What is ADHD?
The fifth edition of the American Psychiatric Association’s Diagnostic Statistical Manual (DSM-5) lists Attention-Deficit Disorder (ADD) / Attention-Deficit/Hyperactivity Disorder (ADHD) as a “Neuro-developmental Disorder” and refers to it as a neurological disease. It notes that it is not only found in children, but in adolescents and adults.
The DSM-5 states that “individuals with ADHD may present with both inattention and hyperactivity/impulsivity, or one symptom pattern may predominate … Three presentations of ADHD are commonly referred to: combined-type, inattentive-type and hyperactive/impulsive-type … the appropriate presentation of ADHD should be indicated based on the predominant symptom pattern for the last six months.”
Summarizing the DSM-5’s description of ADHD, the ADHD Institute defines it as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities), and negatively impacts directly on social, academic, or occupational functioning. Several symptoms must have been present before age 12 years.”
The National Institute of Mental Health (NIH) considers ADHD “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
The NIH delineates three basic types:
- Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized, and these problems are not due to defiance or lack of comprehension.
- Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate, or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
- Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
The National Resource Center on ADHD’s website (CHADD) reiterates this information and lists the symptoms of each type:
ADHD predominantly inattentive presentation
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through with instructions
- Has difficulty with organization
- Avoids or dislikes tasks requiring sustained mental effort
- Loses things
- Is easily distracted
- Is forgetful in daily activities
ADHD predominantly hyperactive-impulsive presentation
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively in children; extreme restlessness in adults
- Difficulty engaging in activities quietly
- Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty waiting or taking turns Interrupts or intrudes upon others
ADHD combined presentation
- The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.
According to the Mayo Clinic’s website, ADHD “is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior … children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age [but] some people never completely outgrow their ADHD symptoms.”
It cites several scenarios on how life can be difficult for children with ADHD, namely that they:
- Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
- Tend to have more accidents and injuries of all kinds than do children who don’t have ADHD
- Tend to have poor self-esteem
- Are more likely to have trouble interacting with and being accepted by peers and adults
- Are at increased risk of alcohol and drug abuse and other delinquent behavior
The Mayo Clinic suggests that children with ADHD are also more likely than others to have conditions such as:
- Learning disabilities, including problems with understanding and communicating
- Anxiety disorders, which may cause overwhelming worry, nervousness
- Depression, which frequently occurs in children with ADHD
- Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating frustration
- Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant, and hostile behavior toward authority figures
- Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
- Bipolar disorder, which includes depression as well as manic behavior
- Tourette’s syndrome, a neurological disorder characterized by repetitive muscle or vocal tics
Causes of ADHD
Both the National Institute of Mental Health (NIMH) and CHADD inform us that, despite numerous scientific research studies, the causes of ADHD have not been identified. NIMH suggests that “like many other illnesses, a number of factors can contribute to its development,” such as:
- Cigarette smoking, alcohol use, or drug use during pregnancy
- Exposure to environmental toxins during pregnancy
- Exposure to environmental toxins, such as high levels of lead, at a young age
- Excessive sugar intake
- Low birth weight
- Brain injuries
CHADD reports, however, that more than 20 genetic studies show evidence that ADHD runs in families which indicates a strong genetic link. It reports that “the complexity of ADHD [is probably] the result of multiple interacting genes.”
It also advises that other factors in the environment may increase the likelihood of having ADHD such as:
- exposure to lead or pesticides in early childhood
- premature birth or low birth weight
- brain injury
CHADD advises that the following factors are NOT known causes, but can make ADHD symptoms worse for some children:
- watching too much television
- eating sugar
- family stress (poverty, family conflict)
- traumatic experiences
Many contributing factors seem to be proposed for the cause of ADHD, but it appears that most professionals and researchers believe that its fundamental cause consists in a brain chemical imbalance and a brain malfunction.
ADHD has been medicalized, and there is a concerted effort to advance the idea that ADHD is definitely NOT caused by moral failure, poor parenting, family problems, poor teachers, or faulty socialization. In the absence of hard evidence, ADHD is viewed as a brain-based medical disorder of genetic origin.
Treatment for ADHD
The NIMH and the Mayo Clinic are confident that treatments exist that reduce symptoms of ADHD and improve daily functioning (i.e., medication, psychotherapy, education or training, or a combination thereof).
Many different medications are recommended and various therapies are recommended such as the following:
- Behavior therapy: Teachers and parents can learn behavior-changing strategies, such as token reward systems and timeouts, for dealing with difficult situations.
- Psychotherapy: This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns, and learn ways to deal with their symptoms.
- Parenting skills training: This can help parents develop ways to understand and guide their child’s behavior.
- Family therapy: Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
- Social skills training: This can help children learn appropriate social behaviors.
