ADHD: Myths vs. Reality

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1. Information about AD/HD abounds making it difficult to know which sources are trustworthy and reliable, and which are not. What are the myths vs facts of ADHD? Support your answer with empirical evidence.

Information about AD/HD abounds making it difficult to know which sources are trustworthy and reliable, and which are not.
Conflicting information causes confusion among not only members of the public, but the media and policymakers alike. Separating the facts from fiction requires examining the scientific evidence behind all questionable claims.

1. MYTH: AD/HD is not a real disorder.

FACT: AD/HD is a neurobehavioral disorder characterized by differences in brain structure and function that affect behavior, thoughts and emotions.

Questions regarding the existence of AD/HD continue to persist in the public arena, despite the overwhelming scientific evidence supporting the validity of AD/HD as a real disorder. Research has demonstrated that the biological basis of the disorder lies in differences in brain structure and function, as well as differences in the presence of specific genetic abnormalities. Neuroimaging studies have found differences in the size of brain structures such as the prefrontal cortex, the basal ganglia, and the cerebellum, as well as lower than normal blood flow in these same brain areas.

Genetics also appears to play an important role in the etiology of AD/HD. Over 20 published studies have suggested associations between AD/HD and specific forms of the DAT1 and DRD4 genes. Non-genetic factors that have been implicated in the etiology of AD/HD include prenatal care and exposure to environmental toxins. While studies of the possible impact of toxins are intriguing, findings generally indicate that such influences are not powerful enough to indicate widespread cause, and thus most likely account for few cases of AD/HD. Widely touted causes also include food additives, sugar and possible food allergens, but unlike lead, alcohol, or tobacco, the effects of these agents have generally remained controversial and have not been replicated in rigorous studies.

With respect to diagnosis, there is a common misconception that physicians are unable to diagnose a condition without a blood test, x-ray, or physically observable change in the body. The lack of a blood test or brain scan that can reliably make a diagnosis of AD/HD does not preclude the existence of a disorder. No such diagnostic tools exist for conditions such as migraine headaches, premenstrual syndrome (PMS), and even asthma, all of which are principally diagnosed by the pattern of symptoms observed by the doctor, and often reported only by the patient. Historically and still today, physicians often make diagnoses, including migraine headaches, a strained lower back, tinnitus, schizophrenia, and PMS, based on a characteristic set of symptoms and other clues that fall far short of any physical "proof." As with other disorders, it is likely that, in time, sophisticated tests will be developed to assist clinicians in the diagnosis of AD/HD.

Critics of the disorder's validity also highlight the discrepancy in rates of diagnosis in the United States compared to other countries, saying that AD/HD is an "American disorder." On the contrary, the difference in rates of diagnosis and treatment of AD/HD is a testament to the advanced standards of American medicine, which other countries have been slow to emulate. At a 2000 meeting of the Council of Europe, the consensus of member countries was that AD/HD is underdiagnosed by a factor of 10 to 1 across Europe.

2. MYTH: AD/HD results from crowded classrooms, bad teachers, and bad parents.

FACT: Research has consistently failed to support the "bad parent" or "bad teacher" theory.

Research on the impact of home, family, and classroom factors on AD/HD symptoms indicates that such factors do not cause AD/HD. Problems at home and school can cause difficulties in a child's life, regardless of whether a child has AD/HD or not. It is also well known that children with all types of chronic illnesses fare worse when they are experiencing stressful life circumstances. Family stresses can exacerbate asthma symptoms, but this does not mean that the family stress causes the asthma. Similarly, family stresses can exacerbate AD/HD symptoms, but this does not mean that the parenting or home life causes AD/HD.

The behavior problems associated with AD/HD stem from difficulties with the brain's executive functions, which are planning and forethought, inhibition of impulsive responses, and inhibition of processing task-irrelevant stimuli. Behaviors resulting from these difficulties can be perceived as ill-mannered, indifferent, and oppositional or defiant. When such difficulties become part of a longer-standing pattern of behavior, the individual may receive frequent and negative feedback. Because individuals with AD/HD can become easily demoralized, depressed, anxious, or angry, a vicious cycle of negativity can ensue, placing the individual on a downward spiral of unhappiness and failure unless effective interventions interrupt the negative cycle.

3. MYTH: AD/HD treatments ...