Is ADHD a disease?

Probably not. But that doesn’t mean it isn’t “real.” Persons who truly suffer from it should be medicated.

On the penultimate day of boot camp, neuroethicist Martha Farah talked to us about brain development. Sub-regions of the prefrontal cortex, responsible for executive control (attention, planning, task-switching) seem to develop last, well into a persons’ 20’s. ADHD seems something like a dysexective syndrome. Children (and adults) diagnosed with the disorder have a hard time sitting still and focusing on tasks, especially school work (or for adults, work work).

Dr. Farah said that there may be a normal distribution (pictured above) of ADHDishness, with persons at one end having abnormally strong ability to concentrate/pay attention/focus on tasks, and persons at the other end having abnormally weak ability to do these things. (Of course, most of us are in the middle.) In recent years doctors have been more likely to carve off the tail end and declare these people “abnormal enough” to warrant a diagnoses of ADHD.

This isn’t an unusual tactic: we do it with blood pressure, for example. Even though high blood pressure isn’t the result of some bodily system going “wrong,” we delineate persons with blood pressure higher than 139/89 as having high enough blood pressure to be treated, most often with medicine. This is a somewhat artificial line: there isn’t much difference between 139/89 and 140/90. But we have to draw the line somewhere.

As this study indicates, there is justified concern that ADHD is being over-diagnosed, especially in children. Parents and teachers, tired of dealing hyper kids spoiled by “kid-centered” parenting, and drug companies, who stand to make lots of money selling their drugs, have encouraged doctors to push the line further up the distribution, resulting in persons closer to normal being designated abnormal.

But this doesn’t mean there aren’t some kids at the extreme end of the distribution who really need help. And Adderall and Ritalin really do seem to help some people focus. More importantly, the drugs help some kids enjoy school and the process of learning. Further, Dr. Farah told us about a study that found that if a kid was medicated for ADHD early on, he was less likely to get addicted to illegal substances later. This may be because the kid isn’t self-medicating for feeling bad that he isn’t successful or happy at school.

In the end, it is the responsibility of parents and doctors to make sure that kids are properly placed on the ADHD distribution, and medications are prescribed only if this help is really needed.

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