AD/HD: It's Not What You Think

When Chris A. Zeigler Dendy’s son Alex was 12 years old, he was diagnosed with attention-deficit/hyperactivity disorder (AD/HD). For Dendy and her husband, the news came as a relief. “Thank goodness we finally found out why this wonderful, smart, sweet, young man was struggling so much in school,” Dendy tells TakePart. “It explained all the struggles that he was having.”

For families with younger children, an AD/HD diagnosis can be devastating. “I think it’s a little harder to accept when they’re younger,” Dendy explains. “If it’s brought up some time in the first grade, parents have to go through this period of denial and grieving. They don’t realize what’s ahead.”

The Centers for Disease Control and Prevention(CDC) estimate that 5.4 million American children ages 4 to 17 have been diagnosed with AD/HD.

Despite its prevalence, myths and misconceptions about the disorder's causes, symptoms, nature and treatment cloud public perceptions.

TakePart spoke with several AD/HD experts to separate fact from fiction, and learn more about this complex condition.

MYTH #1: AD/HD IS NOT A REAL DISORDER

Sandra Rief is one of the country’s leading experts on how to reach and teach children with learning, attention and behavioral difficulties. Her books and education materials provide practical strategies for helping students with AD/HD achieve academic success.

“There are a number of misconceptions,” Rief tells TakePart. “Such as: AD/HD is not a real neurobiological or significant disorder, that it is related to poor parenting, and that these children's behavior can be managed with more discipline.”

In fact, the National Institutes of Health, the Surgeon General of the United States, and an international community of researchers and physicians recognize AD/HD as a valid disorder with a neurobiological basis.

Numerous studies show that the brains of children with AD/HD are physiologically different from those of their peers. The most-affected areas of the brain are the ones that control executive function. 

Children with executive-function deficits struggle with basic cognitive processes—working memory, paying attention, controlling emotion, solving problems, organization and self-monitoring. These impairments make doing well in school especially challenging.

MYTH #2: AD/HD IS CAUSED BY POOR PARENTING

In addition to being the parent of three grown children with AD/HD, Chris A. Zeigler Dendy has also been a classroom teacher, school psychologist, mental health counselor, executive director of a statewide mental health advocacy organization, and the author of several books on helping teens cope with AD/HD.

Dendy tells TakePart that when people see children with AD/HD being inattentive or unruly, they blame the child’s misbehavior on poor parenting skills and lack of discipline.

In reality, the principal cause of AD/HD is genetic.  Environmental factors that affect brain development can also play a role. “Mothers who smoke or drink during their pregnancy are more likely to have children with AD/HD,” she says. “Also, environmental toxins, like PCBs and lead, that our children are exposed to are other possible causes.”

Currently, no evidence suggests that social factors linked to parenting skills or child-rearing practices cause children to develop AD/HD.

MYTH #3: CHILDREN CAN CONTROL THEIR AD/HD SYMPTOMS, BUT CHOOSE NOT TO

Because AD/HD doesn’t affect intelligence, children can be bright and creative one moment, but disorganized, inattentive and impulsive the next. Parents and teachers wonder why an otherwise intelligent child behaves in seemingly careless and noncompliant ways.

Confused adults, not understanding AD/HD, tend to blame the child for any misbehavior.

“Areas where children struggle have been viewed more as laziness and not choosing to work, but are really executive skills,” Dendy explains. “For example, the seemingly simple process of getting started. For our children to get started on academic work, or work that is boring, or work that is routine, it’s very difficult. Their brain chemistry isn’t producing enough or working hard enough to help them get started.”

Another potential area of confusion has to do with homework. Children in general tend to dislike homework, and often need parental coaxing to finish it. But children with AD/HD don’t lack the motivation or self-discipline to complete their homework—they lack the executive skills.

“One friend counted up almost 20 steps to do a simple task like homework,” Dendy says. “You’ve got to remember to get your book, to get it home, to get it out, and what the assignment is. Then you have to remember to work on it, finish it, put it near the door, take it back to school, get it to the locker, get it to the room, and get it out of your notebook. There is any place in that chain of action where children with AD/HD can easily forget, and this homework they spend hours doing never gets turned in. Those are executive skills that our kids struggle with.”

MYTH #4: CHILDREN WITH AD/HD HAVE POOR SOCIAL SKILLS AND CANNOT MAKE FRIENDS

Rief tells TakePart that many children with AD/HD know how to make friends, but struggle at the performance level. They have the skills they need, but don’t know when and where to use them.

“Children with AD/HD often have no problem making friends. It's keeping them where they struggle due to their AD/HD-related behaviors,” Rief clarifies. “AD/HD is a performance disorder. The child with AD/HD particularly benefits from the adult providing cues, signals, and other techniques to remind the child of what he/she needs to do in key environments…then reinforcing the child for appropriate skill use.”

MYTH #5: MEDICATION IS OVER-PRESCRIBED TO CHILDREN WITH AD/HD

Adderall, Concerta, Strattera and Ritalin are some of the medications commonly used to treat AD/HD. Critics argue that medication should not be used to control young children’s behavior, and that doctors are too quick to write prescriptions for children who don’t really need them.

However, recent research demonstrates that medication can significantly improve symptoms in about 70 percent of people with AD/HD.

Dendy notes that over-medication of children with AD/HD isn’t the problem—lack of treatment is.

“If you look at the science, the data doesn’t support the fact that AD/HD is over-diagnosed or over-medicated,” she says. “You may have rare instances certainly. There’s no situation that’s ever perfect. But broadly speaking, across the U.S., the bigger problem is the under-diagnosis, and the number of kids who aren’t on medication. Research has shown that a lot of kids who have AD/HD are not even being treated."

MYTH #6: AD/HD IS A DISORDER OF CHILDHOOD AND CAN BE OUTGROWN

According to Dendy, most children and teenagers do not outgrow AD/HD. Instead, they must learn to cope with a disorder that will affect them in different ways as they move through life.

Characteristics of AD/HD that cause problems for school children can be valued in adulthood. For instance, Dendy’s father and sister had AD/HD and struggled in public school. But both chose careers well-suited to their gregarious and high-energy personalities, and enjoyed great success and satisfaction in the adult phase of their lives.

KNOWLEDGE IS POWER

Though myths and misconceptions about AD/HD linger, Dendy observes that public understanding of the disorder is on the rise. “There’s definitely been a big improvement in the awareness of AD/HD and the co-existing executive function deficits that go along with it,” she says.

Dendy spent three years working on an educators’ manual with the national AD/HD advocacy organization CHADD. Free copies of the book were given out to every public school in the country.

“If parents understand it better, they have more realistic expectations for their children,” says Dendy. “And if they educate their child, they go a long way toward protecting their child’s self-esteem. He understands why he misbehaves and can’t do well academically.”

Rief tells TakePart that she hopes future research will uncover the definitive causes of AD/HD and “be able one day to prevent so many children and adults from struggling with this disorder.”

Photo: chris.corwin/Creative Commons via Flickr.