ADHD: A Definition and A Solution
What is it and what do you do about it?
By Dr. Noel Swanson
In the old days ADHD used to be called "minimal brain dysfunction" because people assumed there must be something wrong with the brain that they just hadn't yet been able to identify. Many scientists still believe that.
I have had a number of people asking about ADHD (attention
deficit hyperactivity disorder).
Not surprising, really, since it is such a common concern.
So what is it, when should you be thinking about it, and
what do you do about it?
First of all, just as I discussed in last week's article on
It is not particularly useful to think about it as an 'it'.
Just as children range from short to tall, skinny to fat, so
they also range from placid to hyperactive.
Since there is such a wide range, at what point to do start
to say there is something 'wrong' with the child?
There are only two ways we can define "wrong".
Either there is a clear, biological, problem that is
qualitatively different from normal. Not just a matter or
degree, but of something being broken or disordered (like
asthmas is different from just being short of breath).
Or the degree of "abnormality" is so great that it causes
problems of its own accord. Thus being too tall causes
problems (hitting heads on door frames, joint and back
problems, possibly). Being too fat causes problems
(diabetes, heart problems, etc). And being too active
causes problems (people don't like the things you do!)
So, let's look at these two types of definition. First, is
there any evidence of something biological being "broken"?
That is a difficult question. There is evidence that
hyperactive children have different brains than placid
children. Just as there is evidence that tall people have
longer bones than short people. There is even evidence that
taxi drivers have different brains to non-taxi drivers. But
that still does not answer the question as to whether there
is something "broken", or if it is again, just a matter of
In the old days ADHD used to be called "minimal brain
dysfunction" because people assumed there must be something
wrong with the brain that they just hadn't yet been able to
identify. Many scientists still believe that.
Either way, it is actually pretty irrelevant, as we shall
see when it comes to deciding what to do about it.
The second question is whether being hyperactive causes
problems beyond that of placid children. The short answer
is "yes". And typically, the more "hyper" you are, the more
trouble you get into.
So, at the extreme end of the scale, the kids that are
really climbing the walls, it is pretty easy to say that
they have a "disorder" and to give it a name such as ADHD.
But where is the line between normal and ADHD? Come to
that, where is the line between normal and fat, between
normal and too tall (or too short). And does it depend on
whether you live among the 7ft Masai warriors, or the 4ft
The line is, of course, arbitrary. We put the line where it
seems to be "about right". Usually there is some
statistical reason for it - e.g. being more hyper than 95%
of the population. But it also depends a lot on what
society is happy, or not, to consider as "normal" childish
And on that we, as a society, have probably become less
tolerant in the last couple of decades. We now want all our
children to sit still and pay attention in class, whereas in
past decades, if they didn't get on with school, then they
Now, if your child is getting into problems at school or
home, you usually want to know why? One of the questions
you might ask yourself, and others, is "is there something
wrong with my child".
The reason you would ask that, is because of the assumption
(from the rest of medicine) that if you know what is "wrong"
with him, you will then know how to cure or treat him.
Hmmm. Let's see how that plays out...
So you go to an expert to get a decision as to whether or
not he has something wrong. The doctor has no fancy tests,
as there is nothing physical to look for. So she asks some
questions about what, exactly, it is that he does. She may
also ask the school and other carers for their observations.
Then she feels she has to come up with an answer for you.
But what does she say?
If she says, "Yes, he has something wrong. It is called
ADHD", you are then going to want it treated and fixed.
But if she says, "No, there is nothing wrong with him", you
are going to assume that he is just playing up and needs
"more discipline" (ie more punishments).
Not only that, but suppose he is just on that arbitrary
borderline between "having" it and "not having" it? Which
way should she jump?
Both answers cause problems and, really, both answers are
Instead, let's tackle it from a different perspective.
Your son is constantly having problems. Everyone can agree
on that. The problems are similar to the list of problems
in the "diagnostic criteria for ADHD", which you can see
Everyone can probably agree on that, to a greater or lesser
Okay, so now the REAL questions is not "does he have ADHD",
but "WHAT DO WE DO TO HELP HIM?"
Now that takes us much further!
Here is what you can do:
1. Learn all you can about ADHD - whether or not he has
been given the diagnosis. Why? Because you will then
better understand why he does the things he does (my book
will also help with that).
2. Hyperactive children benefit from calm, consistent, firm
but fair management. They don't need diferent discipline
than placid children, but they do often need it to be
enforced much more consistently. Sorting out your parenting
techniques will definitely help. The best way to do that is
to use the strategies in my book:
3. The same applies to school. Working closely with
teachers is vital, and finding the right teacher for your
child is equally crucial. School can definitely make or
break these children.
4. If doing the above is not enough, then it may be time to
consider medication. The most common ones are the
stimulants (Ritalin, Dexedrine, Adderall). The doctors will
probably require a "diagnosis" before they will prescribe.
That's okay - you know that the diagnosis doesn't really
mean anything, but it does give them permission to prescribe
You have not failed if you take the medication route. Just
as you have not failed if your child has to take an inhaler
for asthma. It is just one of those things, and if it
helps, then use it.
But, remember that the medication is NOT a cure. It is NOT
a replacement for proper parenting and schooling, and it
does NOT mean you child does or does not have ADHD - since
it has exactly the same effect on any child (it is simply
more dramatic the more extreme the child is).
You can find more info about the stimulants here:
As you can see, the real key is to assess your own child's
unique strengths and weaknesses, and to work on these, in
conjunction with the school, to achieve the best outcome.
If you do that properly, then a formal diagnosis becomes
HOWEVER, we live in an imperfect world, and some people are
just unable to think in these terms. This is particularly
true of formal systems such as health and education who will
want a "label" in order for them to decide whether or not
they are going to help you.
If that is the case, and the label "fits", then don't be
afraid to use it. But it can cut two ways - once your child
starts to think that he "has" ADHD, this, in itself, may
undermine his confidence, as he feels that he is damaged or
disabled in some way.
On the other hand, the label might be just the thing he
needs to boost him. Knowing that it is not his fault that
he is so hyperactive may release him from his guilt and
sense of failure, and allow him to try again, perhaps, this
time, with medication to help. Either way, hold the
diagnosis lightly, and recognise it for what it is - just a
convenient shorthand for a bunch of behaviors.
SO: As with Asperger's, think carefully before you go the
route of looking for a label and a diagnosis. It may just
open the doors your child needs. Or it may shut them in his
face. You know your child best. Now read up as much as you
can, and then YOU take charge of helping him to achieve the
very best future. And if that involves doctors and
medicines, well, so be it.
As ever, you can pick up The GOOD CHILD Guide as an instant
download from here:
Dr. Noel Swanson, Consultant Child Psychiatrist and author of The GOOD CHILD Guide, specializes in children's behavioural difficulties and writes a free newsletter for parents.
As both a professional who has worked in both North America and Britain, and as a parent of a teenage son with Asperger's and Tourette's syndromes, Dr. Swanson is uniquely qualified to help parents whose children are struggling with special needs of one sort or another. Having experienced the frustrations of raising such a child, and of battling with the education system to provide him with the support that he needs, Dr. Swanson has made it his mission to help other families who also want to do the very best that they can for their children.
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