9 ADHD Myths and Fallacies That Perpetuate Stigma

Block letters spelling out ADHD myths vs. reality

Despite groundbreaking research and clear neurological findings, people continue to harbor many inaccurate beliefs — and promote some downright myths — about ADHD, which only perpetuate misunderstanding, stigma, and shame. Learn the scientific truth about attention deficit hyperactivity disorder here.

Myth #1: ADHD isn’t a real medical disorder.
Myth #2: ADHD is a modern farce created by drug companies
Myth #3: ADHD is the result of bad parenting.
Myth #4: ADHD affects only boys.
Myth #5: A kid who can play video games for hours couldn’t possibly have ADHD.
Myth #6: Children with ADHD eventually outgrow their condition.
Myth #7: Children who take ADHD medication are more likely to abuse drugs.
Myth #8: Special accommodations for ADHD are an unfair advantage.
Myth #9: People who have ADHD are stupid or lazy.

ADHD Myth #1: ADHD isn’t a real medical disorder.

ADHD has been recognized as a legitimate diagnosis by major medical, psychological, and educational organizations, including the National Institutes of Health and the U.S. Department of Education. The American Psychiatric Association recognizes ADHD as a medical disorder in its Diagnostic and Statistical Manual of Mental Disorders — the official mental health “bible” used by psychologists and psychiatrists.

Attention deficit hyperactivity disorder (formerly known as just attention deficit disorder) is biologically based. Research shows that it’s a result of an imbalance of chemical messengers, or neurotransmitters, within the brain. Its primary symptoms are inattention, impulsiveness, and, sometimes, hyperactivity.

However, like other psychiatric conditions, ADHD lacks biological validity. This means that experts still don’t understand the underlying biological causes, or the exact pathology, of ADHD. In most areas of medicine, the underlying pathologies of disorders are very well defined. Psychiatry, however, is an exception in this regard.

ADHD also lacks objective diagnostic tests that can confirm whether a person has this disorder. In its place, doctors use symptom evaluations and other measures to determine ADHD symptomology.

Though scientists are working hard to find biological validity and objective diagnostic tests, there are other ways to feel confident in an ADHD diagnosis in the meantime. The first way is through something scientists call reliability. This refers to the ability for two different clinicians to evaluate the same child and independently come to the same diagnosis.

ADHD is a very reliable diagnosis. As a matter of fact, it is one of the most reliable diagnoses in all of psychiatry, and in particular, child psychiatry. The reliability of diagnosing ADHD is on par with the reliability of diagnosing pneumonia with a chest X-ray (an example of an objective diagnostic test). This is quite impressive. (DSM Field Trials)

ADHD Myth #2: ADHD is a modern farce created by drug companies

ADHD is neither a modern phenomenon nor a purely American or Western one. It was not dreamed up in response to pressure from the pharmaceutical industry or in response to modern academic pressures and the drive to succeed in school.

Now, those are important concerns and things that could be potentially contributing to an over diagnosis of ADHD. But ADHD is not entirely explainable through those phenomena.

If you go back a century in medical literature, you’ll see descriptions of children who look very much like children with ADHD. A century ago, that specific diagnosis didn’t exist, but physicians described children that were hyperactive, impulsive, inattentive, all the things that we would put together to make an ADHD diagnosis today. Some of the earliest reports date back all the way to the 1700s.

In the 1800s, the German physician Heinrich Hoffman wrote poems and drew illustrations to describe the children he saw in practice. One great example is Fidgety Phil, who he describes as, “Let me see if Philip can be a little gentleman. Let me see if he is able to sit still for once at the table. But Fidgety Phil won’t sit still. He wriggles, he giggles, and then I declare, swings backwards, and forwards and tilts up his chair.”

Here, Dr. Hoffman clearly is describing, is a hyperactive, impulsive child — the same type of clinical presentation that today we would call ADHD. He also describes Johnny Look-in-the-Air, a boy whose head is always in the clouds and wandering about.

ADHD is not purely a Western phenomenon or even an American phenomenon. We know this from epidemiologic studies of the prevalence of ADHD wherein researchers go out into communities around the world assessing a wide number of children and determining the rates of ADHD. This has been done in the African continent, in South America, in Asia, in North America, and in Europe. And it shows us that ADHD is, indeed, found worldwide.

