ADHD: Disempowerment By Diagnosis
By David Mielke, M.S.
“Mr. Mielke, I won’t be able to complete the assignment. I have ADHD.”
“I don’t have to copy those notes from the board; someone needs to copy them for me.”
“You can’t say ‘No’ to me; I can take the final exam in the special ed classroom.”
I’ve been a high school teacher for almost 40 years and currently teach two elective courses (psychology and sociology) to 11th and 12th graders at Culver City High School in California. My background includes a B.A. in psychology, an M.S. in counseling, and I was just a dissertation away from my PhD in clinical psychology. (I’m not sure you can ever say “just” a dissertation away!)
The three examples above illustrate how giving a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) can profoundly disempower students.
Each of these three students was perfectly capable of doing what the other students in class were doing: completing an assignment at home, copying notes from the board, and taking the final exam in my classroom with classmates. But in each case, they cited their ADHD “disability” as a reason to be excused from routine classroom expectations.
Have I fallen down the rabbit hole or gone through the looking glass? After all, giving a diagnosis is not meant to create a disability, is it? Why, then, does an ADHD diagnosis so often lead to what psychologists call “learned helplessness” and to the disabling belief in students that “I can’t do it”?
Let me share a few thoughts and observations about ADHD based on my academic training and those 40 years (!) of teaching.
1. There are no objective tests for ADHD.
Physical illnesses are diagnosed objectively; ADHD diagnoses are entirely subjective. My high cholesterol was diagnosed by a blood test and the torn ligament in my knee was diagnosed by an MRI, but there are no blood or imaging tests for ADHD. Not one.
Dr. Smith may give your child this diagnosis while Dr. Jones may laugh and share that he had trouble paying attention in geometry too!
2. ADHD didn’t even exist until 1989.
ADD (Attention Deficit Disorder) made its debut in 1980. “Hyperactivity” was added nine years later. Prior to this, teachers understood that kids, by definition, were energetic, goofy, silly, and my favorite, “squirrelly.” In school they needed frequent breaks, recess in the morning and in the afternoon, classes in art, music and physical education, and “free time” where “kids could just act like kids.”
Now, as a school principal recently reminded me, “We need them to be on task from bell to bell.” Have we forgotten what it’s like to be a child?
3. A disorder—or just behavior that teachers don’t like?
If you track the evolution of the disorder in successive revisions of the DSM, it starts with “attention” (ADD), expands to include “hyperactivity” (ADHD), and expands yet again to include “disruptive behavior” in the new DSM V disorder “Disruptive Mood Dysregulation Disorder” (DMDD).
Johnny won’t pay attention, he won’t sit still, and he can be disruptive. Teachers used to recognize these as normal childhood behaviors. Now they’re disorders? What’s next? Sloppy Handwriting Disorder? Tardy to Class Disorder? A recent cartoon recast bullying as Compassion Deficit Disorder!
4. Kids internalize these labels and see themselves as permanently disabled.
I’m old enough to remember when kids were said to be “going through a phase” or experiencing “growing pains.” Now my students speak of “having” ADHD in the same way any of us might speak of “having” diabetes or “having” high blood pressure.
Could there be a more disempowering message than to tell a young person that there is something permanently wrong with his or her brain? And if there is something wrong with a student’s brain, why should he or she work hard to master difficult concepts and skills? “I won’t be able to complete the assignment; I have ADHD.”
5. Isn’t it my job to engage my students?
According to Michael Corrigan, more American students are taking stimulant drugs for attention than all of the children living in Ireland! We’re living in a Mad Hatter’s world where we have chosen to change our kids’ brains with drugs rather than change what we’re doing in our schools.
As a teacher, I know that if I’m losing my students’ attention I need to change what I’m doing in class. That’s Teacher Prep #101 !
6. We pay attention to things that are important or interesting.
When I was teaching a health class years ago, I noticed that students would often drift off when we were studying the circulatory system, but when we were teaching safe sex everyone paid attention! No one had ADHD on those days!
Speaking of safe sex, I attended a workshop for teachers during the early days of the HIV epidemic and the facilitator taught in 20-minute segments broken up with short breaks. When I asked him about it, he responded that “that’s about how long people can pay attention.” If that’s how long teachers can pay attention, what about a 12-year-old boy in a math class?
7. Video Games!
Speaking of 12-year-old boys, if ADHD is a brain disorder that prevents students from concentrating, how is it possible that kids with this diagnosis will concentrate ferociously for hours and hours on video games? Are the symptoms only expressed at school? Does the disorder go into remission when kids turn on their PlayStations and Xboxes?
