Recently, I overheard a father say to his wife after attending a field trip for the first time with his 7-year-old daughter “ADHD is real and our children don’t have it.” The point, of course, was that his experience had been a bit stressful as he was inundated all day with a busload of hyper, rambunctious 2nd graders. Although the father was exaggerating a bit and most likely, the majority of the kids were simply excited to be on a field trip, the sad truth is around 5.2 million children in the United States between the ages of 3 and 17 are diagnosed with ADHD. Do those 5.2 million actually have ADHD?

ADHD, or attention deficit hyperactivity disorder, is defined by the DSM-IV as having the following characteristics:

Essential features:
A. Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.
B. Some hyperactive-impulsive or inattentive symptoms must have been present before seven years of age.
C. Some impairment from the symptoms must be present in at least two settings.
D. There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder.

In a nutshell, a child may be diagnosed with ADHD if they exhibit the inability to focus in different environments (i.e. home and school) enough to interfere with social, academic or occupational functioning. The actual physiological etiology of ADHD is not completely understood although many theories have been explored such as interference with brain waves and neurotransmitters. The diagnosis of ADHD relies on the subjective observations by parents, teachers and caregivers and the objective review of the subjective questionnaire completed by those observers. What am I trying to say? The diagnosis relies on everyone’s opinion compiled into a generic questionnaire.

The generic questionnaire does not truly determine some key factors in these observable behaviors. A child may be unable to focus in class and become disruptive or disassociated with the rest of the class because the child is bored. The child may be equally bored at home. The child may watch too much television or eat a diet high in sugar and chemicals which leads to mood swings, inability to focus and irritability. Although we as adults display other more restrained behaviors when we’re in a “mood,” children often express this stifled, restless feel by acting out or being “hyper.”

As well, we also must consider “behavior” problems versus ADHD. The fact is, some children CHOOSE not to behave whereas those who actually do have ADHD may not have as much control over their behavior. Kids with behavioral issues may not have enough boundaries and structure at home. They may be going through a difficult transition period at home such as divorce or a new sibling.

So, why do we diagnose so many kids with ADHD without looking at other reasons behind their inability to focus or hyperactivity? The father was correct in saying that “ADHD” is real. There are kids and adults for whom there are organic causes of ADHD, but even these kids and adults may benefit more from alternative treatment plans. However, there are a few possible reasons for over-diagnosis of ADHD.

By Nathan Ruof D.C.