“‘I think the current diagnosis of ADHD is a mess and has been wildly overdone. It blames a variety of symptoms entirely on the child’s brain, and ignores the child’s environment and the interaction with it.’” (Philadelphia Inquirer, William B. Carey, pediatrician, researcher, and medical educator, dies at 93)
Admittedly, I am a bit of a hoarder.
This hoarding tendency of mine has overlapped with a multitude of articles I have saved for many years, unable to toss or to even scan them on to the internet.
As part of the ritual of the New Year, I commit to going through these articles attempting to organize them better, but rarely tossing them.
I always think they would be great springboards for later blog topics.
Going through the piles one article jumped out at me that I have saved for over 20 years. It was by Dr. William Carey, the renowned professor of pediatrics at the Children’s Hospital of Philadelphia who passed away this July at the age of 93.
Within the article, “Is ADHD a Valid Disorder,” Dr. Carey raises many important issues that are as relevant today as they were when it was written. As the coffee stains on the article attests, it has been reread by me many times.
While not knowing him personally or having the pleasure of attending his lectures, I have been a behind the scenes disciple of Dr. Carey.
Dr. Carey emphasizes that there is no one test or objective instrument to diagnose ADHD (often referred to in more casual terms as “ADD.”)
Typically, in the process of obtaining a diagnosis of ADHD a parent typically will say a few common buzzwords. Here are some of the more common:
“He just can’t focus.”
“He’s easily distracted.”
“She won’t get started.”
“He hates homework and the teacher says his attention is very poor.”
“The teachers say that they are not doctors, but… (with the clear implication that they think the child needs medication).
“She’s always fidgeting.”
When descriptors like these and a few others have been present for at least 6 months, the scales tilt in the ADHD direction and a “diagnosis” is typically obtained.
After receiving this diagnosis parents will often report a sense of comfort, feeling that they have “finally gotten the answer.”
As is my nature, I will push back on this “the answer,” emphasizing that there are many other factors that may not have been understood or addressed.
Just below the coffee stains on my saved article, Dr. Carey noted:
“The assumptions that the ADHD symptoms arise from cerebral malfunction has not been supported even after extensive investigations. The current diagnostic system ignores the probable contributory role of the environment; the problem is supposedly all in the child. The questionnaires most commonly used to diagnose ADHD are highly subjective and impressionistic…The label of ADHD, which is widely thought of as being beneficial, has little practical specificity and may become harmful.”
Don’t be too quick to toss things out. They may come in handy one day.
Thanks for sharing. I am thinking about how to meet the needs of a student whose environment exacerbates the problem of attention, in this day of CDL/remote learning.
It certainly is challenging. I keep counseling parents on bringing greater levels of structure in terms of routines and setting up of basic rules. Each family’s situation is different so, it’s hard to make generalizations, but I certainly see how needed the structure and boundaries are in setting up the environment to maximize the learning.
I sat beside you long ago in Cape Cod at a presentation week by Ned Hallowell. (You sent me an autographed copy of your book)
I am a Canadian teacher with a masters in literacy and I have textbook ADHD- there is no discussion! If this man just died now at 93- he likely didn’t know what fMRIs show us! It IS a brain incompetence in 2 areas- I don’t understand why you let that question be the title or point of your article? Can’t that question be buried by now?
(We ADDers take things personally and we react impulsively!)
Nice to hear from you and nice to hear your view? I am just sharing the perspective. I think there are many kids who fall under the description of what Dr. Carey describes who are too quickly diagnosed with not a lot of data. It’s just a caution.
(As an aside, I have a lot of ADD qualities of the inattentive variety myself.)
Thanks for sharing your view.
Helllo Richard….as you and I have discussed many times, probably ADHD as. Psychiatric diagnosis is a misnomer. For instance, if one has some fine motor deficits we don’t call that student FMDD or Fine Motor Deficit Disorder. Let’s just say some kids have trouble with sustained attention and functional MRI’s do show differences in blood flow in those with attention problems. What is often not recognized is those same kids often have issues with reading, writing or spelling and in others with math. So the take home is to look carefully at all parameters needed for learning optimally and by-passing any weaknesses while emphasizing strengths! Simply having a list of symptoms as the DSM5 suggests for diagnosing ADHD is a disservice to a student. Your kind of work up is what all kids need when parents or teachers say “he doesn’t pay attention”
Always appreciate your comments and wisdom. Hope you are well.