The Problem With ADHD
Why is it that cases of Attention Deficit [Hyperactivity] Disorder are increasing dramatically with each passing year? Given that there are no clearly identifiable genetic causes, we must assume that the reasons behind it are social. Since diagnoses of ADHD are not more prevalent in any particular setting, be it cultural or socioeconomic, it is reasonable to suggest that the increase in diagnoses corresponds to some larger social shift.
My hypothesis is that ADHD is not a disorder at all, but one manifestation of a shift in global consciousness. I am not suggesting anything metaphysical here, rather that the proliferation of technology – particularly that which allows access to information and/or stimulation – has dramatically changed human behavior and interaction.
That the increasing prevalence of ADHD is most visible amongst the youth population only reinforces this possibility, as children have not merely been acclimated to this new technological climate, but are being born into it. A correlation has already been drawn between the mass proliferation of television and the increased need for immediate gratification. Before television, or even radio, the only way to acquire information privately was to read, which for anyone takes considerably longer than receiving the same information from electronic media. If one becomes accustomed to acquiring and accessing information at high speeds, they will have little patience for slower content delivery methods.
This shift from delayed to immediate gratification can occur in a short span of time. Consider the ease and complacency with which we once surfed the internet using a dial-up connection. Slow as it may have been, it allowed us access to a great deal of information much faster than reading a book, and faster still than searching a library for the particular books containing the information we sought. For those of us who have moved on from dial-up to DSL or Cable or even T-1 internet connections, going back to dial-up is unconscionable. We might even feel more inclined to read a book than to wait minutes for a single web page to load.
Now imagine a child who has only ever known this fast-paced information-saturated environment, with television, internet, and video games providing instant stimulation. Where it is difficult for those of us who have witnessed the progression of information delivery systems to regress to slower formats, it may be near impossible for children who have only ever known this environment to do the same.
High speed, even instant, delivery of information has also created an environment in which people are accessing larger quantities of data from multiple sources. We have, out of necessity, learned to navigate tremendous amounts of information for the particular bits we need, to filter out – with varying degrees of success – that which we do not need. We are inundated by information – willingly and not – from everywhere, creating a veritable culture of information.
An analog can be found through comparing the everyday behavior of people in a major city to that of people in a smaller town. In a smaller town, people may take the time to greet and socialize with many, if not most, of the other people they encounter. Invariably, all things move at a slower pace – travel, commerce, conversation. A large city on the other hand is likely to be the opposite – faster driving, high-speed marketplace transactions, and shorter conversations conducted using faster speech. It is likely that the average person in a larger city will completely ignore the vast majority of the people they pass on the street, not necessarily out of any disinclination to communicate, but because they have learned – out of necessity – to filter out most people, due to there being so many of them. Were they to stop and talk to even a small percentage of those they passed, they would not get anything else done.
People from large cities who visit small towns often experience impatience and frustration with the slower pace. They may even become annoyed or flippant with the people of that town for being attentive, for conversing or providing a service more slowly. They are, unlike the citizens of the small town, accustomed to high-paced interactions, to multi-tasking, to people and information filtering. For the people of the small town, those from the city may seem to have short attention spans, or even to be rude.
In truth, their methods, and even reasons, for interacting with others are simply very different. A conversation for a person in a large city is just as likely to serve a very particular purpose as it is to be for socializing. Often times in a large city, one person approaches another out of a specific need, and once that need is fulfilled, or once it is evident that the other cannot fulfill the need, the person moves on. People from the city do not have shorter attention spans, they are simply accustomed to shorter and more purposeful conversations, as opposed to talking for its own sake. It is for this same reason that people in larger cities tend to be more cynical of those who approach them, as chances are good that the other wants something other than casual conversation.
Television – and more so the internet – have had the effect of bringing the “big city environment” into every setting where they are available. No matter where we are, we are able to communicate with many people – often simultaneously and often in short bursts – at the same time that we access and parse through huge amounts of information. We have the ability to accept or filter out as much or as little information as we want, and that time allows.
