Hartmann's ADD/ADHD Newsletter
Every now and then somebody comes along and says something that makes you want to say, "Hallelujah, brother and sister!"
In the current issue of Men's Journal is an article by Joseph Hooper speculating on the possibility that George W. Bush has ADHD (the March 2001 issue). But that's not what I want to shout "Halelujah!" about. It's a short line buried in the article, toward the end.
After listing the criteria for spotting ADHD (variations on distractibility, impulsivity, and a need for high levels of stimulation), the author of the article quotes psychologist Russell Barkley as saying that in order for a person to qualify as having ADHD, the symptoms MUST cause impairment in a person's ability to function in the world, keep a job, and/or form lasting relationships. "If not," the article quotes Barkley, "you don't have a disorder. You have a personality."
Of course, this has been the official DSM criteria virtually from day one: impairment of function is required for a diagnosis. But where the "Eureka" came in for me was when Barkley pointed out that two people could have the exact same symptoms in all regards except impairment, and one would have ADHD and the other would have "a personality."
Which raises the question: What is impairment?
Of course, we all know the consequences of impairment: people can't function. But that's like saying we all know that fever makes people's foreheads hot. How could it be possible, however, that with two people who are identically impulsive, identically distractible, and identically hyperactive, one would have a disease and the other would have "a personality"?
What is the mechanism of impairment that can cause this huge gulf from "normal with a personality" to "so diseased a person must take psychoactive drugs? I've found that what causes impairment is twofold: inappropriate context and missing skills.
For example, a left-handed person in an art class where they're doing paper-cutting Origami work, but all the scissors are right-handed scissors, would have impairment. That unfortunate person would perform below the standards for the class, finding it difficult to either cut the paper with their right hand, or to clumsily use right-handed scissors in their left hands. (Lefties can tell you all about this.) You could do studies to show that their self-esteem is down, their performance down, and their future prospects in the Origami business are dim. All would be true, but irrelevant, because they're looking at the symptom and not the cause, which is that the context is inappropriate (they need left-handed scissors) or they're missing a skill (the ambidextrous ability to cut paper using scissors in either hand).
Does this mean that left-handedness is a disorder? In the example above, it seems it would qualify: it is a definable set of symptoms, marked by measurable differences in brain structure and activity, resulting in an impairment of function that can be projected into a dimmer future than that of right-handed paper- cutters in only-right-handed-scissors schools. But in the real world (at least until one of the pharmaceutical companies comes up with a drug to "cure" left-handedness), nobody considers left-handedness a disorder: it's merely part of the spectrum of the variety of human beings. Some even argue that it's associated with increased creativity and other insight skills. (Being a rightie, I can't comment from personal experience.)
Similarly, I suggest that we're framing ADHD wrong. We're looking at a set of symptoms and brain differences, and then when we find that AND impairment, we call it a disease. But what if the impairment is caused by the classroom or the job being totally inappropriate for the brain-wiring of the ADHD individual (a problem of inappropriate context)? Or what if the impairment is caused by the ADHD student or adult not yet having learned appropriate study or job or interpersonal skills (a problem of missing skills)?
If my hypothesis that what we call ADHD is actually a skill set, but one useful for a paramedic but not in a traditional public- school classroom (or a hunter but not a farmer) is correct, then it should be easily testable. Take ADHD children and change the context of their classrooms into high-stimulation, interactive models (as is done in many charter, gifted, Montessori, and Waldorf schools), or teach them study skills.
And those tests have been done.
Our experience at The Hunter School, and my own personal experience and that of my ADD/ADHD children, demonstrate the fact that ADHD with impairment is always either a failure of context or skills, regardless of "personality." When we take children who are failing (even with meds) in public schools and admit them to The Hunter School, we always (so far, in 3 years) have been able to educate them, and the vast majority we've also taken off or dramatically reduced their medications. When my own son moved from the public school (on Ritalin) to a private school (Horizon School in Atlanta, where he took no Ritalin), his "impairment" vanished and he began to function well (he's now a senior at Georgia State University).
When, as a child, I was moved from "normal" classrooms into the "gifted" classroom (started as a result of Sputnik in the mid-1950s and all but abandoned in elementary schools by the late 1960s in order to move funding from education to the Vietnam war), my teachers quit telling me to sit down, shut up, and pay attention. In the gifted classrooms, I loved learning – they couldn't stop me (and thus I got a summer scholarship in biochemistry to MSU at age 14). My youngest brother, attending elementary school as the war was ramping up and the gifted class "experiment" was being wound down, ended up in a "normal" classroom…and was given Ritalin. I'm sure it would have been my fate, too, had I had to endure the "leftie in a rightie's world" inappropriate context of a "normal" classroom.
Similarly, the incredible success of Sylvan Learning Centers, Hooked On Phonics, Don Blackerby's work, and other programs like theirs across the world that teach study skills and learning, with their many success stories about how children, once learning new skills to use in a classroom, no longer needed medications, testifies to the possibility that part of ADHD "impairment" is a failure to pick up certain useful and important skills. And it demonstrates that these skills can be taught!
The challenge, then, is twofold. We must change our schools, and we must introduce into our curriculum specific instruction for children in how to learn to learn in a school setting. Both are possible, and, based on those programs which have done so successfully, indicate that we can dramatically reduce the number of children who are wounded by being told they have a brain disease, are disordered, or are deficient. For the sake of our children, our future, we must begin this today.
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