Any topic concerning young children and prescription medication is bound to be contentious. But add to the mix phrases like "abnormal behavior" or "my kid is better than your kid because you're a lousy parent," and you have the enduring ADHD controversy, with its ongoing discourse about how to treat a disorder that some folks aren't convinced exists.
ADHD stands for Attention Deficit Hyperactivity Disorder, a family of neurobehavioral and developmental disorders first diagnosed in the mid-1800s — yes, we've been wrestling with inattentive and restless kids for a long, long time. ADHD encompasses the outdated term attention-deficit disorder as well as hyperactivity and impulsivity, sometimes called "boys will be boys." In terms of clinical diagnoses, it affects about 3 to 5 percent of children and is indeed a little more common in boys, according to the National Institute of Mental Health.
Although books such as "Ritalin Nation" have convinced many that ADHD is purely a behavior problem brought about by bad parenting and our fast-paced lifestyle, the preponderance of evidence reveals how ADHD has a biological base. The primary cause seems to be genetic, along with prenatal or early postnatal exposure to toxins such as lead or cigarette smoke.
For most doctors and psychologists, what remains controversial is not whether ADHD is real but rather how to diagnose and treat it.
Now there's a name
Nearly every psychological or cognitive disorder goes through a period in which the public, and even doctors, dismiss it as imaginary or the result of a weak will. Depressed? Snap out of it. Addicted? Toughen up and just say "no." But modern imaging techniques reveal how such disorders are the result of real changes in the brain.
ADHD is no different. Some people still are convinced that the cure is a matter of a swift slap on the rear-end. The problem area, however, is another part of the body entirely: ADHD seems to be the result of dopamine receptors in the brain not functioning properly, as well as other characteristics in the frontal lobes of the cerebrum that differ from brains of people without ADHD.
The word "differ" is important here, for ADHD is not a sign of inferior intelligence. As with dyslexia and mild forms of autism, the brain is merely different. The child could be brilliant or otherwise normal or could have a less than stellar IQ.
The cerebrum is that section of the brain involved with problem-solving and controlling impulses. In a society that values problem-solving and controlling impulses, and which has created a school system based on this, ADHD can cause quite a predicament. So ADHD is often treated with an eye toward helping a child cope in such a society.
The problem of "what is normal" makes ADHD all the more difficult to diagnose.
Clearly all children can be hyperactive, impulsive or lost in a daydream. Although brain scans do reveal differences in the brains of children and adults with ADHD compared to control subjects, the differences are not defined well enough to serve as diagnostic tools.
Diagnosis instead is based on how far from average the behavior of the child is. Characteristics such as being fidgety or unable to pay attention must be pervasive, manifest themselves before age 7, and be severe enough to negatively affect school or social interactions. Hyperactivity in the playground might be fine, for example, if the child can behave well in the classroom.
Because of the wiggle room in diagnosing ADHD, parents should seek multiple opinions before placing their children on a drug therapy.
Ritalin is but one of many drugs available to treat ADHD. These drugs do nothing to cure ADHD but allow the child to focus in school so that he doesn't fall behind and become "less intelligent." Usually drug therapy is coupled with behavior therapy.
These drugs do carry risks, particularly for children with heart defects, so the prudent doctor tries to prescribe just what is needed to help a child focus better.
In his 1999 book "Ritalin Nation," author Richard DeGrandpre theorized that ADHD is caused by America's "rapid-fire culture" of MTV and videogames and parents too busy for their children. While DeGrandpre did alert the public about a nation perhaps a little too casual with prescribing drugs, nearly all the medical elements of his book were false or have since been proven to be false.
Bad parenting can exacerbate the situation, but it doesn't cause ADHD. Videogames, too, don't seem to cause ADHD and, in fact children with ADHD often aren't very good at videogames and don't play them because, well, they can't focus. This cuts across classes and affects kids with no access to videogames. Also, what DeGrandpre labeled as purely behavior reveals itself in various kinds of letter-recognition and number-counting tests to be analogous to dyslexia or autism.
New medication might soon be available that could be safer than Ritalin and similar stimulants, targeting the neurotransmitter norepinephrine instead of dopamine. Doctors, fortunately, do remain very focused on ADHD.
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Christopher Wanjek is the author of the books "Bad Medicine" and "Food At Work." Got a question about Bad Medicine? Email Wanjek. If it’s really bad, he just might answer it in a future column. Bad Medicine appears each Tuesday on LiveScience.
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Christopher Wanjek is a Live Science contributor and a health and science writer. He is the author of three science books: Spacefarers (2020), Food at Work (2005) and Bad Medicine (2003). His "Food at Work" book and project, concerning workers' health, safety and productivity, was commissioned by the U.N.'s International Labor Organization. For Live Science, Christopher covers public health, nutrition and biology, and he has written extensively for The Washington Post and Sky & Telescope among others, as well as for the NASA Goddard Space Flight Center, where he was a senior writer. Christopher holds a Master of Health degree from Harvard School of Public Health and a degree in journalism from Temple University.