Caveat: Experts are hesitant to speak to causation. Causation is very difficult to prove. I noticed this morning in a book written by an expert in ADHD, that he would only offer theories on causation. In some instances, my theories are in opposition to his. To some extent my disagreement may come from the presuppositions I bring to this topic as a Christian. That being said, not everyone agrees with what I have to say on ADHD especially the discussion on discipline and family structure.

As a reader commented, many of the symptoms of ADHD are similar to characteristics of boyhood. I would probably carry this a bit further to state that many of the symptoms of ADHD are characteristic of childhood.

ADHD is genetic. Some children are born with a propensity to higher levels of activity, and greater measures of distractibility. One mother whose children are now grown described to me her two children. Her daughter could sit down and read a book all day and seemed to prefer quiet, less active activities. Her son, on the other hand, from birth was always moving, barely controlled, flying from activity to activity and full of energy. These children were born with different temperaments.

ADHD is familial. When I have on my schedule a child for an ADHD evaluation or follow-up, I know that there is between a 25% and 50% chance of a “no-show.” Some parents of children with ADHD have the adult manifestations of ADHD. While no longer hyperactive, they tend to be disorganized, find concentrating difficult, and are easily distractible. This is manifest in a parenting style that lends itself to the development of ADHD type traits in the children.

ADHD is discipline related. When children have control of their environment at home they may have difficulty adjusting to a more controlled environment at school. This can be because of a permissive parenting style, or because of inconsistent parenting. These children may not know what it is like not to get what they want, when they want it. They may never have been taught that you don’t just do whatever comes to mind. Along these lines, it seems to me that single parent families whose children are reared both in the home and at daycare seem to have more problems with ADHD.

ADHD is entertainment related. Many children watch tremendous amounts of TV, play computer games and video games. All of these activities are in some way stimulating for the brain. The image is constantly changing, the sound is intense, the mental involvement is often exciting (although intellectually unchallenging). These young brains get accustomed to this high level of arousal. When they go to school, church, or any other much less stimulating environment, their brains are screaming at them for some stimulation, stimulation that can be achieved by getting out of a seat, talking, being disruptive or living in a daydream world.

ADHD is physiologic/ medical. Many children with medical and physical problems have difficulty with control and attention. For instance, a child who snores at night may not be getting the rest that he needs. This child will find some of the cognitive skills that are required for impulse control difficult. (Think of lack of sleep like alcohol: it makes judgment more difficult.) Interestingly, this poor impulse control appears as hyperactivity because the child thinks about something and then does it. Children who are tired for other reasons often struggle with attention as well. It is important to consider bed times, snoring, noisy environments and any other factors that may contribute to poor sleep in children when assessing ADHD. Other medical problems may lead themselves to the manifestations of ADHD, although by definition if any medical diagnosis can explain the behavior then it is not technically ADHD. ADHD seems to be more common in children with other problems such as learning disabilities, mental retardation, injuries to their brains, etc.

It might be helpful to think of ADHD like one would think of weight. My brother has never in his life had to watch what he eats. He doesn’t exercise much, but for some reason he has been unable to gain weight, let alone ever get overweight. I, on the other hand, have been struggling not to gain any more weight, and in fact lose weight, for several years now. If I ate and exercised like my brother, I would have some serious weight problems. He and I demonstrate different genetic potential as it pertains to the trait of weight. But clearly discipline and behavioral factors weigh into my final body composition. The aspects that make up ADHD may be considered on a similar continuum of traits. One may be born with the ability to pay attention to the minutest detail for hours or conversely not be able to pay attention to one thing for more than a couple of seconds. In terms of attention, one of these children is going to be much easier to rear. The one child may never have any of the characteristics of ADHD while the other may fit the definition for several years or for his whole life, depending on the environmental inputs. If taught skills for paying attention and if taught to properly control his impulses this child will likely do well, although even in adulthood may struggle with keeping on task. Does that mean that he has a “disorder” or a “disease”? I don’t think so. Does he fit the definition of ADHD? Probably. The children in between these two extremes are going to be affected by parenting, TV, environment, illness and sleep to varying degrees. For some, nothing you could do will make them ADHD, for others if the parenting and environment isn’t God centered, Biblical, consistent, and loving the child may have “ADHD.” And as in my example, a few, no matter what you do, may fit ADHD.

More on this later. I probably will deal with diagnosis and treatment options

Posted by Lee Brock on Tuesday, November 29th, 2005 at 11:18 am.