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Is attention deficit hyperactivity disorder a brain chemistry disorder that needs medical intervention or a perfectly healthy response to being in the wrong environment? Peter Kelly explains...

According to the NHS, attention deficit hyperactivity disorder (ADHD) is a condition where the brain works differently to most people. If you have ADHD, you may have trouble with things like concentrating and sitting still. 

Symptoms of ADHD involve your ability to pay attention to things (being inattentive), having high energy levels (being hyperactive) and your ability to control your impulses (being impulsive). 

You may show signs of being inattentive such as: 

-       being easily distracted or forgetful.

-       finding it hard to organise your time.

-       finding it hard to follow instructions or finish tasks.

-       losing things often, like your wallet, mobile or keys.

You may show signs of being hyperactive and impulsive including:

-       having a lot of energy or feeling restless.

-       being very talkative or interrupting conversations.

-       making quick decisions without thinking what might happen as a result.

These symptoms usually start before the age of 12. In the 1990s, James Swanson was working as a research psychologist at the University of California where he specialised in the study of attention disorders.

You could say he is the godfather of ADHD. In the early days of his work, he felt assured he was doing the right thing even though there was a lot of controversy around his work and protest opposition.

In the 1990s, he started conducting research studies into the benefits of taking Ritalin. The Church of Scientology campaigned against his work, even once flying a plane over a conference with a banner that read ‘Psychs, Stop Drugging our Kids’.

At that time, diagnosis for ADHD was rising rapidly but had not quite reached three per cent of children which was the rate Swanson and his peers believed was the true rate of ADHD in the population.

They had other concerns. Ritalin appeared to help with symptoms straight away but they were not sure why or how it worked. They started long-term large-scale studies comparing a medical approach to non-pharmaceutical approaches like parent training and behavioural coaching.

After 14 months, the results were clear. The children on Ritalin had significantly less symptoms. Ritalin worked, word spread and prescribing rates increased.

The current rates of ADHD diagnosis in the US is 11.4 per cent. That includes 21 per cent of 14 year-old boys and 23 per cent of 17 year-old boys. Boys get diagnosed with ADHD more than girls.

Going back to Swanson’s study, after 14 months, Ritalin was working wonders but after 36 months there was no difference in symptoms in the comparison groups.

Adult prescriptions for ADHD are also now on the rise. It is no longer a condition of school children. In America now, ADHD is very clearly seen as a medical or chemical disorder that requires a medical or chemical solution.

There are inherent deficits in children's brains (increasingly adults’ brains as well) and the medicines repair some of these deficits.

This is not how ADHD is seen in France. It is harder to get a diagnosis for ADHD in France. Children who would be diagnosed in America are classed as normal, highly active children in France. The diagnosis parameters are narrower.

In France, when a child is diagnosed with ADHD, the first assumption is that it is a situational and psychological issue rather than a chemical one. They will look at the child’s situation to see if changes in routine or environment might yield results before looking for a chemical solution.

This reminds me of the incredible TED talk by Sir Ken Robinson on education where he tells the story of Gillian Lynne, who is having trouble paying attention in school.

It details how her parents were called to the school and how the head teacher explained to her parents that there was nothing wrong with her, that she was just in the wrong environment as she was meant to be a dancer.

Her parents send her to a different school and set her on a different path and she becomes a ballerina, dancer, actress and theatre director. She is one of the great choreographers of London’s West End musicals such as Cats and Phantom of the Opera.

So, who got it right, France or America? I think in this situation, is was probably more likely France than America in this situation. Is ADHD a brain chemistry disorder that needs medical intervention or a perfectly healthy response to being in the wrong environment?

Would environment change yield better results than medicine? Is our society, and particularly our education systems, too rigid in its structure? Are creative people crushed by systems designed by academics to favour the academically-minded?

As my brother-in-law always says, the truth is probably somewhere in between.

Peter Kelly is a pharmacist based in London and a stand-up comedian.