Attention-deficit/hyperactivity disorder (ADHD) is characterized by chronic, pervasive, and developmentally inappropriate patters of inattention, impulsivity, and/or hyperactivity. (Netherton, Holmes, & Walker, 1999, p. 98)
I wasn’t surprised at all that ADHD was mockingly referred to as “the latest fad in psychiatry” or “the disorder of the 90s.” I graduated from high school in 1995, and I remember hearing about it as early as 8th grade. It was probably the first “formal” pathology I was ever exposed to, and the first disorder I was able to have a conversation about with my school peers. Obviously this was driven by the media to some degree, but at some point it became part of our collective conscious as high school students. Even as kids, we could drop ADHD in a conversation and everyone would have some general idea what you were talking about. I was barely 14 the first time I saw someone trade Ritalin for enough cash to get a soda and a candy bar.
We all grew up with people that “didn’t listen to instructions” or “became bored easily.” We’ve all ran into the kid who “makes indiscreet remarks without regard for social consequences,” I like to call them the class-clowns. What confuses me, is that the ambiguous nature of the criteria for diagnosis could probably apply to most kids in one way, shape, or another.
This is the first DSM-IV-TR I have experienced that requires sub-typing. I was previously unaware of ADHD Combined Type, ADHD Predominantly Inattentive Type, ADHD Predominantly Hyperactive-Impulsive Type, ADHD in Partial Remission, or ADHD NOS. (Netherton et al., 1999, p. 101) The separation of the diagnostic criteria in the DSM-IV-TR and the ICD-10 seems to make logical sense to me.
I, too, was under the impression that most people outgrow their ADHD problems as they reach adolescence. (Netherton et al., 1999, p. 103) I still know a few adults that would describe themselves as ADHD, despite the fact that research suggests that the vast majority of people learn to compensate for these problems and therefore make a satisfactory adult adjustment. Perhaps the few self-described adults I know are more the exception than the rule. It leaves me to wonder about prevalence, and how many “normal” adults I know that were previously diagnosed with ADHD.
ADHD is best diagnosed outside the clinical environment since symptoms are much more likely to occur in situations that are highly repetitive, boring, or familiar. (Netherton et al., 1999, p. 104) Because of the nature of the pathology, we are increasingly dependent on the accounts that are reproduced by parents, teachers, and other engaged caretakers. I totally agree with Netherton and associates that it can provide “a basis for determining how likely it is that parents and other caretakers will implement recommended treatment strategies on behalf of their child or adolescent,” (Netherton et al., 1999, p. 106) but I question the consistency of the reporting as a measure of diagnosis. While I can’t totally discount second hand accounts, I would be inclined to go observe personally so that I can draw my own conclusions. Is it considered acceptable for a clinician to go observe a kid in the classroom?
I have never heard of “drug-free holidays,” nor have I know my associates who were diagnosed with ADHD to discontinue the use of pharmacotherapy on the weekends… but I would be inclined to recommend it just we can get a measure of exactly what effects the medication is having. I think the concept is especially useful where combined interventions have been implemented.
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.