Dispelling myths about attention-deficit hyperactivity disorder (ADHD) is important to reduce stigma and improve the quality of life for people who have this condition.
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. It is characterized by hyperactivity, impulsiveness and inattention. Despite being recognized as a mental disorder by major medical and mental health institutions, myths prevail regarding the validity of ADHD as a disorder, its underlying causes and treatment.
Common misconceptions regarding ADHD stem from the belief that it involves medicalization of normal childhood behavior and that the symptoms of ADHD could be addressed by changing parenting styles or would resolve with age.
1. Myth: ADHD Isn’t a Real Medical Disorder
Fact: ADHD is a medical disorder with a strong biological basis rather than simply being a social construct.
The fact that ADHD is a brain disorder has been scientifically proven. Children affected by ADHD show differences in multiple brain structures, and also have different brain activity patterns. A strong hereditary component exists with ADHD, along with various environmental factors that affect normal biological development.
Consistent with these facts, ADHD is recognized as a neurodevelopmental disorder by all major medical and mental health institutions, including the National Institute of Health, the Centers for Disease Control and Prevention (CDC) and the American Psychiatric Association (APA). The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), published by the APA has outlined diagnostic criteria for ADHD, including the age of onset, the prevalence of symptoms and impairment caused by ADHD.
Individuals who have ADHD show signs of impulsivity, hyperactivity and inattention, often resulting in impairment in social, academic and work life. Furthermore, ADHD is frequently associated with comorbid substance use disorders and other mood disorders. These profoundly adverse consequences suggest that ADHD is a real mental health disorder that requires appropriate treatment.
2. Myth: ADHD Is the Result of Bad Parenting
Fact: The precise causes of ADHD are unknown, but susceptibility to the disorder is influenced by both genetic and environmental factors.
Although the precise causes of ADHD are not known, there is a strong genetic component to ADHD supporting the fact that symptoms of ADHD have a biological basis. As far as prevalence, the likelihood of ADHD ranges between 15-60% in the first-degree relatives of individuals with ADHD. Other factors that are thought to contribute to ADHD include:
- Chemical exposure
- Heavy metal exposure
- Nutritional factors
- Prenatal exposure to certain substances
Among psychosocial factors, parental conflict or neglect may contribute to the development of the disorder, but genes and other biological factors play a larger role in determining causation. In other words, ADHD is not a direct consequence of bad parenting, although the latter may contribute to the development or severity of the disorder.
3. Myth: Children Who Are Given Special Accommodations Because of ADHD Are Getting an Unfair Advantage
Fact: Children with ADHD face neurocognitive challenges not experienced by most other children. Special accommodations made for these children are no more unfair than the special accommodations made for children with physical disabilities.
Due to their lack of concentration and difficulties in organizing information, children with ADHD tend to have poor grades, poor reading and math scores on standardized tests and a higher likelihood of repeating a grade.
Although behavioral therapy and use of medications are effective in ameliorating ADHD symptoms, their impact on academic performance is mixed. For example, although medications like stimulants do improve scores on quizzes and worksheets, they do not normalize skills associated with learning new information and the application of the newly acquired knowledge. Behavioral and pharmacological treatments also do not result in improvement in standardized test scores, making provisions like special accommodations or academic assistance for ADHD necessary.
The Individuals with Disabilities Education Act (IDEA) requires all public schools to provide special accommodations for individuals with disabilities, including ADHD. Special accommodations, including extended time during tests, more frequent breaks and modified instructions may be necessary to ensure the improvement and normalization of academic performance. Thus, special accommodations do not provide an unfair advantage to children with ADHD.
4. Myth: ADHD Only Affects Boys
Fact: Both boys and girls are affected by ADHD.
Boys are diagnosed with ADHD three times as frequently as girls. However, ADHD is often under-identified and under-diagnosed in girls, due to the differences in symptoms presented by boys and girls.
Unlike boys, females with ADHD show fewer symptoms associated with hyperactivity and impulsivity and tend to show symptoms involving inattention. Young males also tend to be more frequently referred for ADHD treatment relative to young females with a similar degree of impairment, resulting in under-identification.
