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The debate on whether or not attention-deficit hyperactivity disorder (ADHD) is a real disorder has been raging since the days this diagnosis has been considered as a disorder by majority in the mental health community. There are still however many mental health experts, parents, educators, etc. who argue that ADHD is not a real disorder, pointing out that it does not fit the criteria which usually constitute mental health disorders. Nevertheless, those who believe that ADHD is a disorder argue that it is a real disorder, one that has to be addressed as such and one that has to be taken seriously. This paper shall discuss both sides of the issue, raising five points each for those which believe that ADHD is a disorder and those which do not believe it is a disorder.
For those who argue that ADHD is a real disorder point out that while the criteria and the definition for ADHD has changed several times since it was first identified as a disorder, the essential aspects which make it a disorder has not changed. The changes in the definition and criteria of the disorder can be attributed to the changes on how the disease has been conceptualized by the experts. These changes can also be attributed to the fact that practitioners, pediatricians, psychiatrists and learning specialists have their unique but still valid perspective about what would be considered ADHD. Numerous studies throughout the years have helped advance and improve the understanding of the complexities of this disorder, and there are still different aspects of this disorder, mostly on appropriate treatment which have yet to be completely studied and understood. At present, the APA Diagnostic and Statistical Manual of Mental Disorders (DSMIV) recognize ADHD as a disorder which involves behaviors, emotional, education, and cognitive elements impacting a child at various degrees. The essential feature of ADHD as defined by the DSMIV relates to the disorder displaying a “persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (2000, p. 85). The child with ADHD would display persistent patterns related to ADHD behaviors which appear more severe or frequent as compared to other children whose behavior issues may appear only occasionally. The APA also highlights the fact that the symptoms of the disorder may not be as severe when compared to other children whose disorder is under strict control or those who are engaging in interesting one-on-one activities. In other words, those who believe that ADHD is a real disorder point out that ADHD may not be understood well by those who do not believe that it is a disorder. They point out that there is a context which has to be associated in understanding this disorder, especially as children are very much different from each other and may react differently to different settings.
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Another reason for ADHD being a real disorder is that it does manifest the criteria which qualify it as a disorder, but some children may not necessarily display similar or the same symptoms. In the combined type of ADHD, this diagnosis mostly sees the child presenting inattention and impulsivity, but not so much on impulsivity. ADHD may also be of the inattentive type, and at times, it may both be the impulsive and the inattentive type. ADHD with otherwise unspecified type manifests usually among teens and adults, but it presents with a variance of impulsivity and inactivity in the patient.
ADHD is also considered a real disorder because scientific research and neurological studies provide proof which indicates differences in the MR brain images of children with ADHD and those without. In the study by Ghiassian, Reiner, Jin and Brown (2016) the authors compared structural and functional MRI brain images of those with and those without ADHD. Based on the learning algorithm the authors developed, they were able to establish effective classifiers for both ADHD and autism (Ghiassian, Reiner, Jin & Brown, 2016). Their study covered two large public datasets. Their algorithm was able to differentiate ADHD from those without based on a hold-out accuracy of 69.6% with parameters based on personal characteristics as well as brain scan features (Ghiassian, Reiner, Jin & Brown, 2016). The algorithm and applications they used did much better than previous methods applied on the datasets. Their study is one of the first studies to illustrate an automated learning process which can be used to classify patients with ADHD and control subjects based on brain imaging data (Ghiassian, Reiner, Jin & Brown, 2016). This study helps forwards that ADHD is very much real and this can be noted in the differences in the brain scan image results for those with and those without ADHD (Ghiassian, Reiner, Jin & Brown, 2016). This is a result which cannot be ignored as it is scientific and biologically based.
