Controversy—mental disorder or state of mind?

ADHD has been a subject of great controversy and debate. A number of people who have been diagnosed with the syndrome—some of them psychologists and psychiatrists—have challenged the notion that personality traits such as inattentiveness, impulsivity, and distractibility deserve the label symptoms. They contend that many people labeled as having ADHD are neither “deficient” nor “disordered”—they are simply different. ADHD, this vocal minority argues, is not a mental disorder at all but a different state of mind, and it is because of this difference that people with ADHD often do not function well in standard learning or work environments. It is society and its expectations that have to change, they claim, not persons with short attention spans and high energy.

Indeed, the view of ADHD as a problem requiring medical intervention is highly culture-bound, being largely peculiar to the United States and Canada. This is not to say that the behaviours characteristic of ADHD are absent from children in other nations. The larger question is whether children in other countries are identified by their parents, teachers, and physicians as having a problem. In Great Britain and France only about 1 percent of children are diagnosed with “hyperkinetic disorder,” the closest equivalent to ADHD in the World Health Organization’s International Classification of Diseases (the diagnostic system used by most medical professionals outside North America). And the British medical establishment hopes this number will remain comparatively low. The British Psychological Society suggested in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: “The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians.”

Emerging scientific evidence about the causes and consequences of ADHD lends some plausibility to this viewpoint. As noted above, neurologists are finding that the anatomic and physiological differences underlying ADHD appear to be mere variations in the timing of brain development, not outright defects. Other researchers suggest that the behaviours characteristic of ADHD may once have conferred an evolutionary advantage, which would explain why their underlying genetic components have been conserved in the human gene pool.

Nevertheless, the majority of American medical professionals are certain that ADHD is a disorder and not just a normal variance. Indeed, some argue that the categorization of ADHD as a neurobiological disorder was an important step forward, since it clearly distinguished the ability to pay attention or control one’s impulses from other mental capacities such as innate intelligence. Once ADHD was acknowledged as a disorder, impulsive or inattentive people could no longer be dismissed as “slow” or “stupid.” Instead, the disorder could be managed with an appropriate treatment regimen—usually including medication but also incorporating certain organizing techniques—that would allow a person with ADHD to develop to the full extent of his or her intelligence.