Is Attention Deficit Disorder (ADD/ADHD) an illness?

Debs G’s note: This post was originally published in Sunlight Follows Me (my old medical blog) on 20 Sept 2005, and has been revised and updated for publication on Owls Well.

Now, I totally agree that some people, after being diagnosed with an illness, will automatically attribute all their life’s tribulations to the workings of the disease. So many times, I have had patients coming in to see me, expecting to see their social problems disappear with the treatment of their physical problems.

Now, I personally believe that everybody has a brain that is wired in a totally unique way, and that we all have our little insanities. We all perceive the world in a different way from the next person. We all have our personal problems and struggles.

Illness, namely illness resulting from issues in the cognitive, social or psychological realm, results only when the thoughts or beliefs of a person interferes with their lifestyle and from performing very basic functions like eating, sleeping or interacting with other people. That is, these personal problems are only an illness when the person in question isn’t able to manage in society, and may even pose a danger to themselves or to the people around them.

I think there is a case for identifying people who need assistance from a professional outside of one’s own family, and sometimes it helps to have a diagnosis, a label, because that gives an answer to the question “What is wrong with me or my child?”. Knowing the answer to that question is often the first step to recovery. People who come to see doctors often don’t have an adequate social network that has the strength, knowledge or the resources to cope with their afflictions.

ADD, or Attention Deficit Disorder, and its variant, ADHD (Attention Deficit and Hyperactivity Disorder) is one of these medical diagnoses that draws a lot of negative publicity. As awareness for this disorder grows, we are currently seeing a lot more children being labelled as having ADD/ADHD.

I actually have a very deep personal interest in children with ADD, having had the opportunity to followup several children with this disorder over a minimum period of 5 years, as well as having grown up with a little sister who was formally identified as an ADHD child at the age of 10.

ADD defined as a triad of hyperactivity, impulsivity and distractability. It is only diagnosed in children of school-going age (ie. after the age of 5), which is why most teachers tend to view this disorder with rather a jaundiced eye. There are still alot of people out there who are very skeptical about the existence of ADD – but I can assure you that ADD is very real and children who have it do need help.

ADD is a developmental disorder, much like autism. Unlike autism and other developmental disorders like dyslexia, ADD is still not widely understood. Autism when reduced to bare bones, is a failure of development of emotional centres – which is why children with autism often are unable to socially interact. ADD, however, is the failure of development of concentration.

The failure to develop adequate concentration skills means that the ADD child has learning difficulties. This does not only apply to learning from books, but also learning from observation and deduction. ‘Behavioural influences’ will not teach this child anything because they won’t be able to pick up the subtle cues. Thus, the ADD child does not learn important and very basic social skills, and this leads to inappropriate behaviour.

Now, one of the differences between the ADD child and the ‘ill-behaved’ child is that no amount of good parenting or discipline will change the ADD child. This is a key problem that many parents and teachers fail to understand.

An ‘ill-behaved’ child will eventually respond to a change in social environment or consistent and firm discipline. For example, if an ‘ill-behaved child’ is placed in a structured and orderly environment with positive reinforcement for good behaviour, he or she will fall in line by the sheer force of peer pressure and the desire to be rewarded.

The ADD child does not understand when they have done a bad thing (common example: Repeatedly getting up and walking around the class whilst the teacher is still talking and everyone else is still seated) because they have not learned what is considered socially appropriate. They simply have not observed that nobody else behaves the same way they do because it is unacceptable to do so. Disciplining an ADD child often has little or no effect, because they have not fully understood why they have been naughty – so instead of feeling sorry or guilty, they feel incredibly maligned. Worst of all, because they still haven’t learned what they did wrong, they are likely to repeat the ‘bad’ behaviours time and again.

The ADD child is an exasperating child. They fiddle and fidget. They often do incredibly stupid things for no reason. They are easily provoked. They get into trouble. They don’t know the difference between ‘silly’ and ‘irritating’. Exasperated parents will say “Grow up!” or “When will you ever learn?”, exasperated teachers will say “Apply yourself!”, exasperated peers will say “I hate you, go away!”.

The ADD child often does poorly in school and has no friends to speak of (it’s difficult to tolerate their inept and awkward behaviour – especially their lack of respect for personal space, and their bizarre multi-conversations about several topics at once). Everyone around them appears to dislike them and yell at them alot. You can understand how the ADD child will have really low self-esteem. It’s a pretty sad situation to be in for a small kid.

The second difference between the ADD child and the ‘incorrigible’ child is the effect of pharmaceutical treatment. The drugs used to treat ADD will only work on ADD children – in a normal person, the medication (which is similar to amphetamines or ‘speed’) will only worsen hyperactivity and impede concentration, but paradoxically, it works to calm down a person with ADD.

In calming the child, it gives them a greater ability to focus their minds so that learning can take place. I am always amazed at the efficacy of ADD treatment – results can be seen in less than a month (Fewer phone calls from angry teachers, fewer accidents in the household, grades at school seem to be picking up, child actually seems to be absorbing what you say).

This, of course, does not mean that all the changes can be solely credited to the effects of medication. It is up to parents and teachers to encourage the child’s newfound focus in the right direction. It is totally up to the child to motivate themselves to work hard in order to change. The medication is used to ‘buy time’ whilst the child’s concentration ability develops to a more age appropriate level.  

It is probably true that ADD kids, if left to their own devices, may eventually develop enough concentration skills to be able to cope socially. Indeed, there are many who have managed to get by with ADD, only for the issues to surface during their working adult life, when they are required to focus during long boardroom meetings or spend many hours beavering at a desk.

However, naturally developing the strategies to cope with ADD could take years, and a kid with a poor school record will be greatly disadvantaged – especially in an unforgiving society like Singapore, where performance first few years of schooling has a great impact on the sort of educational opportunity a child will have in the future. Additionally, the social isolation that is associated with ADD children can be psychologically damaging.

The idea of medical treatment for ADD is that it is used as a stepping stone, to bring a person to a level when they can begin to deal with the difficulties that they are facing. The medical profession is often used as a resource to access other services – counselling, behavioural therapy, support groups, social workers and health visitors – that can be helpful to the patients. But it is the patient who is ultimately responsible for their own personal trials. Doctors are only helpers; it is the patient who must battle their own demons.

It is also useful for a person to be able to name their afflictions. Naming it means that you have power over it. Having a diagnosis gives the person something more tangible that they can deal with. It gives a family hope that there is something that can be done and shows them what sort of special needs a person may have, and how to manage them. It also brings awareness to other people who can in turn respond with understanding, and maybe even a little forgiveness.

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