Tom Cruise aside, many wonder about the high rate of diagnosis of ADD in our society today.  Are we over-diagnosing and over-treating these children?  Are we just throwing medicine at a problem that we should be using better discipline to fix?  Is ADD something that is "wrong" with the child, something to be fixed?  Or is it something that just is "a kid being a kid" that we should expect and not be surprised about.

My views on this are tainted by the fact that I have no doubt that I would have been diagnosed with ADHD when I was a child.  I was a constant under-achiever, a child who scored very high on every standardized test, but yet never did much better than a B average in school.  I was impulsive - being sent to the principal's office on a very regular basis and giving my parents much to be frustrated at.  I see many of those traits still in my life and fight those "demons" on a regular basis.  So when people make proclamations about the "reality" of ADD/ADHD, I have a strong response.  When I see children really struggling in school, not because they lack the intelligence but the ability to stay focused, I feel a lot of sympathy.

I approach ADD as not something to be fixed, but a part of the personality of the child.  We all have things that are good and bad in our personalities.  Many of our strongest traits have a flip-side that cause a great deal of problems.  People who are detail-oriented are very good when it comes to doing the job well - they don't rest until they have all of the details right.  On the other hand, these people can become paralyzed by their perfectionism and often are too fearful to take risks and show creativity for fear of making mistakes.  Then there are those of us who are big risk-takers.  We are the trail-blazers, the creative ones.  The motto of our lives is "why can't I?"  It is very hard for us to take no for an answer.  Yet it is very hard for us to pay attention to the details.  We get bored easily and want to move on to the next task before we are finished with the task at hand. 

This is precisely what has motivated me to become so involved with Electronic Medical Records.  First, I see it as a way to solve a problem that plagues all doctors.  I have been a trail-blazer in this area, not fearing failure, but taking the risk necessary for success.  On the other hand, I also am very bad at the details, which is why computerizing my records is absolutely necessary.  I could never keep a neat paper chart.  I fear the consequences of my own disorganization, and that fear has also driven me to let the computer do that work for me.

The main problem with ADD is that the child does not fit in the environment in which they have been placed - namely, school.  When you take a child who is creative, won't take no for an answer, is independent, and gets bored easily, and you put them in a classroom for 6 hours, you can't expect a lot.  They may be smart, but the ability to sit and focus for the needed time just is not there, and they will be disruptive and/or perform far below potential.

Now, there are some circumstances where children may be able to overcome these tendencies, but their home situation is so unstructured that they are swimming upstream.  This is part of why I was able to succeed despite my obvious ADHD - my household was very predictable and organized.  My parents were consistent and encouraging (as a whole), and so I did not do so much damage by my under-performance that I could not get in to college.  Most children don't have this advantage.

So, is ADD something created by our society?  Yes and No.  It is something innate in some personalities that is amplified by our fast-paced society.  Both parents are working in most households, or the family has been splintered by divorce - leading to a breakdown in the predictability of life.  Yet some kids overcome it and others don't.  In an agrarian culture, this really was not much of a problem.  In today's culture it is a huge problem.

One of the first things I do on a consultation regarding ADD is to reassure the parents and child that there is nothing "wrong" with them.  This is not a "disease" but rather just the way the child is wired.  This does not mean that medication may not be appropriate (I will discuss that in future posts), but it does take away the stigma as a bad thing.  Is it a weakness?  Yes, but it is also a strength that I have greatly benefited from.