AD/HD

Attention-Deficit / Hyperactivity Disorder (AD/HD) is a controversial topic. Within Christian circles some have gone as far to suggest that AD/HD is nothing more than rebellion resulting from bad parenting or society’s attempt to turn sin into sickness. There are troubling statistics that may make one doubt the legitimacy of AD/HD as a diagnosis. For instance, why has the incidence rate for AD/HD increased significantly in the United States in recent years but remained relatively stable in Great Britain? How do we explain the 700% increase in psychostimulant use during the 1990s? Are we having an AD/HD epidemic? And if so what has happened to cause so many of our children to be damaged? Although answers to these questions are complex, overdiagnosis and the overuse of medications are legitimate concerns that trouble many parents whose children are affected by this problem. I suggest three explanations for the recent and dramatic increase in the diagnosis of AD/HD. It is likely that there are many other factors that have contributed to this increase, but I would like to focus on the three I see as most influential.

The first is the problem of misdiagnosis (overdiagnosis). Clearly some children are misdiagnosed with AD/HD and wrongly given psychostimulants. Misdiagnosis can happen with any illness whether it is mental or physical in nature (an accurate diagnosis is always the product of quality professional training and an efficient evaluation). Parents must search out qualified professionals who will take the time to rule out all other possibilities before making a final diagnosis. Misdiagnosis and the overuse of medications in children are not unique to AD/HD. We can look no further than antibiotics to find another example. Throughout the 1980s and 1990s pediatricians wrongly, but knowingly, prescribed antibiotics for non-bacterial infections. This was done in many cases to pacify the parent who demanded something be done for their sick child. Because these children had viral infections the antibiotics were useless in their treatment. Ultimately this overuse of antibiotics has led to antibiotic resistant strains of bacteria and infections that are now more difficult to treat. Is it a far leap to imagine that the same scenario may occur with AD/HD; a troubled child, a weary teacher, a struggling parent, and a pediatrician trying to better the situation? It is imperative that a child showing AD/HD-like problems and behaviors receive a full medical and psychological assessment prior to diagnosis. While I believe that misdiagnosis definitely occurs and may have contributed to the increase in AD/HD diagnosis and treatment, I do not believe that to be the only reason.

A second factor contributing to the increase in AD/HD is that a better defined set of criteria and greater acceptance of the diagnosis has lead to more children who actually display AD/HD problem behaviors being diagnosed and treated. This is not a bad thing! We all know that children are each unique. They develop and mature at different rates. Some will acquire physical skills quickly, others more slowly. Still others will never acquire certain physical abilities. Is it so difficult to imagine that the same can be said of cognitive abilities? Some children will struggle cognitively, regardless of their environment and parents. Appropriate diagnosis and treatment gives these children a chance at a normal and productive life that they would not have had otherwise.

A third factor that I believe has contributed to the dramatic increase in the prevalence of AD/HD is related to societal changes that have placed greater demands and expectations on children. Anxiety levels in children and college students have increased significantly since 1950. This increase has been associated with a lack of social connection and a sense of a more threatening environment. Our fast paced, high stress society is damaging our children. Just think for a moment about some of the things that younger and younger children are exposed to everyday: divorce, fear of violence, drug use, unlimited materialism, unrealistic academic expectations and absentee parents. Dr. Sam Goldstein, a prominent AD/HD researcher, says it this way, “…a review of all sources of childhood data suggests that children are finding it increasingly more difficult to meet the expectations and demands of our culture. In response, more and more are experiencing problems…Thus, increased cultural demands upon children increases the number struggling to meet the expectations of the culture. This acts as but one more force leading children to the doorsteps of physicians and psychologists… Even if it is one out of twenty, that is five percent of the population. That is five percent of all children who simply struggle to sustain effort, and require more time, patience and support to develop the self-discipline necessary to deal with life’s daily requirements.”

It is my hope that you will recognize AD/HD as a real disorder that affects the lives of real children and their families. These children wrestle daily with debilitating physical, psychological and spiritual issues. While mistakes may have been made in relation to diagnosis it does not change the fact that children who struggle with this disorder can be effectively treated and the church has a significant role to play in that healing.