Alternative treatment modalities are recommended by the Mayo Clinic:
- Yoga or meditation: Doing regular yoga routines or meditation and relaxation techniques may help children relax and learn discipline, which may help them manage their symptoms of ADHD.
- Special diets: Most diets promoted for ADHD involve eliminating foods thought to increase hyperactivity, such as sugar, and common allergens such as wheat, milk, and eggs. Some diets recommend avoiding artificial food colorings and additives. So far, studies haven’t found a consistent link between diet and improved symptoms of ADHD, though some anecdotal evidence suggests diet changes might make a difference. Caffeine use as a stimulant for children with ADHD can have risky effects and is not recommended.
- Vitamin or mineral supplements: While certain vitamins and minerals from foods are necessary for good health, there’s no evidence that supplemental vitamins or minerals can reduce symptoms of ADHD. “Megadoses” of vitamins — doses that far exceed the Recommended Dietary Allowance (RDA) — can be harmful.
- Herbal supplements: There is no evidence to suggest that herbal remedies help with ADHD, and some may be harmful.
- Proprietary formulations: These are products made from vitamins, micronutrients, and other ingredients that are sold as possible treatment supplements for children with ADHD. These products have had little or no research and are exempt from Food and Drug Administration oversight, making them possibly ineffective or potentially harmful.
- Essential fatty acids: These fats, which include omega-3 oils, are necessary for the brain to function properly. Researchers are still investigating whether these may improve ADHD symptoms.
- Neurofeedback* training: Also called electroencephalographic (EEG) biofeedback, in these sessions a child focuses on certain tasks while using a machine that shows brain wave patterns. The goal is to learn to keep brain wave patterns active in the front of the brain, improving symptoms of ADHD. More research is needed to see if this works.
- Exercise. In addition to its health benefits, regular exercise may have a positive effect on behavior in children with ADHD when added to treatment.
*CHADD reports that a relatively new treatment has been introduced, known as “neurofeedback” which is “a computer-assisted therapy that measures brain activity via electrodes placed on the scalp, with activity then visualized on a monitor. This allows a person to learn how to control brain activity in response to the computerized feedback. Over a gradual learning process, the brain is rewarded for changing its activity to more appropriate patterns.” Dr. Van Der Kolk claims that it can rewire the brain to focus/concentrate while reducing impulsivity.
What Should Christians Know About ADHD and its Treatment?
The Medicalization of ADHD
The medicalization of ADHD is in full swing. CHADD estimates that more than 10% of children in the United States ages 4-17 were diagnosed with ADHD and that over 15% of children grades 1-5 are diagnosed with ADHD. These kinds of numbers are alarming to many people who question the validity of the APA’s assertion that ADHD is a neurobehavioral disease.
The current trend of delivering children over to the medical establishment for diagnosis and treatment is meeting with some consternation. With all the hype, it is easy to assume that the child has a brain disease and needs medication and other interventions to “rewire chemical circuits” of the brain. The medicalization of ADHD has taken the family and schools by storm to where kids are routinely referred for psychiatric care (i.e. medication).
There are dissenting voices to this state of affairs, however. Dr. Leon Eisenberg, the scientific father of ADHD, in his last interview he gave before his death at age 87 in 2009, for example, viewed ADHD as a fictitious diagnosis which consists only of identifying a list of behavioral symptoms. Indeed, a medical diagnosis does not seem to capture the essence of this problem and is too simple an answer to a complicated issue. And, a label of ADHD would not seem to be helpful, and likely stigmatizes the child.
Author Kati Li tracks the history of how children’s behavior has become medicalized in a well-documented article that appeared in The Journal for the Scientific Study of Religion. She claims that “by diagnosing kids with ADHD, biological factors have come to override what used to be considered moral problems under the jurisdiction of the family.”
Li points out that medicalization of ADHD does not hold kids responsible for deviant behavior. Rather, it views unacceptable behavior as an indication of a disease process — as “sick” behavior. In effect, families are no longer held responsible for disciplining, socializing, and protecting their children.
Medication for ADHD children, however, is a concern of both Christians and non-Christians, alike. In the book, ADHD:Beyond the Meds, author Jeremy Martin makes several important points about medicating ADHD. First, he alleges that, “In many cases, drugs used to treat ADHD are gateway drugs for other drugs, both legal and illegal.”
Commonly prescribed drugs for ADHD are similar to amphetamines (speed), a drug in the same class as cocaine and a substance bartered for recreational use.
Second, Martin is also concerned about whether these medications are really effective, since many kids prescribed ADHD medication continue to have major behavior problems.
Third, medication for ADHD may have unnerving side effects. He claims that it can lead to addiction, nervousness, anxiety, insomnia, decreased appetite, headache, stomachache, nausea, dizziness, and heart palpitations.
Anthony Martignetti is also critical of using psychiatric medication, believing that “talk therapy” is much to be desired. He writes that medication may be the desired intervention for several reasons.
