Is ADHD Real?
Neurologist Richard Saul says it isn’t. In a recent article1 for Time Magazine, he writes, “I’ve come to believe, based on decades of treating patients, that ADHD [Attention Deficit Hyperactivity Disorder]— as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.”1
Dr. Saul goes on to say that the collection of symptoms that “define” this “disorder” can be caused for a number of different reasons. “In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.”
I am so happy that this idea is getting more out into the general air, where parents and teachers can read about it – and perhaps rethink what is going on with their “problem” children. ADHD, like any label, tends to reduce thoughtful consideration of its probable causes.
Which is not to say that the behavior described as ADHD isn’t real. There is no doubt in my mind that children these days are having more difficulty attending to tasks and staying focused than they used to. I got into the developmental movement business in the first place because after a few decades of teaching piano, I was finding that my students seemed less able to learn the instrument. I was seeing vision problems, gross and fine motor problems, immature behavior . . . I felt foolish, having to teach a child where middle C was, when he could sometimes barely stay on the bench!
According to Dr. John Ratey, author of several books on attention problems, “ADHD stems from a malfunction of the brain’s attention system, a diffuse linkage of neurons that hitches together areas controlling arousal, motivation, reward, executive function, and movement.”2 I find this neurological picture helpful; it seems like a window into the brain of a child who is easily distracted, disorganized, and unable to put the two plus two of cause and effect together. Ratey goes on to cite research that shows that folks with ADHD symptoms show 10% less brain activity than folks without – “and that the largest deficit was in the area of the prefrontal cortex, which has a firm hand in regulating behavior.”3
This interests me a lot, from the point of view of a reflex specialist. Reflexes “live” in the medulla, in the back part of the brain – as far away from the pre-frontal cortex as can be. Reflexes become active under stress – and as I’ve written many times before, when the system is in stress, the brain believes that survival is an issue. Survival trumps everything else, for obvious reasons – executive function is a luxury you can enjoy once you are already up in the tree and the sabre-tooth tiger is far far away. When the goal is to survive, running fast trumps thinking about which way to go.
So when the reflexes are active, and speed of reaction becomes paramount, the neural links between the back and front part of the brains detach. Suddenly, you can’t get to the there of the creative problem solving, executive functioning ability to self-regulate - from the here of reflexive survival stress. That’s why people who are under stress (and I would suggest that ADHD behavior is, to a large extent, stress-based behavior) don’t always think very clearly or seem to have much control over their actions.
It is also interesting to me that Dr. Ratey prescribes movement as an antidote for ADHD. Movement is what grows the brain. And the right kinds of movement integrate the reflexes, re-attach those links between the survival brain and executive function, and create the possibility of calm, considered action. Dr. Ratey says, “[The pre-frontal cortex is] prone to positive reinforcement through exercise.”3
So if exercise is helpful for the development of the pre-frontal cortex – and the behavioral, academic, social, and health benefits that ensue – why exercise the thing that gets taken away when children misbehave? Or don’t perform well academically?
And if exercise works so well – which is safe and developmentally appropriate – why are parents of children with ADHD symptoms increasingly offered – and sometimes pushed into - untested, unresearched pharmaceutical “solutions?”
Dr. Saul is concerned about ADHD medication for three reasons:
1.“The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace . . . I worry that a generation of Americans won’t be able to concentrate without this medication.”
2.“There are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide.”
3.“Stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.”1
Here's the good news: an ADHD diagnosis is not a reason to medicate. It is an opportunity to look at the needs of each particular child, and to find creative ways to address each particular situation.
But the right activities can help every child. Any movement (including music!) that integrates the reflexes builds the neural pathways between the survival system and the rest of the brain – including the pre-frontal cortex. And when executive functioning is strengthened, the ADHD symptoms tend to slip into the background.
1Doctor: ADHD Does Not Exist by Richard Saul, Time, 3.24.2014
2Spark: THe Revolutionary New Science of Exercise and the Brain ©2008, John J. Ratey, M.D., Little Brown and Co., p. 142
3Ibid., p. 143. 1990 study from the National Institute of Mental Health, Alan Zametkin and colleagues