Girls with ADHD tend to show more symptoms related to anxiety, depression and distress, whereas boys with ADHD show more overt symptoms related to hyperactivity and impulsivity, resulting in conduct problems. This difference in symptoms, especially with regard to conduct problems that are likely to be reported, may be responsible for the discrepancy in the diagnosis of ADHD in females.
5. Myth: Children With ADHD Eventually Outgrow Their Condition
Fact: Adults struggle with ADHD too.
One study reported that around 15% of children with ADHD continue to meet the full criteria for the disorder in adulthood, and over 65% partially meets the criteria. However, a separate study showed that 35% of adults who had ADHD in childhood, continued to fulfill the full DSM-5 criteria for the disorder. This indicates that many children do not outgrow ADHD.
Persistence of ADHD is associated with comorbid psychiatric disorders and social and occupational impairment. Children suffering from ADHD who do not receive treatment are also at a higher risk of substance use disorders. This fact indicates that the effective treatment of ADHD symptoms is necessary to avoid comorbidities.
6. Myth: ADHD Is Overdiagnosed
Fact: Although critics claim that ADHD is overdiagnosed, there is little evidence to support this claim.
Although there are cases of misdiagnosis of ADHD stemming from the shared symptoms of ADHD with other psychiatric disorders, there is under-diagnosis of ADHD in girls. Furthermore, many families with individuals suffering from ADHD are reluctant to seek treatment or cannot afford treatment, resulting in under-diagnosis.
Thus, although there is evidence for misdiagnosis, there is little evidence to support over-diagnosis. The prevalent beliefs about overdiagnosis are likely informed by biases based on anecdotal evidence, mass media coverage, concerns about the safety of medications and the validity of ADHD as a disorder.
7. Myth: Children With ADHD Are Overmedicated
Fact: Although the legitimacy of concerns about the overmedication of children must be acknowledged, the data from various studies does not support the case that children with ADHD are overdiagnosed and overmedicated.
A CDC survey conducted in 2003 showed that 4.4 million children between the ages of four and 17 years old had a history of ADHD diagnosis but only 56% were taking medication for the disorder. These data suggest that many children who have ADHD may not be receiving the necessary help.
8. Myth: All Kids With ADHD Are Hyperactive
Fact: Not all cases of ADHD are characterized by hyperactivity.
The DSM-5 identifies three different subtypes of ADHD, including:
- Predominantly hyperactive-impulsive ADHD (ADHD-H): Individuals who have predominantly hyperactive-impulsive ADHD show impulsive behavior in social contexts with a tendency to talk constantly and interrupt others. They also have a tendency for constant motion involving fidgeting and squirming.
- Predominantly inattentive ADHD (ADHD-I): The predominantly inattentive subtype (ADHD-I) is characterized by an inability to focus for a long time, difficulty following instructions as well as difficulty being organized. This subtype of ADHD is not characterized by hyperactivity.
- Combined ADHD (ADHD-C): The third combined subtype, ADHD-C, consists of individuals who show symptoms of both inattentiveness and hyperactivity-impulsivity.
A recent meta-analysis found that ADHD-I, the subtype that does not involve maladaptive hyperactivity-impulsivity, was the most common subtype in the population, but ADHD-C was the most common subtype referred for treatment.
9. Myth: People With ADHD Are Lazy or Dumb
Fact: Many individuals with ADHD are intelligent, and only a small subset of ADHD individuals have impaired intellectual ability.
Many individuals with ADHD are perceived as being lazy or stupid due to their poor concentration and difficulty sustaining interest in a task. Besides being a biological condition that influences the attentional abilities of an individual, ADHD individuals also exhibit deficits in motivation.
Individuals with ADHD are unable to delay gratification and show an impulsive preference for short-term rewards over long-term gains. These motivational deficits are accompanied by dysfunction of the brain reward pathway involving the neurotransmitter dopamine. Thus, individuals with ADHD may show an intrinsic inability to sustain interest, especially in activities that involve delayed gratification.
People who have ADHD are at a high risk of comorbid mood disorders and substance use disorders. If you or a loved one face a drug or alcohol addiction and a co-occurring mental health condition, The Recovery Village can help. We offer comprehensive treatment for addiction and co-occurring mental health issues. Call today to learn more.
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