contd. from

So this is a biological disorder.

It's largely a biological disorder. It has many causes, but all of the known causes fall within the realm of neurology and genetics. We can rule out the social environment, such as bad parenting, intolerant teachers, the breakdown of the American family, a decline in family values, excess amount of TV viewing or video games. These have all been proposed as causes of ADHD. But there's no evidence that we can find that will substantiate them.

All of the evidence that keeps turning up in our research points to genetics and neurology as being largely responsible for the excessive behavior and the poor self-control that we see in these children. So I think we can safely say that what we've learned in the past ten years is that environmental causes of ADHD are not credible. They do not account for the substantial amount of scientific findings that exist on this disorder today.

Is this a mental illness?

Well, it depends on how you want to define a mental illness. I prefer to call it a developmental disability, because, like mental retardation, like the learning disabilities such as dyslexia and autism, it comes on very early. It appears to be a problem with the way the brain is developing. It affects the child's life in many different capacities, and it has long-term consequences for the individual. So, in that sense, it's very much like the other developmental disabilities that we know so much about.

It is classified as a mental illness by the American Psychiatric Association, and it is placed in their manual of mental disorders as such. But that's just a matter of classification. I think more scientists view it really as being akin to the developmental disabilities, rather than being more like schizophrenia or bipolar disorder, where there's some, perhaps, gross abnormality in the individual's development. Here, instead, what we're seeing is an immaturity and a failure to develop as quickly as other people in these critical areas of personality development and self-control.

A lot of people--such as parents--feel very uncomfortable with the label. Is it important to label it?

Well, labeling is a two-edged sword. Of course, it brings with it all the negative connotations. You're being singled out; you'll be stigmatized. It is a label that is mentioned in psychiatric textbooks as a mental disorder, and, of course, people are afraid of stigmatizing their children so young in life with the label of a mental disorder. But on the other hand, there is the upside to labeling, an upside that we can't avoid, and that's why we continue to use labels.

First of all, by using a precise label, we can connect this group of individuals up with a large body of scientific knowledge about other people with this label and with this disorder. So if we use this label, it brings with it a tremendous amount of information that can help the individual better understand their disorder and how best to manage it. If we start labeling it with some euphemism, some ambiguous personality term like, they're just "high-energy children," you've disconnected immediately from this larger body of accurate scientific knowledge that we have. And that's a disservice to these people.

The other disservice it will do is that there are rights, protections and access to services that people with ADHD have a right to now because of various legislation that has been passed to protect them. There are special education laws. And the Americans with Disabilities Act, for example, mentions ADHD as being an eligible condition. If you change the label, and again refer to it as just some variation in normal temperament, these people will lose access to these services, and will lose these hard-won protections that keep them from being discriminated against. . . .

There are 6,000 studies, hundreds of double-blind studies, and yet, there's still controversy. Why?

There is controversy about ADHD, I believe, partly because we are using a medication to treat the disorder, and people find that to be of concern. But there's also concern because ADHD is a disorder that appears to violate a very deeply held assumption that laypeople have about children's behavior. All of us were brought up believing, almost unconsciously, that children's misbehavior is largely due to the way they're raised by their parents and the way they're educated by their teachers. If you wind up with a child who is out of control and disruptive and not obeying, that that has to be a problem with child rearing.

We can thank Freudian thinking and Watson's behaviorism, and other ideas that are part of our common knowledge, for making us believe that behavior problems are learned. Well, along comes this disorder that produces tremendous disruption in children's behavior, but it has nothing to do with learning, and it isn't the result of bad parenting. And therefore it violates these very deeply held ideas about bad children and their misbehavior.

Now, there is no controversy among practicing scientists who have devoted their careers to this disorder. No scientific meetings mention any controversies about the disorder, about its validity as a disorder, about the usefulness of using stimulant medications like Ritalin for it. There simply is no controversy. The science speaks for itself. And the science is overwhelming that the answer to these questions is in the affirmative: it's a real disorder; it's valid; and it can be managed, in many cases, by using stimulant medication in combination with other treatments.

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Written 2000. Updated 2001. Reviewed: 02/2006