I have ADHD. I’m 24, and I was diagnosed almost three years ago. I will probably be on medication for the rest of my life. Frankly, given the alternative, I’m okay with this. Attention Deficit Hyperactivity Disorder (ADHD) is a spectrum, like Autism, and I’m at the more severe end of it. Without medication I’d be essentially unable to function properly in the world or do my job.
A recent piece in the Observer on Sunday claimed that, based on the opinion of an American neuroscientist, ADHD is a ‘made-up’ disorder. The same piece also heavily implies that millions of children are being dosed with powerful drugs for no real reason. This is, to put it bluntly, total bullshit.
Articles like the Observer’s inspire a level of anger in me I generally reserve for anti-vaccination idiots and AIDS-denialists. Hopefully you’ll understand why in a few paragraphs. But first let me make this crystal clear: ADHD is neither made-up nor is it a childhood disorder. It is a serious psychiatric condition that can be pretty debilitating if untreated. And it has very little to do with attention span.
ADHD is not, as the name would imply, primarily a disease of attention or energy. It’s far worse and far more pervasive than that. While it does greatly affect your ability to focus on work — children with the disorder have a tendency to run around a lot — those are only the most obvious symptoms at the age they generally manifest. It’s a bit like saying Autism is mainly characterised by a lack of eye contact, or depression by staying in bed all day.
ADHD is a developmental disorder affecting the executive functions of the brain along with dopamine levels. It is thought to be mainly genetic in origin. Dopamine is a neurotransmitter involved in a huge array of activity but specifically, and crucially in this case, the brain’s reward system. The executive system, loosely defined, is your brain’s safety buffer and line manager for your thoughts and behaviour. Among other things it governs your ability to control impulses, think before you act, ignore distractions, defer short term satisfaction for long term gain, and control how you express emotion.
Symptomatically, people with the disorder have problems controlling their reactions, focusing on work, and can often fly into intense rages or crying jags where others wouldn’t. We have very poor working memories and can find it almost impossible to stop actions we find immediately rewarding when required (e.g. putting down the Xbox controller to go to sleep). We also lack an internal sense of time. I suffer from all of the above symptoms, which are common to all people with the disorder in varying degrees. It’s by no means an exhaustive list. Living with it is a daily challenge. Medication helps an awful lot and, because it’s a developmental disorder, it gets a bit better with age. About half of all children diagnosed with ADHD (3%-5% of the population) will continue to have the same issues as adults.
I’d hope it’s reasonably obvious by now that ADHD is a real thing. If nothing else, the literally thousands of studies on it published just in the last few years should convince. But before we move on to why exactly the Observer piece makes my blood boil, some background is required.
A Little History
While ADHD was only given its modern label in 1980 when the DSM-III (Diagnostic and Statistical Manual, 3rd Edition) was published, papers describing the condition appear in the medical literature as far back as 1798. Alexander Crighton, a Scottish doctor who practiced across Europe, dedicated a whole chapter in his book Attention and Diseases to it and describes symptoms ‘which render [the patient] incapable of attending with constancy to any one object of education,’ among other debilitating effects.
So ADHD, or something almost exactly fitting its description, was recognised as a potentially serious condition as long ago as the end of the 18th century. There are numerous other descriptions throughout the following centuries until we arrive at the DSM-III and it acquires its current name.
Why then is it such a controversial diagnosis today? After all, the names and classifications of psychiatric disorders change fairly often, and almost all such diagnoses are merely a label attached to a grouping of clinical symptoms. It may come as a surprise to some that we actually have very little direct evidence from neuroscience — rapidly advancing as a field though it may be — connecting particular symptoms of mental illnesses with activity in the brain. fMRIs and CT scans can only tell us which bits of the brain are more active at a particular time or which are damaged, they don’t describe what those bits do. The best we have for now are educated guesses and inference. So until that changes we’re stuck with clinical presentation as the main way of judging what’s wrong with someone mentally, and therefore how they should be treated therapeutically.
Problems with neuroscience aside, the answer lies in how ADHD was described in the DSM-III and IV, as well as how it is often diagnosed and subsequently treated. Until the recent publication of the new DSM-V, which has received criticism for a variety of reasons, it was classified by the manual as a childhood disorder. Despite the fact that ADHD impairs your ability to function in society no matter what your age might be, until last year the major international reference book for psychiatric diagnoses applied it solely to children.