Another proof that ADHD is a real disorder is the fact that treating it as a disorder has led to improvements in the behavior of affected children. In the systematic review by Walker, Mason, Clemow and Day (2015) point out that patients who have been diagnosed with ADHD and who have undergone treatment with Atomoxetine (ATX) have manifested significant improvements in their ADHD symptoms. The review covered studies which applied ATX treatment for children with ADHD, mostly covering publications from January 1998 to March 2014 (Walker, Mason, Clemow & Day, 2015). A significant improvement in symptoms was noted in the treatment group, and more importantly significant improvements based on Quality of Life scales as well as Disability Scales (Walker, Mason, Clemow & Day, 2015). This study provides significant proof that ADHD is a real disorder because a difference in behavior and an improvement in the quality of life of the diagnosed patient are seen following treatment with ATX (Walker, Mason, Clemow & Day, 2015). Without any difference in behavior and reduction of symptoms, ADHD may indeed be discounted as a disorder, however, since children treated as ADHD patients show differences in behavior following treatment, there is an issue or disorder which has to be seen and acknowledged as such (Walker, Mason, Clemow & Day, 2015).
It can also be argued that ADHD is a real disorder because its symptoms can be associated with the occupational choice and performance of the individual diagnosed with the disorder. In the study by Verheul, Block, Burmeister-Lamp, Thurik, Tiemeier, and Turturea (2015), the authors highlighted how the performance of patients with ADHD in business or entrepreneurship is different when compared to those without ADHD. The symptom of ADHD, mostly on hyperactivity and inattentiveness has been known to affect an individual’s occupational choice and performance (Verheul, et al., 2015). In relation to the individual-environment fit studies, individuals with ADHD may have more entrepreneurial intentions (Verheul, et al., 2015). In other words, this is a positive outcome which impacts on entrepreneurial decisions of the individual with ADHD (Verheul, et al., 2015). The authors also highlight the fact that with ADHD, some deficiencies including impulsivity and the inattentiveness as well as the impatience can affect the individual’s ability to cope with the regular work environment. Work which does not call for close supervision and which allows for more independent action may therefore be more appropriate for those with ADHD (Verheul, et al., 2015). This study highlights how the symptoms of ADHD are real and how they cannot be ignored because they have the ability to affect the individual’s work life and entrepreneurship (Verheul, et al., 2015). There are qualities of ADHD patients which are unique to them and which give rise to other behavior and actions which cannot be downplayed or ignored by the rest of the population (Verheul, et al., 2015). There is also a strong need for these individuals to counteract their chaotic lifestyle which may explain why they may prefer work which allows their independence (Verheul, et al., 2015). In effect, the reality of ADHD cannot be ignored in the work context when those who are diagnosed with this disease manifest behavior which would not be seen or observed in other workers or individuals.
Summers and Caplan (1987) are simpler about their perspective on ADHD. Their acknowledgement of this disorder is based on the rhetoric that failing to acknowledge it as a disorder would put those with ADHD at risk for the exacerbation of symptoms (Summers & Caplan, 1987). The authors highlighted the dangers of failing to acknowledge how real ADHD is as a disorder, mostly in terms of school-aged children with ADD and seizure disorders (Summers & Caplan, 1987). The authors note how there were notable exacerbations of behavior issues for those with ADD and being aware as well as acknowledging ADD as a disorder helps clinicians manage issues and concerns related to the disorder, including concerns related to treatment (Summers & Caplan, 1987). In other words, the denial of the disorder would also be tantamount to the failure of health practitioners to respond to the actual mental health needs of patients.
On the other hand, ADHD is also not considered a real disorder by other experts, authors, and mental health practitioners. According to Dekker, Agelink van Rentergem, Koole, van den Wildenberg, and Popma (2017), there are complicated pathways which can help explain the symptoms manifested by children with ADHD, and these pathways may not necessarily support a cohesive diagnosis pointing to ADHD. Based on the criteria for ADHD which is often used, there are some gaps in the links for some children who are said to have ADHD (Dekker, et al., 2017). Instead, their symptoms may point towards other issues. Moreover, responses to reinforcement for ADHD patients have not been seen to improve other criteria. Improvements were only noted in terms of improving the client’s attention span (Dekker, et al., 2017). These results imply how some treatments including time-on-tasks among those with ADHD may point towards issues related to depletion of executive resources and depletion of motivation (Dekker, et al., 2017). In other words, even where symptoms related to ADHD may be identified, the diagnosis need not be ADHD as there are other possible pathways to consider (Dekker, et al., 2017). In this context, the authors are not denying the symptoms related to ADHD, but they are presenting alternative pathways for understanding the symptoms.
