Attention Deficit Hyperactivity Disorder: Medical Condition or Social Construct?

I am skeptical about attention deficit hyperactivity disorder (ADHD). I do not disbelieve that the traits of ADHD exist; I do not disbelieve that these traits can impair children's ability to learn in a traditional classroom. I am skeptical of whether these traits are symptoms of a disorder, as opposed to characteristics of personality. I question whether the learning difficulties experienced by individuals diagnosed with ADHD should be relieved by making changes to the individual, as opposed to the social and educational environment.

The “symptoms” of ADHD are as shallow as they are disparate. Can such behaviors as procrastination, disorganization, or talkativeness, however excessive, be considered a disease as opposed to personality quirks? The fact that ADHD was once termed “defective moral control” is telling. This is a social disease, born of people failing to live up to cultural expectations. We take for granted that these expectations are factual; we view time, attention, and the expenditure of energy, each as having one correct application, from which the individual with ADHD deviates. That professionals used to believe that ADHD disappeared by adulthood, also suggests that this is not a disorder, but an interpretation of behavior in certain contexts.

Another telling trait of this “disorder” is the referral bias against boys (Hallahan, Kauffman, and Pullen, 228). We raise our boys, consciously and unconsciously, to be more aggressive, assertive, and active than we do our girls. It is easy to see how hyperactivity, impulsiveness, or lack of attention to uninteresting subjects, would go hand-in-hand with these mannerisms. Our girls, on the other hand, are bred to be passive, demure, and compliant. Little wonder they are less apt to be diagnosed with ADHD. Perhaps we should examine our schizophrenic expectations of the qualities we expect to see in boys.

The way our culture exalts certain abilities as, not only preferable, but necessary, is unfortunate. In a different cultural context, personality traits such as focused attention or a desire to accomplish tasks well before they're due, might be considered indicative of a disordered mind. In fact, child behavior expert Alfie Kohn has already suggested as much:

Consider a student who always starts her homework the moment it’s assigned. What might look like an admirable display of self-discipline, given that there are other things she’d rather be doing, may actually be due to an acute discomfort with having anything unfinished. She wants—or, more accurately, needs—to get the assignment out of the way in order to stave off anxiety. (“Self-Discipline”)

Similarly, Thomas Armstrong, in his book, The Myth of the A.D.D. Child, notes that we ignore the opposite end of the spectrum. He ponders why we do not medicate children who are hypoactive, or offer treatments for children who are too focused (15). Our society rewards the results of those behaviors. 

Professor of psychology Alison Gopnik speaks of schools as an experiment in how new environments can change the effects of genes. Tying this into the modern rise of ADHD, she says:

Some people were probably always better than others at paying sustained attention to just one thing. But these variations would have made no difference throughout most of human history—that kind of sustained focused attention isn't especially important for a hunter or a farmer, and it may even be a disadvantage. 

However, paying attention makes a very big difference in the environment of a schoolroom. In school, children who are good at paying attention to begin with will develop even more impressively focused attention skills. So the genetic differences become exaggerated, and being bad at attention becomes a problem, even a kind of disease. (173)

Evidence suggests that the characteristics of ADHD may also make one more prone to creativity (Yellin). But our authoritarian society values obedience over ingenuity. Psychologist Lawrence Kohlberg asserted that most adults do not ascend beyond conventional morality, a level at which “The person blindly accepts social conventions and rules and believes that if society accepts these rules, they should be maintained to avoid censure” (Parke and Gauvain 512). We relish the thought of children who do whatever they're told, but do we really want to create a nation of adults who are biddable sheep? 

I believe it is helpful to think of ADHD individuals as having a particular temperament, personality type, or learning style, rather than a disability. The latter provides an excuse for not making attempts at success, or trying to effect changes in the system. Many young people claim to be ADHD (with or without diagnosis). When they do something others feel is inappropriate or insufficient, they shrug their shoulders and say, “Oh, well, I'm ADHD.” (Note the conflation of the person with the disorder.) Whereas it is feared that the label may stigmatize children, among teens and young adults it's almost come to be a rite of membership in youth culture: I'm ADHD, just like everyone else. At a time when they are coming into a concept of self, this becomes woven into their identity. 

