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Neurodiversity: Is ADHD a True Mental Disorder?

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

Controversies Surrounding ADHD

ADHD has become a controversial psychological disorder. Debates center on whether or not ADHD is a mental illness/disability: Perhaps ADHD is merely a variation of a normal condition. There are notable cultural variations and gender differences. Additionally, the accuracy of prevalence rates has been called into question. As we will soon see, these two camps (real disease vs. variation on the norm) have different explanations for the rapid increase in ADHD rates. This controversy is further fueled another debate about the wisdom and ethics of giving children powerful medications; and, the stigma of an ADHD label. This diverse group of concerned people include ADHD professionals, educators, caregivers, child advocates, religious and ethical groups, and others.

Neurodiversity: Is ADHD a true mental disorder?

magnifying glass on question markThe central controversy surrounding ADHD is whether or not it is actually a "disorder." Despite well-documented brain differences and significant impairment, some experts do not view these differences as symptoms of a disorder. Instead, they see these differences as normal, but somewhat extreme, variations of human behavior. These experts use the term "neurodiversity" to describe normal, genetic, brain-based variations in behavior.

Some disorders are evidenced by symptoms that represent a complete and total deviation from normal and healthy functioning (e.g., diabetes). Likewise, some conditions are perfectly healthy but uncommon (pregnancy). However, in both cases, these are all or none. You cannot be a little bit pregnant, nor have a touch of diabetes. You either do, or you do not, have these conditions. Think of this like a light switch. It is either on, or it is off.

However, unlike many biologically-based symptoms, behavioral symptoms can be a matter of degree. There are some behaviors that everyone demonstrates to some degree or another (e.g., inattention). Think of this like a dimmer switch with an infinite intensity range from on to off. ADHD is like a dimmer switch. It is characterized by behaviors (inattention, impulsivity, excessive energy, distraction) that everyone demonstrates in varying degrees. Therefore, the question then arises: At what point does something become a disorder?

The neurodiversity argument asserts that since a large portion of the population demonstrate ADHD-like behaviors, albeit to a lesser degree, ADHD is not actually a true disorder. It is simply an extreme example of a normal variant. To complicate matters, as we mentioned before, symptoms like impulsivity and excessive energy are not unique to ADHD. Several disorders have these symptoms. The fact that ADHD symptoms are not exclusive to that disorder seems to bolster the neurodiversity argument that ADHD is not an actual disorder.

Naturally, there are those that oppose the neurodiversity argument that ADHD is not a true disease. These experts readily acknowledge that people naturally vary in terms of energy, attention, and impulsivity. However, these experts emphasize that only some people experience impaired daily functioning as a result. This interference in daily functioning is central to distinguishing disorders from normal variations of behavior. In fact, this problematic interference in social, educational, and/or occupational functioning is a requirement for all psychiatric disorders. In the normal range, behaviors such as occasional inattention or daydreaming tend to be sporadic and are usually present in only one setting. This is in contrast to ADHD where the behaviors are readily observed in multiple settings.

For children with sub-clinical ADHD symptoms, their behaviors may cause them some problems. However, these problematic behaviors are not the dominant behavioral style across different settings. Most children are able to demonstrate some control over their problematic behaviors when sufficiently motivated. In contrast, children with ADHD seem to lack this ability to self-regulate, despite their motivation and desire to do so. Their problematic behaviors are frequent and severe enough to impair their functioning in multiple settings, across time.

Fortunately, this argument over the validity of the ADHD diagnosis has faded in recent years. This is attributable to the increasing number of studies that have found consistent biological differences between people with ADHD, as compared to those without. Repeated findings of biological markers support the idea that ADHD is a diagnosable condition. LINK

Beyond the United States, the international community reached an official agreement about the nature of ADHD. In 2001, over 80 ADHD experts around the globe signed and published the International Consensus Statement on ADHD. The purpose of this document was to challenge widely-held public skepticism and debate surrounding the validity of an ADHD disorder, requiring medication. By 2005, an additional 100 experts in Europe signed their names to the document. This additional support further strengthened and validated the statement that ADHD is indeed a valid mental disorder. At this time, the majority of professionals around the world view ADHD as a true, diagnosable condition.