Tuesday, January 29, 2013

ADHD, ODD, & Other Assorted Bull****!

Last week, there was word in the news that there has been a marked rise the number of children diagnoses with attention-deficit hyperactivity disorder ("ADHD On Rise Among Minority, High-Income Families").  The implication is that this rise in diagnoses of this accepted disorder reflects the recognition that many challenging behaviors exhibited by children nowadays can be explained away. But does clinical intervention explain away many negative behaviors in children?
Let’s face it…America is a blame-oriented society. During the last 25 years or so, we’ve come to routinely blame either some perceived and “foreseeable” circumstance or other individuals for anything that occurs that results in some real or imaginary harm to us. As soon as something happens—a vehicle crash, a spilled cup of hot coffee, or an intended compliment taken as a harassing statement—we’re burning rubber away from the scene of the perceived slight, headed to the nearest lawyer’s office. Our ultimate goal is to seek monetary redress for the irreparable “damage” to our egos, sensitivities, or the infliction of some highly subjective (and questionable) “pain and suffering” on our lives.
Aside from replacing baseball with a new favorite American past time—suing—such insane thinking has resulted in a new ethos among Americans. We have grown to attribute what happens to us on circumstances rather than our own individual short-sighted judgments or actions. This is a phenomenon that I have witnessed among America’s youth, day in and day out for the last 15 or so years that I have been working with them. And the most tangible example of this devil-made-me-do-it mentality are the results of our nation’s clinical health professionals over-diagnosing neurobehavioral “disorders” such as attention-deficit hyperactivity disorder (ADHD) and Oppositional Defiant Disorder (ODD).
No, I’m not a clinician as such. However, growing up in a time period where such “disorders” were not known or even identified as such, it’s hard for me to accept their validity as bona fide maladies. Back in my day, “hyperactivity” (as symptoms strings related to such currently acknowledged behaviors was called) was dealt with by the influence and coercive power of a social ethos that both reinforced self-discipline and responsible parenting. Back then, children who couldn’t seemingly sit still for some reason were not indulged with some new-age “understanding” of their “condition;” they were told to “sit down and stop moving.” And because most other children were told the same thing and reared in the same manner, the individual desire within these children not to stand out in such comparatively more rigid social times because of their behaviors was enough—more or less—to keep their actions in check. General thinking of the time helped to mitigate these issues to a great extent.
Parents, for the most part, were governed by a variation of this same socially-powered sense of responsibility when it came to raising children with these issues. This is to say that parents were more cognizant as well as sensitive to the potential stigma of being considered a “bad parent” by allowing their children to run amok in school and around the community. In the home, such rambunctious behaviors were oftentimes considered a sign of disobedience toward parents…and which simply wasn’t tolerated by parents who were both compelled and duty-bound—also by force of social expectations—to correct such behaviors (notice I said behaviors, not “affliction”).
True, there had always been some level of empirical medical science that validated the reality of some children having a “hyperkinetic disorder” as early as the 1960s (as ADHD was called back then), it was more or less identified within the realm of constant physical movements. Later, other “symptoms” were added to this phenomenon, giving it something of a psychological dimension. Now, verbal and cognitive impulsiveness were added alongside motor impulsiveness as a component of the condition, which lead to the belief that combined, these “symptoms” were related to behavioral issues. The new string of “symptoms” attributed to ADHD soon qualified it (somehow) as a medical diagnosis.
When Adderall and other psychotropic drugs were introduced in the 1990s to combat this now-recognized “medical/psychological disorder,” it sort of let parents off the hook for certain behaviors exhibited by their children. Not only did drugs provide a quick fix alternative to rambunctious and oftentimes out-of-control behavior that was at one time addressed by direct parenting, but gave many parents a medical validation of their children’ behaviors. And needless to say, children were just as eager to adopt an excuse for why they would choose to engage in such behaviors. And living in a blame-oriented society, both children engaged in behaviors excused by ADHD and their parents have seized upon this “out” as a means of justifying their actions and lack of responsible parenting, respectively.
The same dynamic plays out even more when it comes to ODD—the three-dollar bill of clinical diagnoses. In fact, as I work with kids questionably labeled with this get-out-of-jail free card, I often find myself asking, “What’s the difference between a child who has ODD and a spoiled brat?”