The British Psychological Society, the APA (its American equivalent), and most other professional organisations of psychiatrists and psychologists have for a long time recognised and treated ADHD in adult patients. Because the DSM is only overhauled every couple of decades, however, the perception that the condition is a childhood disorder has stuck in the public consciousness. More importantly, as many people with ADHD are diagnosed as children and the most effective treatment is stimulants like Adderall or Ritalin, there are fears that doctors are medicalising “normal” childhood unruliness and drugging healthy kids. The fact that many stimulant medications are medical variations on amphetamine and can be abused also adds a nice dose of drug-addict stigma as the cherry on top.
It’s a tangled web to unpick, linking legitimate fears over medicalisation of normal behaviour, antiquated “drugs are bad” attitudes, and general stigma surrounding mental illness. That poor impulse control and inattentiveness, explosive emotional reactions, etc. are usually seen as failings of character rather than the result of a mental health problem doesn’t help either. I’ve lost count of the number of times I’ve been told it’s only an excuse for poor behaviour or a way for parents to control their hellspawn offspring with drugs.
It’s also somewhat frustrating that there is arguably a genuine problem with over-diagnosis of ADHD in the US, where GPs are often allowed to diagnose and prescribe for it on their own. As a result there are likely a fair few kids out there who are indeed on medication for something they don’t have. In the UK, that isn’t as much of an issue: a diagnosis requires a specialist psychiatrist, and GPs are often very reluctant to prescribe even if they believe ADHD exists at all. I’ve had GPs accuse me of drug-seeking for a speed hit; tell me that, contrary to all available medical and scientific evidence, stimulant medication doesn’t work to treat it; and insist it’s not a real illness — all in the same conversation.
The Media, or How to Sell Papers and Get Pageviews
That, in a fairly hefty nutshell, is the problem. And you’ll see it reflected in the way the media report anything to do with the topic. The medical-scientific consensus is that ADHD is a very real psychiatric condition, and an often serious one at that. Unfortunately, if you were to listen to the way it’s reported everywhere from the BBC to Fox News to the Guardian you’d come to the conclusion that psychiatrists were dosing children with drugs just for the hell of it at the behest of overwhelmed parents. It’s not the case of course, but when did news organisations ever let the facts get in the way of eyeball-grabbing headlines?
And this is why the Observer’s reporting pissed me off quite so much, and why I felt compelled to write about it in detail. ADHD is a genuine psychiatric condition, often subtler in its effects than something like Manic Depression but which can be just as paralysing and debilitating. It also fuels a cultural attitude towards and stigma around the condition that has had a real and highly unpleasant impact on my ability to access the treatment I need when I need it.
ADHD has affected my life in a number of profound ways, and made it infinitely more difficult. I don’t remember making a single conscious decision in response to situations before I was about 14. If I’m not on medication I can’t focus and I have very little control over how I express strong emotions: I’m 6’5” and my voice carries through concrete walls, so when I get upset it can be disconcerting for others around me — deeply problematic socially. I almost failed university because I simply couldn’t work for most of my final year as my symptoms worsened (I ended up with a 2:1 after being diagnosed and treated in the last couple of months of the academic year). The list goes on. Finally being put on meds was a godsend, and probably saved my life or at least my career. So it hits a nerve when someone comes along and has the gall to dismiss my experiences and those of millions of others, not to mention what the evidence tells us, as “not real”.
Think of it in terms of another less controversial psychiatric disorder and you’ll see what I mean. Would anyone tell a person with OCD that their compulsions and terrifying intrusive thoughts were simply an excuse for really wanting to, say, lock and unlock the door 20 times before leaving the house? I didn’t think so.
I’m sick of the narrative which stigmatises ADHD and the medication which is an effective treatment for it. I’m sick of anyone who takes medication for a psychiatric condition, whether ADHD, Bipolar Disorder, OCD, or any of the other myriad ways our minds can turn against and cripple us, being made to feel ashamed of so doing. And I’m sick of having to explain this to people and medical professionals who should know better. To steal a line from Network: I’m mad as hell and I’m not going to take it anymore. No one else in the quarter of the population who suffer from mental illness should have to either.