Attention Deficit Hyperactivity Disorder (ADHD) : Challenges Established Family Norms and Beliefs

By: William L. Smith Ph. D.
Submitted: 2007-01-17 16:26:59
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Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral disorder of childhood. It is commonly estimates that from 3% to 6% of the child and adolescent population in the United States is diagnosed with ADHD. However, a recent report issued by the American Psychiatric Association (APA) suggest that ADHD may affect as many as 8% to 17% of America's youth. The APA report indicating a greater public health threat than previously thought.

Children and adolescents with ADHD are at a significantly higher risk for numerous emotional and social problems than those without ADHD, including academic and occupational underachievement, violence and criminality, increased suicide and risk-taking behavior. Children with ADHD are also at risk for depression, interpersonal difficulties, and family disruption (J. Kendall, 2003). Although studies have demonstrated that family dysfunction is common in families with ADHD children. Also, family members may suffer serious psychological effects, however, knowledge is noticeable lacking as to how to help these families cope with the daily challenges ADHD.

Article of interest Recently I read an article titled, Working with the Family of a Child with Attention Deficit Hyperactivity Disorder (ADHD). The authors of this article are: D.J. DeMarle, L. Denk, and C.S. Ernsthausen. I recommend this particular article for several reasons the most important being that it is replete with great ideas; and some very good suggestions that sets the framework for addressing family members' relevent concerns about ADHD and make recommendation for effective treatment and support system. Most practitioners understand ADHD as a medical condition. I don't agree with that assessment. It is true that ADHD has a biological and a physiological component. However, I believe that ADHD is a psychological, behavioral, and medical disorder. When we view ADHD as a single entity we run the risk of treating part of the symptoms. For example, if we focus on the medical aspect ADHD, the medical practitioner is commonly consulted to determined if the child meets the criteria for ADHD as required by the Diagnostic and Statistical Manual of Mental Disorder (DSM IV). The evaluating physicians are also called upon for advice and to prescribe treatment for the disorder. However, most physicians with a very active practice cannot devote the time that is necessary with the family to review the nature and causes of ADHD and the multi-disciplinary approach to treating the disorder. Therefore, there is an elevated risk that the doctor may inadvertently reinforce existing fears and misconceptions about ADHD in the minds of family members.

With this in mind we can understand how crucial the multi-disciplinary team and their experiences working with and supporting families throughout the interviewing and consulting process. Research shows that family's reaction may directly influence parental attitudes, the child, and their actions with him or her. It is an accepted fact that parents' attitude is affected by the information received, compassionate understanding, and the level of attention shown by the physician and other professionals sharing the news. This article, in my opinion, is a road map that can guide families through the process and help the team to develop strategy to reduce family members' anxities.

Because ADHD has received mass media attention in recent years many in the general public have reached an opinion about ADHD that is not supported by scientific facts. I offer this brief quote from the article to established a foundation for the unsupported, but wide, belief about ADHD. The authors described the verbal exchange between Don and Mary Butler (pseudonym) who had just been told by their pediatrician that their son Tommy had ADHD and suggests Ritalin as the appropriate treatment. Don turns to Mary and said, "See I told you he was just a lazy and rotten kid, even the doctor thinks so; that's why he is putting him on medication."

ADHD Real or Imagined? Don is expressing a widely held belief that ADHD is not a legitimate medical illness. It has been suffested that many in the medical community has strayed from the scientific path and created a disorder to ease teachers and parents' anxieties regarding childhood inappropriate behavior by routinely drugging children into proper behavior. Those who continue to believe that ADHD is a medical myth must ignore a mountain of scientific studies and research literatures that documents the existence of ADHD as a ligitimate and serious disorder. Based on the criteria established by the DSM IV, ADHD accounts for the greatest number of referrals to child mental health clinic than all other psychiatric and behavioral problems of childhood adolescent.

The continued questioning of the validity of the diagnosis of ADHD has caused uncertainties about its management in the minds of many clinicians and the public at large. Inaccurate beliefs about the validity of ADHD may hinder the appropriate care of some patients and cause confusion about the need for approved treatment. As stated above, critics describe ADHD as a means to label difficult children who are not ill but whose behavior is the problem. They further contend that, far from having a biological basis, ADHD results from improper parenting and poor, ineffective, teaching practices. These attitudes further stigmatize patients and their families, and increase the burden of this debilitating disease. There is overwhelming medical evidence that ADHD not only cause specific disabling symptoms that often persist into adulthood, but many studies shows a biological connection and a characteristic response to approved treatment.

Rodney Dangerfield, the well-known actor/comedian, often said "I get no respect." The thought that came to my mind was ADHD gets no respect. That is certainly the conclusion one might reach after reading so many insidious statements that ADHD is not an authentic and debilitating disorder. Many of us, including this author, who work with children diagnosed with ADHD have no illusion about the reality and seriousness of this disorder.

Like many teachers, in todays educational settings, I come in daily contact with students diagnosed with various disabilities, including ADHD. Therefore I have a profound sense of resentment toward those who support the beliefs that ADHD is not a legitimate illness but nothing more than a label created specifically to absolve parents and teachers of their responsibility to manage uncontrollable children. However, I can understand how the uninformed and those who choose to view ADHD from a distance might easily be led astray. For example, many of us at some point exhibit some of the symptoms common of ADHD. We sometime get distracted, we have trouble finishing assigned work or completing other important tasks. On the other hand, children with ADHD are, in most case, less able to care for themselves, less able to behave appropriately in social setting; and less able to communicate on the same level as other children of the same age.

Phantom Symptoms

Final, for unknown reason, symptoms indicating the present of ADHD may temporarily be absent leading others to believe that the person with ADHD can control the behaviors. Also, a definite diagnosis is difficult because there are no tests that can consistently detect ADHD. A physician can only observe behaviors and offer a professional conclusion weather the child has ADHD. If a child is having trouble concentrating, or may be unwilling to cooperate on the day they see the doctor this could lead to an incorrect diagnosis. Therefore, it is very important that ADHD be diagnosed by health care professionals that specializes in these types of disorders with the help and cooperation of parents and teachers.

DeMarle D.J., Denk L., Ernsthausen C.S. (2003) Working with the Family of a Child with Attention Deficit Hyperactivity Disorder. Pediatric Nursing, Vol. 29 (4), 302-308.

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