Is Attention-Deficit Hyperactivity Disorder (ADHD) A "Real" Disorder?

NOTE:  I have the “NO” Perspective. Must respond to Perspective 1, Perspective 2, and Perspective 3 below with a minimum of 250 words each and I reference each.

Perspective #1: Is Attention-Deficit Hyperactivity Disorder (ADHD) a “real” disorder? Yes, it is a real disorder. Alexander Crichton (1763-1856) was one of the first to publish information on children with difficulty being attentive or controlling their behavior in his 1798 published work, An Inquiry into the Nature and Origin of Mental Derangement. After that, it was a matter of various iterations, research, and discovery that eventually led to A. T. Childers work on hyperactivity and behavior disorders in 1935, which discusses ADHD well before it was called that or the DSM was ever published in the 1950s (Childers, 1935). Eventually, the DSM recognized hyperkinetic issues, the precursor of ADHD, in DSM II and then Attention-Deficit Disorder in DSM III, which has led us to this point of discovery. Moreover, psychostimulants have been used to treat what is now called ADHD, since the first study utilizing Benzedrine, a derivative of the stimulant ephedrine, published in 1937 (Strohl, 2011). This study helped find potential, if not real, relief from the effects of the disorder but it also had the unfortunate side effect of announcing to pharmaceutical firms that these drugs could be and would be used on children to make them fit the socially accepted ideals that parents and society had for those children. This started a marketing push for the use of intense psychostimulants for children. Please see the 1956 and 1957 Thorazine ads here, specifically ads 7 and 8, to get a good feel for how Smith, Kline & French Laboratories – the makers of Benzedrine from Bradley’s studies in 1937 – began marketing similar products.   Consequently, ADHD and its treatments are not new concepts, we simply know more about gene regulation and neurotransmitter release than we did in the past. As the fMRI and other scientific advances, like the discovery of DNA sequencing, have made understanding the underlying mental and neurological issues of ADHD easier to recognize, we are beginning to understand that ADHD likely has genetic components that exhibit age-specific risk factors (Sánchez-Mora, et al., 2013). Meaning, we are beginning to realize that both children and adults are susceptible to the onset of ADHD if they have the associated genetic profile (Sánchez-Mora, et al., 2013). Like schizophrenia and bipolar disorders, there seems to be some type of heritable or genetic trigger, which cannot be easily discounted. Therefore, ADHD is a real disorder. On a personal level, my grandmother worked with children who had Autism and ADHD. She chose to work with those that were not mild or well-medicated cases. In mild or well-medicated cases, a person may never know about the issue. However, I saw manic fits from these kids that were scary. It was not just some overindulged child having a hissy fit because they could not have a toy, it was a thing undo itself. I have since met adults with ADHD and their children, so I can say from my own anecdotal evidence, this is a real disorder. (Cheryl)