Many parents appreciate the diagnosis of ADHD because it lets them off the hook—deservingly or otherwise—for children's bratty behavior. However, just because people find a behavior annoying, doesn't mean it's deviant. The public needs to be educated on what behaviors to expect from children. We tend to view children's undesired behavior displays as a manifestation of the moral failings of the parents. We would rather ply the little ones with drugs, than offer social or educational support, because we don't care to be inconvenienced by their children's troublesome behavior. In a culture where we shame people for deficient traits, it is convenient to hang the blame on a disorder, rather than owning our mistakes or unpopular qualities. The fact that we even take this seriously as a disease speaks to our eagerness to divest ourselves of personal responsibility.

In light of the overwhelming lack of evidence that the characteristics of ADHD constitute a genuine disease, it is unconscionable that we so prevalently try to remedy them with drugs. Certainly, such drugs have proven to have the desired effect in improving children's performance (Hallahan, Kauffman, and Pullen 250). To this I say, so what? Is it not hypocritical to deny performance-enhancing drugs to adults, but require them for our children to succeed? 

If unacceptable behavior is the fault of a disease, to what do we attribute good behavior? Children, themselves, credit positive behaviors to the effects of ADHD drugs (Armstrong 44). Do we really want to raise children with the idea that they have no control over their behavior—for good or ill? Less than a century ago, we “soothed” infants by plastering them with tranquilizers, liquor, and opiates. I wonder if a century from now, we will look back on ADHD drugs as equally barbaric. Armstrong points out that “By using drugs to treat behavior and attention span problems, we may be substituting chemistry for coping in coming to grips with life's difficulties” (45).

Armstrong takes the position that, while ADHD is not a real medical disease, it is still sometimes appropriate to use the medications prescribed for it. I disagree. The evidence his book presents, suggests no good reason for favoring drugs over social/educational adjustments. On the other hand, I get the impression that the main reason Armstrong makes an allowance for drugs is that he fears parents will be unwilling to listen to anything he says without making that concession. Indeed, he offers much criticism of drugging children. Most of his book is dedicated to non-medical solutions for typical behaviors. 

I believe that the ideal solution for helping children with ADHD to succeed would mean reexamining cultural norms and overhauling defunct educational practices. If a child is capable—as most children with ADHD are—of focused attention in areas of interest, why is the onus placed on the child for having a deficit of attention, rather than the teacher for failing to make lessons meaningful and interesting? Indeed, Alfie Kohn notes that “the problem may be more one of willingness to comply—especially in performing tasks that the children find boring—than one of a built-in deficit” (“Suffer”).

We know that children respond better to situations in which they are empowered to make choices. Why, then, do we expect them to excel in a system of enforced behaviors and activities? I am being taught, in an accredited, public college, that allowing children to move around, focus on their interests, and partake in hands-on activities gives them a higher chance for educational success. Why, then, are we not implementing this in our public schools? If we devoted half the attention to this question that we've given to ADHD as a medical disorder, we likely could have effected wide-scale changes in our schools by now. 

Unwillingness to comply with tasks when one sees no benefit to engaging in them, suggests an aptitude for understanding the relationship between effort and rewards that speaks of these children's intelligence. It is that kind of critical distinction, rather than blind compliance with a faulty system, that I would encourage in our children. I believe it is the responsibility of educators to use differentiated teaching methods, and build upon the interests of the students in a way that allows students of all temperaments, learning styles, and intelligences to succeed in learning.

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This was my English 111 research paper.

Works Cited:

Armstrong, Thomas. The Myth of the A.D.D. Child: 50 Ways to Improve Your Child's Behavior and Attention Span Without Drugs, Labels, or Coercion. New York: Dutton, 1995. Print.

Gopnik, Alison. The Philosophical Baby: What Children's Minds Tell Us About Truth, Love, and the Meaning of Life. New York: Farrar, Straus and Giroux, 2009. Print. 

Hallahan, Daniel P., James M. Kauffman, and Paige C. Pullen. Exceptional Learners: An Introduction to Special Education. 11th ed. Boston: Pearson, 2009. Print.

Kohn, Alfie. “Suffer the Restless Children.” The Atlantic Monthly 292.2 1989. 81-98. Web. 3 July 2010.

Kohn, Alfie. “Why Self-Discipline is Over-Rated: The (Troubling) Theory and Practice of Control from Within.” Phi Delta Kappan. November, 2008. Web. 3 July 2010.

Parke, Ross D. and Mary Gauvain. Child Psychology: A Contemporary Viewpoint. 7th ed. New York: McGraw-Hill. 2009. Print.

Yellin, Deena. “Harnessing ADHD; More and More Experts Say It Can Be a Gift Rather than a Malady.” The Record. 10 May 2005: F01. Factiva Web. 2 July 2010.