Attention deficit hyperactivity disorder (ADHD) is the most diagnosed childhood disorder in Australia. Most of us now know someone, or someone’s child, who has been diagnosed with ADHD.
Reports on television current affairs shows often portray the impact of the hyperactive and inattentive behaviour associated with ADHD. At the same time, there’s ongoing controversy about potential ADHD over-diagnosis and its treatment with psychostimulant medication. Media reports also commonly raise the question of whether ADHD is “real”. The answer to this question is not difficult.
First, there’s no reason to doubt that the span of human diversity results in some people being more active, more tactile and more prone to distraction. In centuries past, these qualities may have been vital to survival.
Second, we know that if people treat something as real, then it will be real in its consequences. So, there’s also no reason to doubt that an ADHD diagnosis can help a child make sense of his struggles and relieve feelings of guilt for his parents.
But ultimately, the “is ADHD real” debate is about blame. It results in either blaming parents for not disciplining their child or professionals who should be doing more to help. The result is a deadlock with a lot of spent energy and very little positive difference.
One way to break out of this deadlock is to ask why these particular behaviours have become such a problem over the past 20 years. Another is to ask about the difference in national levels of ADHD diagnosis and the rates in lower socioeconomic regions.
Psychologists might note that the presence of poverty, stress, conflict and need in a child’s environment can increase the risk for those with a disposition for such behaviours. And social theorists might observe that contemporary society has less space for children who are active and workers who are inattentive.
Media and cultural theorists might also respond by noting that an obscure diagnostic category has become a popular phenomenon. For me, the turning point was when Bart Simpson was diagnosed with ADHD. It was then that I knew ADHD had become the label for any bad behaviour.
Recently, the revised Australian National Guidelines for ADHD were put on hold because of public controversy over alleged links between one of the key contributors and pharmaceutical interests. For those working in ADHD research, this event wasn’t particularly surprising.
It’s long been easy to get funding for medical or psychiatric studies on ADHD. What hasn’t been so easy is securing funding, gaining ethics approval and recruiting participants for studies in non-clinical areas.
The result is an evidence imbalance that can lead policy-makers to think that ADHD is only about diagnosing and treating the individual with psychostimulants. This is a concern because if we only ask medical questions, we will only get medical answers, and a greater focus on diagnosis and drug treatment.
So, the issue for the terms of reference for the pending National Guidelines isn’t so much who they included, but what they excluded. That is why it was pleasing, as noted in George Halasz’s contribution to The Conversation, that the new national Clinical Protocols for ADHD took a much broader scope.
While they still focus on intervention, these protocols also ask broader health questions such as how might we respond to ADHD (and its co-morbidities) as a holistic condition.
Not for a moment do I want to dismiss the difference that diagnosis and medication can make in the life of a family. Nor am I advocating taking away what may be the only support they have. But what we need to remember is that irrespective of the specific cause of ADHD-like behaviours for a particular child, it’s the people and institutions around them that define particular behaviour as problematic.
That’s why Australia needs to start a broader conversation about ADHD. And if we do, we might uncover a deep contradiction in our past response.
While we laud the qualities of activity, alertness and resistance to authority in our grandparents as foundations of the ANZAC tradition, we consider these same qualities in our children as something to be treated with medication.
It leads to the question – if Ginger Meggs were around today, would he be ADHD?
Brenton Prosser is the author “ADHD: who’s failing who?”