A Dialogue with an ADHD Non-Believer

Dear Sir,

It was with some interest that I read the article What You Should Know About Attention Deficit Disorder by Edward W. after having it handed to me by a member of our church. There were elements of the article that were insightful, helpful, and needed to be said in a public forum, especially the discussion of the moral and spiritual dimensions of behavior. For this part of the article I applaud Mr. W.

However, Mr. W's discussion on the physiological/biological aspects of ADD ADHD was lacking to the point of being misleading to the readers. I am sure that Mr. Welch had no intention of misleading any readers, as that would hardly reflect the "biblical guidelines with which to understand ADD" that he seeks to communicate. Therefore, for the sake of clarifying some details, may I present the following evidence. Perhaps in the near future you would run an article that would present some of this information to your readers, so that they have an accurate understanding of the disorder.

"Other books use a biological approach, claiming that brain functioning explains every behavior." - p 58

I might say that I have read several books on the biological realities of ADD ADHD, and brain functioning in general, and none of them have claimed "that brain functioning explains every behavior."  They do, however, point out the differences in both structure and function of a brain with ADD ADHD, or other disorders, vs. brains without these disorders. It is misleading to suggest that "books (using) a biological approach" make such a claim. Perhaps one or two do, but I am not familiar with any at all.

"In other words, their attention is inconsistent rather than universally poor." - p 59

This is a fair description, although a better description would be that their attention is "inflexible." People with neurological difficulties, whether ADD, head injuries, autism, fetal alcohol syndrome, forms of depression, or dementias, have varying degrees of neurological inflexibility. Neurological flexibility is a sign of a healthy brain. It is the ability to move attention from "global" forms of attention to "specific" forms of attention at will, in a fraction of a second. These various types of attention are objective and observable (with PETS, SPECTs, EEGs, QEEGs, and other technologies). People with ADD have difficulty moving from specific to global, or global to specific, styles of attention. It should be noted that inflexibility of attention is a marker of a neurological problem, though by itself is not diagnostic of any specific problem.

"First, ADD is not a precisely circumscribed set of symptoms. The ever-present "often" in the diagnostic criteria betrays the loose boundaries of ADD, and it explains why Americans use the diagnosis so frequently. Almost anyone can squeeze into the parameters - at least on certain days." - p 59

This statement is also potentially misleading to the readers. "The ever-present 'often' in the diagnostic criteria?" is very similar to the "ever present" "nearly every day" in the diagnostic criteria for Depression. The "often" is simply a realistic description of life for individuals with ADD. It is not "always" as with a structural head injury. It is "often" because it is the result of neurological mechanisms being "often" under-aroused and "often" under-performing.

". . . and it explains why Americans use the diagnosis so frequently."

Studies show that 3% to 5% of the population has ADHD. Over-diagnosis, if there is any, is not due to the diagnostic criteria, but rather to a lack of a comprehensive diagnostic work-ups by most physicians.

"Almost anyone can squeeze into the parameters - at least on certain days."

This is misleading to the readers, and simply not true. Remember, the DSM-IV also includes these important, and highly discriminating, criteria:

• Six or more symptoms of Inattention, having lasted at least six months, to a degree that is maladaptive;
• Six or more symptoms of Impulsivity-Hyperactivity, having lasted at least six months, to a degree that is maladaptive;
• Symptoms of the disorder were present before the age of seven;Impairment is present in a variety of settings; and
• There is clear evidence of clinically significant impairment in social, academic, or occupational functioning.

The reality is that barely anyone can "squeeze into these parameters." But about 5% of the population can. It is careless to suggest that "anyone? at least on certain days" can meet the diagnostic criteria. It also conveys a negative picture of those who do actually suffer with the condition.

Would you publish a statement that read, "Almost anyone can squeeze into the parameters of Alzheimer's - at least on certain days?"  I would certainly hope not, and yet it is published in connection with ADHD. This is disappointing.

This is the end to part one of this discussion. You can learn more about Attention Deficit Hyperactivity Disorder by visiting the ADHD Information Library's family of web sites, beginning with http://www.ADD101.com.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.