As a current case manager, former long-term substitute teacher, and older adult who remembers a time when those around me were not engaged in behaviors that could be written off as some form of neurological impairment, the hardest part of my position is to work within the parameters of (some) diagnoses I simply don’t agree with. While granted, I come across some children who’s behaviors definitely indicate that there is some crossed wires somewhere in their gray matters, many others are just the victims of (a) diagnosis that’s used as a general categorization of misbehaviors that our post-take-them-to-the-woodshed society is not willing to concede as being just another bratty kid in need of more direct parenting…and an occasional hickory switch to the their backsides!
I see my fair share of children who throw tantrums and hissy-fits whenever their parents tell them “no,” as well as those who seem to give Oscar-worthy portrayals as a deaf person when it comes to telling them to do something. For the minority among these children whom I would classify as being accurately diagnosed as having disorders along these lines, the drugs do make a great difference in their behaviors. But for many other kids whom clinicians decide to slap these labels on, I find it enables these children’ negative behavior, providing them with yet another excuse not to comply with (parental) authority. Furthermore, it absolves parents of responsibility for their children’ behaviors, as well as burdens teachers—already overwhelmed with other children and related-responsibilities—with having to deal with bad kids that medical “professionals” had decided are “learning impaired” and therefore, warrant special dispensation when it comes to expectations of learning.
The problem I have with ADAH, ODD, and other fairytale-like beliefs when it comes to our children’ behavior is that the criteria for making such assessments are totally subjective; they are defined entirely in terms of their symptoms, not in terms of some malfunction of the body. This is to say that a diagnosis of either of these imaginary afflictions are not based on objectively measurable factors, such as chemical imbalances or MIR scans of know behavioral maladies like chronic depression and schizophrenia (yes, I know about scans that "seem to indicate differences in the brains of ADHD children, but like the "gay gene," this is nothing more than uncorroborated medical speculation in children where the conclusion of ADHD is made simply by a doctor literally looking at them). They seem to be predicated more on moral judgments of social expectations.
Take for example criteria for diagnosing a “case of ODD.” Among the list of “symptoms” which indicates the presence of this “disorder” are: “actively defies often actively defies or refuses to comply with adults' requests or rules;” “often deliberately annoys people’ “is often spiteful or vindictive,” and so forth. Hell, that doesn’t sound a disorder to me…it sounds like Macaulay Culkin’s character description of “Kevin McCallister” from the Home Alone movies! The logical implication of this insanity is that if a child were exhibiting these characteristics toward home invaders instead of his/her parents, they would be applauded as rightfully “resisting criminals.” But since such behavior is at odds with teachers, parents, and other authority figures familiar to said child, it’s “recognized” as a “disorder.” Yeah, right.  Isn’t it funny that ADHD and ODD are characterized by unusual negative behaviors rather than unusual compliant behaviors?
As it stands, the over-diagnosing of these issues—I believe—are the result of a combination of changing social trends (i.e., emerging and competing schools of thought on how to raise children), the stronger emotional influence of the media, and the advancements in medical technology and research. I believe these to be valid factors contributing to the rise in diagnoses of both ADHA and ODD…when applicable. However, trying to validate a child’s negative behavior by giving it a clinical “cause” is license to children that that they have the right to defy parents and teachers…that there is a “valid” reason why they engage in such behaviors. In a sense, those who take this path of jaded and questionable thinking would be right, but not in the way they think. If everyone involved would go back to the levels of universal responsible parenting, along with the power of conformity when it comes to rearing children, the number of children and teens over diagnosed with these issues would dramatically shrink!


  1. I'm going to throw in a mix of agreement and disagreement. I am a mental health counselor. I work more with adults than kids. I too have skepticism of diagnoses like "ODD" which often seems like bad behavior. There is some research to suggest it is a precursor to antisocial personality. I think there is an array of conditions that contribute to this, from poor parenting to lack of parenting to braind development to social culture. ADHD I have fewer doubts about. I was dx'd with ADHD (non hyperactive type) as an adult. it fits. If you observe the disorganization and poor career outcomes of even some very intelligent adults, you tend to see there is a functionality problem. Brain function is a huge contributor to thoughts, feelings, and behavior. Poor sleep is often a factor contributing to issues with brain function. I do think the diagnoses are often uses as excuses for poor behavior. Or excuses for poor parenting or non-rigorous teaching. But I have no doubt about the significant role of poor brain function in overall behavior.