According to Advokat and Scheithauer (2013), the authors discussed the paradox on why some drugs which are meant to be cognitive enhances do not seem to improve long-term academic performance for college students. This relates to previous results among ADHD students where there were not many deficits noted in terms of neuropsychological tests and minimal improvements also seen from stimulants (Advokat & Scheithauer, 2013). From this study, it can be deduced that treatments and interventions meant for ADHD may not necessarily produce efficient results (Advokat & Scheithauer, 2013). This leads the reader to question on whether the disease actually exists as a disorder or as separate symptoms manifesting (Advokat & Scheithauer, 2013). There are too many gaps in the knowledge of ADHD patients and before any form of treatment can be formulated to address such gaps, it is important to first establish how real the disorder is (Advokat & Scheithauer, 2013). There are admittedly impairments for some ADHD students, however, the applied treatments for ADHD did not affect student performance (Advokat & Scheithauer, 2013). In other words, the presence of stimulant drugs did not affect the performance of both ADHD and non-ADHD students (Advokat & Scheithauer, 2013). There is therefore a need to review essential details about the disorder before treating it as a real disorder.
Hamed, Kauer, and Stevens (2015) point out that the diagnosis of ADHD is based on numerous factors and the consequences of failure to diagnose are still not clear. This study acknowledges the discussions on the disorder and whether or not it is a real disorder or not (Hamed, Kauer, & Stevens, 2015). The authors also highlight that there are different factors which impact on the final diagnosis of any disorder, and noting all these factors should be the priority in order to avoid making automatic judgments related to ADHD (Hamed, Kauer, & Stevens, 2015). The studies which have been cited by Hamed and colleagues point towards the fact that there are different experiences which need to be evaluated before a diagnosis can be made which would actually resemble the ADHD symptoms (Hamed, Kauer, & Stevens, 2015). The authors also forwarded the possibility that the symptoms may each be associated with separate disorders especially as the symptoms may not be consistent in their presentation for each patient (Hamed, Kauer, & Stevens, 2015). In this context, there are once again vague elements in the manner by which ADHD is diagnosed which cast doubt on whether or not it is a real disorder.
According to Quinn and Lynch (2016), there are doubts on whether ADHD is a real disorder. For one, it has become an all too common diagnosis for children that there are worries on whether this disease is being overly diagnosed among children. They also argue that some children are naturally inattentive and impulsive and that parents are having a hard time coping with their children and may find it easier to give in to an ADHD diagnosis (Quinn & Lynch, 2016). Having such a diagnosis helps ensure access to drugs which can potentially make their children calmer and less hyperactive (Quinn & Lynch, 2016). Quinn and Lynch (2016) argue that parenting has become a difficult process that it has become an automatic reflex for parents to support and ADHD diagnosis (Quinn & Lynch, 2016). As a result, the ADHD diagnosis has been accepted and admitted as a diagnosis even as there are actually doubts on its validity as a disorder.
In considering the above arguments, it is still difficult to answer the question on whether ADHD is a real disorder. On one hand, there are studies which support ADHD as a real disorder, however there are also other studies which cast doubt on its validity as a real disorder. Such gaps and questions provide an unclear understanding about ADHD, and do not help practitioners in deciding appropriate forms of treatment. It is also important to note that this disorder has numerous pathways and variations which do not help in establishing a firm diagnosis on the disorder. Each child is different and detecting symptoms of ADHD on the child may not necessarily produce similar results when detecting symptoms in other children. Still, known treatments for ADHD have been known to manage patient impulsivity and hyperactivity, and practitioners consider this a sign to indicate that the disease is a real disorder. Experts and practitioners also highlight that ignoring a diagnosis of ADHD can be detrimental to a child’s welfare, as his mental and health development can be affected. ADHD is however overly diagnosed these days that it is now difficult to establish who actually has ADHD or who has lazy parents who cannot cope with their active children.
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