First, parents may “interpret discipline, age-appropriate accountability, and boundaries to be forms of psychologically damaging abuse…which creates children without boundaries who are unresponsive to parental controls and who act and appear to be what we would have referred to in another time as ‘spoiled brats.’”
Second, he asserts that it could well be a function of parents not having the time to focus adequate attention and energetically engage with their children. Parental guilt and parental fatigue may lie behind the reason that children lack boundaries and resist instruction.
Third, Martignetti blames societal change that views aggression, competitiveness, “roughhousing,” and other forms of “acting-out” as pathologically harmful to the development of self-esteem.
It’s interesting that Ms. Li’s study reveals that the medicalization of ADHD only offends some Christian groups (i.e. Catholics and Conservative Protestants). Conservative Protestants believe that the Bible is the infallible Word of God and that man is predisposed to sin, disobedience, and rebellion against God’s laws, which translates to an emphasis on discouraging behaviors that present a health risk (i.e. drinking, smoking, fornication, drug use, extramarital sex, etc.).
Evangelicals maintain that the Christian’s body is a temple of the Holy Spirit and must be kept clean as the Bible teaches. As a whole, evangelicals reject secular psychiatry and favor a Bible-based approach to life and treatment. Evangelicals, therefore, would be less likely to view ADHD as a disease for religious reasons.
Conservative Protestants and Roman Catholics recognize that ADHD has spiritual implications. The Bible addresses many of the behavioral symptoms, and the church encourages Christians to explore Biblical teaching that highlights them.
Biblical studies can include references on “attentiveness” (Proverbs 6:6-8, 6:20-21, 7:24, 12:11, 24:27; Colossians 3:23; James 1:19; Deuteronomy 6:6-8; 1 Peter 1:12-15), “self-control” (Galatians 5:23, 2 Peter 1:6, 1 Corinthians 9:27, Proverbs 10:19, 25:28, Matthew 12:36, Philippians 4:8), and “impulsivity” (Proverbs 18:13, 21:5, James 1:2-4, 1:19, Galatians 5:22).
In addition, Philippians 2:3-4 speaks to a need to develop a “service-to-others” orientation, Romans 12:2, Ephesians 4:23, and Philippians 4:8 teach the value of controlling one’s thoughts, 1 Corinthians 14:40 infers that building structure into our lives is important, 2 Timothy 3:10-11 indicates that modeling “proper behavior” is important, and 2 Timothy 3:16 says that all Bible teaching is useful.
The Pursuit of Godly Seed is a volume from a conservative Christian orientation that can be instructive on how Bible principles of child training and home life could be a potential antidote for ADHD. This book recognizes the consequences of rejecting, neglecting, and devaluing children and the need to provide them with proper nurturing, protection, teaching, training, discipline, and guidance.
The author writes that children can be offended by parents and caregivers, which can prevent them from following the Lord, and these children can thereby be turned away from God and incur judgment upon themselves (Matthew 18:1-14). The author lists six things that could well fit this text: (a) being raised in a “lukewarm” Christian home, (b) being beaten in a fit of anger, (c) having to suffer the pain and confusion of divorce and remarriage, (d) being verbally abused, and (e) being sexually molested. Although the author does not draw a connection with ADHD, it seems reasonable to do so.
Christians would do well to question the diagnosis, research, and recommended treatment of ADHD. An online article reports that Dr. Eisenberg, the man who “discovered” ADHD, made a shocking statement on his deathbed. He is quoted as saying that “ADHD is a prime example of a fictitious disease.”
The article chronicles how Eisenberg made a luxurious living off of his “fictitious disease,” thanks to pharmaceutical sales. The article documents how he received the “Ruane Prize for Child and Adolescent Psychiatry Research and how he was a leader in child psychiatry for more than 40 years through his work in pharmacological trials, research, teaching, and social policy and for his theories of autism and social medicine,” according to Psychiatric News.
This article is enlightening and is a caution against accepting much of what is believed and taught about ADHD. It reveals that using the guise of helping children, the medical industry is undermining the role of parents and family and interfering with the healthy upbringing of children. Parents are placing their children on these drugs to correct an alleged brain disease and subjecting them to unnecessary dangers. Impulsive and inattentive children are in need of parental love, guidance, and discipline rather than medical intervention. They desperately need the hope of being the blessing that God intended them to be.
Kenaston, Denny. The Pursuit of Godly Seed. Reamston, Pa: Home Fires Publishers, 2003.
Li, Kati. “Religion and Medicalization: The Case of ADHD,” Journal for the Scientific Study of Religion, 52(2), 2013, p. 309-24.
Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/adhd/home/ovc-20196177
National Institute of Health https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
National Resource Center on ADHD. http://www.chadd.org/understanding-adhd/about-adhd.aspx
Van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014, p. 324.
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