Within the last week I read two books with sections on ADHD and American boys. This topic is near and dear to my heart so I admit that I am overly interested and over sensitive. But one of the books had great reviews so I gave it a try… I was fuming mad by the time I finished it. 

Can we take a few minutes to talk about ADHD. Everyone has their soapbox and this is mine. The DSM-5 defines ADHD this way: 

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
   • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
   • Often has trouble holding attention on tasks or play activities.
   • Often does not seem to listen when spoken to directly.
   • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
   • Often has trouble organizing tasks and activities.
   • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
   • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
   • Is often easily distracted
   • Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
   • Often fidgets with or taps hands or feet, or squirms in seat.
   • Often leaves seat in situations when remaining seated is expected.
   • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
   • Often unable to play or take part in leisure activities quietly.
   • Is often “on the go” acting as if “driven by a motor”.
   • Often talks excessively.
   • Often blurts out an answer before a question has been completed.
   • Often has trouble waiting their turn.
   • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

If you’ve spent time with an ADHD child then you know there is a huge difference between a child who isn’t interested because of their age or environment and a child with ADHD. You can be hyperactive and inattentive and not have ADHD. Ever been with a tired 7 year old? They are both hyperactive and inattentive, but a nap will change the whole situation. ADHD is a whole different ball game. 

My oldest was diagnosed with ADHD when he was in first grade. Prior to this diagnosis there were some definite signs that was what going on was more than “typical boy behavior”. This became increasingly obvious as his little brother got older and started to be able to perform some of the tasks that he could not. Concepts like “get ready for bed” or “get ready for school” went over his head. 

I need to preface by saying this kid is smart, he’s not academically or developmentally delayed. He has a better grasp of spoken English than I do. And it wasn’t that he wasn’t physically capable of doing the individual tasks involved in the getting ready or going to bed processes either. But he cannot break down complex processes into their individual steps the same way another child or adult can. 

This inability to break down the process makes it virtually impossible to organize himself and get going on something without better direction. While at age 3 his little brother understood that getting ready for bed entailed changing clothes, brushing teeth, using the bathroom, and climbing into bed, at 5 and 6 my oldest could not come up with the list of tasks without guidance. It was kind of like if you gave me a complex algebra problem. I would understand that my goal was to solve for the value of x, but I wouldn’t be able to tell you the steps needed to get to the answer. 

And it wasn’t just the issue of organizing himself to get two or more step tasks done. He also had trouble controlling himself. There’s a difference between a child who is bored with the situation and wants to play and a child who is up and moving without consciously being aware of it. 

The other day my 7 year old was climbing on the couch instead of eating breakfast, when I asked him why he was doing that he responded with “because I want to”, but if you ask his older brother why he is sitting on the counter during a meal when he has been asked and reminded to sit with his butt glued to his chair, he responds with genuine shock. He is unaware that he has gotten up and put himself in that position. The movement is unconscious and clouded by everything else that is going on. 

The impulse control is not limited to movement, he will have angry outbursts that don’t fit with the severity of the situation. He constantly interrupts and talks out of turn and when we ask him if he realized he was doing that he again is surprised. He answers most questions before the speaker has finished asking the question, he’s a bright kid and easily annoyed by waiting, but by 10 this is a skill many kids have started to develop. 

On the surface these behaviors just seem annoying, and honestly they are exceptionally annoying some of the time, but careful observation shows that he isn’t always aware of his behavior. He knows what the expectations are, is a rule following kid, but isn’t always able to control himself.  

Think about the marshmallow experiment we are all familiar with. In a simplified version of the experiment, a child is given a marshmallow but told if they can wait 15 minutes without eating it, they can have two marshmallows. For some of us the motivation for that second marshmallow would help us curb our desire to have a treat now, but for others, the desire for the treat is too much to keep them from eating it immediately. This is my son with most things. In contrast his brother knows when he’s being obnoxious and has self-control (when he wants it). I admit his brother is more self-aware that the average kid, but there is a marked difference between the two boys. Both have their obnoxious moments, but one is rarely aware of how irritating he is being. The boys respond to situations differently. The older one would probably eat the marshmallow before you finished explaining the rules, whereas the younger one would try and milk the situation and get the whole bag of marshmallows. The younger brother has the ability to think ahead, to forecast, and to guess what impact his actions will have on future events, while the older one’s decisions are often clouded by what is happening right at that moment. 

So here’s my soapbox. Instead of dismissing ADHD as a “made up problem”, “the problem of lax parenting”, or “a quick fix for lazy parents” why don’t we dive deeper? 

As a child of the 1990s I didn’t want my child on Ritalin and I didn’t want him to have ADHD. I didn’t want him to have the label “ADHD” because I associated that with boys who couldn’t behave and were essentially written off by the education system for being disruptive and disrespectful. I wanted my kid to be a brilliant overachiever who all the teachers love. I wanted him to be respectful of everyone around him, aware that his actions have a direct impact on others, and conscious that he doesn’t exist in a vacuum. 

But here’s the thing, he has some things to overcome, just like we all do. 

Just like his brother’s overriding sense of justice often clouds his ability to extend mercy to others and requires some reminders about exercising compassion, my oldest needs some help remembering to sit, to listen and not talk, and to be still. 