Perspective #2: As early as 1932, German physicians Pollnow and Kramer noted a characteristic motor activity increase in children not accountable by current medical conditions of the day (Lange, Reichl and Tucha, 2010). Also noted by the duo was that the behavior exhibited served no immediate purpose; it appeared the children were distracted by random stimuli and unable to focus (Lange et al. 2010). Though concentration on any activity was limited, these same children had the ability to immerse themselves for long periods of time if they were interested and engaged. They exhibited mood swings and frequent aggressiveness and disruption of their immediate environment; these factors cumulatively correspond to the Diagnostic and Statistical Manual of Mental Disorders (DSM) requirements for a diagnosis of ADHD: hyperactivity, inattention, and impulsiveness (Lange et al. 2010).      Through all its manifestations, in 1968 the disorder was incorporated into the DSM-II as “hyperkinetic reaction of childhood” with behavioral traits characterized by restlessness and attentional deficits (Lange et al. 2010). The DSM-III renamed it to Attention Deficit Disorder (ADD) with the addition or exclusion of hyperactivity and in its fourth incantation, the DSM-III-R, the hyperactivity subtypes were eliminated and the disorder was renamed Attention Deficit Hyperactivity Disorder (ADHD); if the hyperactivity was absent the diagnosis was “undifferentiated ADD”(Lange et al. 2010).      There exists no definable boundaries of what constitutes a disorder in the current DSM-IV (Stein, Phillips, Bolton, Fulford, Sadler and Kendler, 2010). Context plays a crucial factor when defining a “disorder”. Situational variables can and do contribute as to the validity of the diagnosis. Symptoms are presented on a continuum; there is no preset designation of “dysfunction”. Additionally, evaluation of symptoms is highly subjective; impulsive behavior exhibited on the playground can go unnoticed but might be construed as disruptive in the classroom. Thirdly, perceived dysfunction can be viewed differently according to the biological age of the child; at age two it can be viewed as “the terrible twos” (a developmentally accepted label in our US culture) but at age eight that same behavior can be regarded as impulsive and hyperactive and diagnosed as ADHD.      It is imperative that labeled disorders such as ADHD not be misclassified as separate distinct conditions when they may be nothing more than a range of symptoms on another disorder’s continuum, ie.bipolar or conduct disorder. Antisocial personality disorder and narcissism correlate highly with the hyperactivity exhibited in ADHD and borderline personality disorder has the greatest concurrence with all three symptoms associated with ADHD; hyperactivity, impulsiveness and inattention (Matthies and Philipsen, 2016).  There is a significant heritability factor between autism and ADHD; central nervous system development is believed to be affected; symptoms begin in early childhood and continue into adulthood (Matthies and Philipsen, 2016). Externalized disorders such as oppositional defiant disorder or conduct disorder  are found in approximately 50-70% of children diagnosed with ADHD (Armstrong, Lycett, Hiscock, Care and Sciberras, 2014). The same studies have confirmed roughly 64% of ADHD diagnoses suffered from internalized disorders including anxiety and depression (Armstrong et al. 2014). If externalized and internalized disorders are combined, it resulted in comorbidity rates of more than 22% (Armstrong et al. 2014). Clearly more research is needed to reevaluate and possibly reclassify the multitude of psychological “disorders” currently listed in the DSM. ADHD and its associated symptoms may meet the criteria as a subset of one or more of the diagnostic conditions mentioned above and not a “real” disorder classification on its own. (Mary)

Perspective #3: Hello, class. Is ADHD a real disorder? I would have to say yes. ADHD is very common in childhood. ADHD affects things like focus, concentration, self-control, and involved hyperactivity. It affects many daily life skills. ADHD, often times, runs on families. ADHD affects how someone, especially children, function in school, work, and their overall day to day lives. ADHD is caused by abnormalities in brain anatomy, as well as abnormalities in wiring. There are numerous symptoms of ADHD, and those can include issues with managing time, paying attention, managing emotions, being organized, and a whole list of others. For many years, most thought that ADHD only affected children, but now it is recognized that ADHD affects adults as well. One important symptom of ADHD, especially in children, is that they can focus on something that interests them. This is called hyperfocusing. This means that they can focus on things like video games, etc. but can’t focus on things like school work.  ADHD, from the beginning, has been a widely debated diagnosis. It has been quite controversial. The diagnosis came about approximately 30 years ago. The reason it is so widely debated is due to the fact that many feel as if many of the “symptoms” are in fact normal behaviors of children.  Some could argue that some of these such as a short attention span or not being able to focus on schoolwork are normal behaviors of children, however it is when several symptoms occur it is diagnosable as ADHD. There are some symptoms of ADHD that are centered in only this disorder. The fact that it also is prevalent in adults is another reason why it is obvious that the disorder is real and it does exist. One major symptom of ADHD in both children and adults that help separate it from “normal” childhood behaviors is issues with managing emotions. People with ADHD struggle with behaviors that is inappropriate for their specific age group as well. While it could be feasible to argue that ADHD is not a “real” disorder at all, I believe it is more feasible to understand why it is. While ADHD does include some symptoms that could be considered normal childhood behaviors, many of the other symptoms that go hand-in-hand with ADHD, and are present as well, make it quite easy to see why it is a real, diagnosable disorder. In the end, it is my opinion that ADHD is a real disorder. (Mitchell)

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