What’s more, the rates of ADHD around the world are fairly consistent at between 5% and 6% of each population. If ADHD were purely a Western phenomenon, we would see the rates very high in North America and Europe and very low in all other continents. That’s not what the data are showing us.

ADHD Myth #3: ADHD is the result of bad parenting.

The problem is rooted in brain chemistry, not discipline. When a child with ADHD blurts things out or gets out of his seat in class, it’s not because he hasn’t been taught that these behaviors are wrong. It’s because he cannot control his impulses.

In fact, overly strict parenting — which may involve punishing a child for things he can’t control — can actually make ADHD symptoms worse. Professional interventions, such as drug therapy, psychotherapy, and behavior modification therapy, are usually required.

ADHD Myth #4: ADHD affects only boys.

Girls are just as likely to have ADHD as are boys, and gender makes no difference in the symptoms caused by the disorder. But because this myth persists, boys are more likely to be diagnosed than girls.

ADHD Myth #5: A kid who can play video games for hours couldn’t possibly have ADHD.

It is quite common for a child with ADHD to be very distractible in one setting, but highly, highly focused in other settings.

Why is this? Because ADHD does not mean no attention. Really, ADHD means dysregulated attention. Environments or activities that are highly stimulating can actually lead to hyperfocus. It’s in the more mundane and less stimulating settings where you see the distractibility really come to the surface.

ADHD Myth #6: Children with ADHD eventually outgrow their condition.

More than 70% of the individuals who have ADHD in childhood continue to have it in adolescence. Up to 50% will continue to have it in adulthood.
Although it’s been estimated that 6% of the adult population has ADHD, the majority of those adults remain undiagnosed, and only one in four of them seek treatment.

Yet, without help, adults with ADHD are highly vulnerable to mood disorders, anxiety, and substance abuse. They often experience career difficulties, legal and financial problems, and troubled personal relationships.

ADHD Myth #7: Children who take ADHD medication are more likely to abuse drugs when they become teenagers.

Actually, it’s just the opposite. Having untreated ADHD increases the risk that an individual will abuse drugs or alcohol. Appropriate treatment reduces this risk.

It is certainly true that children who have ADHD are more likely than their neurotypical peers to abuse substances. However, it is not the use of medication that is driving this effect. We know this through longitudinal studies that compare children with ADHD who are taking medication to children with ADHD who are not taking medication. We follow them over time and see that the ones who are taking medication are at no increased risk of substance abuse relative to the ones who have ADHD and are not taking medication.

What’s more, the medications used to treat ADHD have been proven safe and effective over more than 50 years of use. These drugs don’t cure ADHD, but they are highly effective at easing symptoms of the disorder: They are the first-line of treatment for a reason.

What’s driving this misconception is a very, very common mistake — equating correlation with causation. What’s driving the risk for substance use is the ADHD, not the medication.

ADHD Myth #8: Children who are given special accommodations because of their ADHD are getting an unfair advantage.

Actually, children with ADHD are at a distinct disadvantage, and school policies, accommodations, and education legislation concerning disabilities seeks to decrease this disadvantage as much as possible.

ADHD is a real and meaningful diagnosis. Longitudinal studies tell us unequivocally that the diagnosis of ADHD confers risk for a host of negative outcomes, including not completing high school, dropping out of college, teen pregnancies, car accidents, and a whole wide range of negative outcomes.

The federal Individuals with Disabilities Education Act (IDEA) aims to decrease these risks at least somewhat by requiring that public schools address the special needs of all children with disabilities, including children with ADHD. Special accommodations, such as extra time on tests, simply level the playing field so that kids with ADHD can learn as successfully as their classmates.

ADHD Myth #9: People who have ADHD are stupid or lazy — they never amount to anything.

Many well-known, high-achieving individuals from the past are thought to have had ADHD, including Mozart, Benjamin Franklin, Abraham Lincoln, George Bernard Shaw, and Salvador Dali. The list of high-achieving people with ADHD in business today includes top executives such as Richard Branson of Virgin, David Neeleman, founder of JetBlue Airways, and Paul Orfalea, founder of Kinko’s.

BY JONATHAN POSNER, M.D.

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