He is brilliant, his mind is always working. He grasps concepts I can’t even begin to understand, he is social and the other boys love him partially because he is chatty and outgoing. The same things that frustrate me, like how he is constantly losing things or that he is forgetful, also make him great. He may be a million miles away thinking about something else, and while in the moment I might wish he moved through life in a linear fashion, his creative out of the box thinking make it so his imagination is a colorful place to be, makes it so he grasps theoretical concepts quickly, and help him dive into topics deeply instead of just developing a surface level understanding. 

I think when we say that ADHD is a myth or over diagnosed we are doing a disservice to kids like my son. I think we malign their experience and fail to consider that there are brilliant people who don’t necessary function “correctly” in our world. We fail to adapt to them, instead of forcing them to adapt to us. We see them as a problem, we write them off, and we overlook their intelligence. We blame the parents for letting them use technology instead of sending their kids outside to play. We assume that these kids are tainted in some way and don’t direct school resources to them. Instead of adapting the environment to them, we force them to comply-it’s like fitting a square peg in a round hole, it might work, but it won’t be perfect. We shame parents when they choose to pursue a diagnosis or even worse choose to medicate their child. Instead of applauding parents for making the choice they thought best for their child, we tell them they are inflicting permanent damage on their children. We imply that if it were our child we would seek alternative methods of treatment or another diagnosis. 

Can I tell you my best guess? The parents that choose to medicate or treat their child with other therapies probably did so only after a good deal of research, thought, and many consultations with medical and mental health providers.

 It looks months to get my son diagnosed, and even after his diagnosis it took additional time to come up with a management plan for him. No teacher ever told us that he had a self-control problem and forced us to pursue a diagnosis. In fact the teachers tell us he’s a model student. I think that there are times they miss his lack of attention to the lessons because he grasps the material quickly and usually performs above grade level. Despite some tales from critics, this was not a quick or easy diagnostic process. There were several health providers (including therapists) involved. He wasn’t put on medication because I insisted he have it. He is never given medication and then told “see ya!”. We meet regularly with his doctor, and have committed to participating in other “therapeutic” activities to help him develop focus and control. I can’t tell you the number of baseball, basketball, and swim practices I have sat through to help him because his doctors (and scientific research) recognize the value of structured physical activity in helping children with ADHD. I’ve read article after article about ADHD treatment and diagnosis, and I’d bet that many other parents have too. We don’t wake up and think “I’d like to give my kid a controlled substance so he chills out”, we think about what we can do to help these kids develop the coping mechanisms needed to live healthy and productive lives. 

I don’t want this child to grow up without impulse control and find himself in a bad situation later in life because he was never given the chance to develop the necessary skills in a safe environment. Instead I want him to recognize the difference between being in and out of control and develop skills to put himself in check as he grows older. I know it takes him more time than his brother to learn these things and I want to give him every tool available to be successful. 

We  do a disservice to kids when we look at adults and say “well he can never be a ______ because he can’t sit still” or “if I label him now he will never succeed”. My husband has what some might consider an exceptionally boring job, and he has ADHD. He got this boring job years before he was diagnosed. He majored in something boring, enjoyed boring things in high school, and knew he was going to pursue this boring career path in the 4^th grade. Seriously people, the 4^thgrade. I do not have ADHD, but one look at his computer screen makes me zone out. He has ADHD and he can do boring (and HARD) things. It’s not fair to assume that ADHD kids can’t concentrate. I could not do a puzzle if my life depended on it. I hate them. But give my husband or my oldest son a 1000 piece puzzle, or a lego set tedious and they will get it done before you realize it. They can focus, but they need help. They might not be able to focus like other people do. For example I can listen to the radio, cook, and make sure no one dies, while keeping an eye on student emails, and they never could. I might miss a few details, but I will complete my tasks in a timely manner. My son can’t do this juggle, he can do one thing at a time, but the one thing he does will be done exceptionally well.

Kids (and adults) with ADHD need support from the rest of us, they need us to understand that in their world all the volume is turned up to 10 and that they can’t “just turn it down”, they need us to adjust our expectations. 

My son doesn’t understand what “clean your room” or “set the table” means, but he understands, “make your bed”, “pick up the toys” etc. It’s not an inability to understand, it’s a need for different directions. Just like I don’t understand how a+4x+6y=q and need someone to give me more instruction (like what the heck a, x, and y equal) he needs the request to be phrased differently, to be broken down, to adapt to him. 

Not only do these kids and adults need our support, but so do their families. Let’s assume all families are doing their best to help their kids. The parents of ADHD kids need our love and support. Maybe they just need a shoulder to cry on, someone to say “I know YOU will make the best choice for your child!” or “Your kid is so lucky to have you as their advocate” or even just “you’re doing great”” or maybe what they really need is a cookie. Don’t say “well medicating your child hurts their long-term development” don’t say things like “have you tried cutting gluten from their diet” or “ I saw this thing on Facebook”, all bad things. Instead try “parenting is tough!” or “yeah sometimes kids are just the WORST” or “let’s go out to dinner without the kids and you can tell me about it”. Just listen, just support, don’t judge, assume they can read, assume they’ve considered all the options, and assume that they’re coming to you because they need an outlet that is going to sit and listen to them for more than 3 seconds. 

I’ll step back off the soapbox now.