Many of the elder population, and those simply out of touch with these sweeping changes in the global society for other reasons, find it very difficult to jump right in and participate, as this new high-speed environment is completely unlike what they know. Conversely, children born into this environment cannot conceive of an environment of slow and sustained conversation, gradual acquisition of information, and overall delayed gratification. To those on the outside, these children may seem to have short attention spans, but actually they have learned to divide their attention amongst multiple people and activities simultaneously.
In the academic setting, where the concerns around ADHD are greatest, this apparent “attention deficit” may correspond to missed opportunities for learning. I would argue, however, that these missed opportunities do not represent any deficiency or disability on the part of the child, but the failure of educators and administrators to evolve their content delivery methods in accordance with the larger social shifts.
Many current educators have been teaching for a long time, their careers encompassing the shift from the slower-paced low-information climate to the high-speed information-saturated environment. They may or may not have personally evolved to be able to navigate the new environment, but either way, they are not likely to have changed their teaching methods, which have become routine, and in most cases conform to rigid district, state, and federal standards.
Because the environmental shift occurred in a relatively short time span, it likely caught educators and parents off-guard. In only a few years, they witnessed – but may not have consciously acknowledged – a major change in the needs of their students, new needs that could no longer be met by the old practices.
If children have been born into, or have become accustomed to navigating large amounts of information – information they they want to receive – in a short time, they are likely to be impatient where information they do not even value is being provided to them over a long stretch of time. They may, to teachers, parents, and psychologists – all invariably of the “old guard” – appear to have short attention spans, or an “attention deficit”.
Have you ever observed a young person comfortable within this new technology-saturated environment? Have you ever seen one text message on a cell phone, while communicating in 5 separate instant messaging windows on a computer, while playing an online video game, taking a break only perhaps to look up an FAQ for that game, or to post their progress on Twitter or Facebook? This is hardly an exaggeration, as even I – an adult who has managed to adapt to the sociotechnological shift – perform similar feats on a regular basis.
And children born into it are far more efficient than I could hope to be. Would you consider such incredible multi-tasking an attention deficit, or could you perhaps acknowledge that these individuals have a talent for dividing their attention between multiple people, across several tasks, and all at high speed and with lightning efficiency?
This is something that I intend to investigate further, for if my hypothesis is correct, and ADHD is a misdiagnosis, then a great deal of time, money, and resources are being allocated towards a dead end.
However, there are reasons to suspect that even were my hypothesis to be verified, or even if it illuminated some new possibilities for ADHD diagnosis and treatment, that the current approach would not change at all. Why? Because like everything else, ADHD has become a market – a market that has produced billions of dollars for pharmaceutical and insurance companies.
Some data from the Centers for Disease Control:
- Using a prevalence rate of 5%, the annual societal ‘‘cost of illness’’ for ADHD is estimated to be between $36 and $52 billion, in 2005 dollars. It is estimated to be between $12,005 and $17,458 annually per individual.
- There were an estimated 7 million ambulatory care visits for ADHD in 2006.
- The total excess cost of ADHD in the US in 2000 was $31.6 billion. Of this total, $1.6 billion was for the treatment of patients, $12.1 billion was for all other healthcare costs of persons with ADHD, $14.2 billion was for all other healthcare costs of family members with ADHD, and $3.7 billion was for the work loss cost of adults with ADHD and adult family members of persons with ADHD.
- ADHD creates a significant financial burden regarding the cost of medical care and work loss for patients and family members. The annual average direct cost for each per ADHD patient was $1,574, compared to $541 among matched controls. The annual average payment (direct plus indirect cost) per family member was $2,728 for non-ADHD family members of ADHD patients versus $1,440 for family members of matched controls.
Source: CDC
The preoccupation with an imaginary “deficiency” overlooks a real social shift, one that if acknowledged and adapted to, could enable parents, educators, and society as a whole to better meet the evolving needs of children in the short term, and for the whole of society in the long term.
Some questions whose answers might inform my hypothesis:
1. Is ADHD as prevalent, or does it even exist, in low-technology environments?
2. Are children diagnosed with ADHD proficient in the use of data technology (text messaging, internet, video games)?
3. Is the proportion of students diagnosed with ADHD higher in larger cities than in small towns?