another is essential. The interpretation of 'basic respect' is definitely up for grabs (and should leave plenty of room for cheek), but for me a commitment to it isn't. I don't think there's any other way to have intelligent debate, and unintelligent debates are really, really boring.
I'm not trying to call anyone out in particular, but given our very own first baby blogodrama last week, I need this point made explicitly for my own peace of mind.
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In this light, I would like to apologize to Bunny for the inflammatory comments I made last Wednesday against Mati.
I didn't realize you still had his poster tacked up over your bed. You still have Heart, big guy. Never let me take that away from you.
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My intention was to say that of the children who were misdiagnosed, which I feel is a large amount, a lot of them just have disappointed parents. I recognize that ADHD is legitimate, I just don't believe that all of the diagnoses are.
ReplyDeleteThis topical revisit caused me to want to find some numbers. Some interesting things showed up. The following come from a series of CDC ADHD and Learning Disability studies, found here:
CDC SiteI'm not trying to make any specific point here, these are just things I found interesting.
- Children with Medicaid were more likely than uninsured or privately insured children to be diagnosed with ADHD, LD, or both.
- Children who lived in a mother-only family were more likely than those who lived in a two-parent family to have ADHD.
- ADHD was reported more for children whose mother had completed less than a bachelor's degree.
- In 2006, ADHD treatment cost America between $36 and $52 billion.
- Diagnosis of ADHD has risen an average of 3% per year between 1997 and 2006.
- ADHD diagnosis among males was reported significantly more often in families with incomes below the poverty threshold, than in families with incomes at or above the poverty threshold. Rates of reported diagnosis among females were not significantly different across the three levels of poverty.
And lastly, this:
ADHD prevalence by state
MapThere's obviously a lot more involved than a simple have it/not have it situation here. What, I'm not exactly sure.
Hey, this is a good post and Guy, you make good points and have good data. I am not sure how long we need to bang this drum because it's a topic I am sure we can all fight to the death on. Odds, you are correct as well. I will admit, my post may have left no room for "other causes" for this, such as neurological issues. Also, like yourself, I know some very smart people with the attention span of a gnat. It is true, all squares are rhombus's, but not all rhombus's are squares. I don't hate people, just cats.
ReplyDelete