8. Just say “No” to drugs?
Do drugs lose the power to alter our personalities or create dependency when prescribed by a doctor and referred to as “medication?” Are stimulant drugs safe for kids? What about tolerance? Addiction? Withdrawal? Side effects? And can minors give informed consent?
A 26-year study by Nadine Lambert at UC Berkeley found that young people who took stimulant drugs for attention were more likely, as adults, to smoke cigarettes and use stimulant drugs like cocaine and methamphetamine.
Ritalin is not Vitamin C.
9. Do ADHD diagnoses lead to diagnoses of bipolar disorder?
Stimulant drugs create an “up/down” cycle which mimics the symptoms of bipolar disorder. As many as 20% of our children who take stimulant drugs for ADHD will “graduate” on to the more disabling and permanent adult diagnosis of bipolar disorder.
10. Could they just be tired?
Those of us who teach at high schools that start at 8:00 A.M. know how easy it is for kids to fall asleep in small, cramped, uncomfortable desks. Teenagers are terribly sleep-deprived and research confirms that tired students have real trouble with focus and concentration.
Why not start schools an hour later and replace that Ritalin prescription with a prescription for an extra hour of sleep?
11. Could they be gifted students who are bored at school?
Students who learn at a faster pace than other kids get bored in classes that are moving too slowly for them. They are easily distracted, fidget, doodle and daydream. In short, they exhibit all the “symptoms” of ADHD.
If Leonardo da Vinci and Albert Einstein were students in American schools today, there is a good chance they would both be on stimulant drugs!
12. Could the attention problem be the attention they need and are not getting?
Peter Breggin has written about DADD (Dad Attention Deficit Disorder) and MADD (Mom Attention Deficit Disorder). Problems at home lead to problems at school. Kids experiencing a love and attention deficit at home will find it hard to focus on the Periodic Table of Elements.
13. Could this just be “boy behavior” that schools haven’t addressed?
Boys are three times more likely than girls to be diagnosed with ADHD. Boys also account for the vast majority of D’s, F’s, suspensions, expulsions and dropouts.
Are boys’ brains inferior? Do they need stimulant drugs? Or might the problem lie in the structure and design of our schools which leave so many of our boys disengaged?
14. It’s your birthday!
Recent research both in Finland and at Michigan State University found that the youngest child in a class is twice as likely to get an ADHD diagnosis as the oldest child. Younger kids are more “squirrelly” than older kids? They have a tougher time settling down and focusing? What a surprise !
15. Were you a “late bloomer”?
Students are not robots that can be programmed so that they all master the multiplication tables at the same exact time. For some, the “light bulb” doesn’t go on quite as soon as we would like. But are inattention and a lack of interest evidence of a broken brain or does it simply illustrate the wide range of child development and student interests?
16. We’re #1!
American kids are 10 times more likely to be diagnosed with ADHD than kids in Europe and we consume 85% of the stimulant drugs prescribed to kids worldwide. What do other countries know about childhood that we don’t?
17. Do kids like being on these drugs?
Often lost in this debate about the medicalization of everyday life is the subjective experience of young people on these drugs. Students report headaches, anxiety, mood swings, and sleep disturbances. A common complaint is that they “just don’t feel like themselves” and that they look forward to “drug holidays” over the summer.
Drug holidays? Are there any other brain abnormalities that go into remission every July and August but return in September?
18. What’s our responsibility as educators?
Isn’t it time for those of us in education to reclaim our profession?
Who are the teaching and learning experts? Doctors? Drug companies? We are! And if we don’t stand up—for our students—against disempowering diagnoses and harmful drugs, who will? And if not now, when?
David Mielke, M.S. teaches Psychology and Sociology at Culver City High School (California). His academic background includes a B.A. in Psychology (Yale), an M.S. in Counseling (California State University, Los Angeles), and doctoral coursework at the California Graduate Institute. Mielke also serves as the President of the Culver City Federation of Teachers and is a Vice-President of the California Federation of Teachers. This article was republished with permission from madinamerica.com.
I really respect your motivation to advocate for your students. It’s obvious that you genuinely care about what’s best for the kids you work with, and that deserves a major shout-out!
I can certainly understand some of your feelings on this topic. Misdiagnosis, overpathologizing, and learned helplessness can be a problem with this disorder, as it can be with most of the diagnoses in the DSM. It’s also true that medications are not a good fit for everyone. There are always pros and cons that should be carefully considered.
But, respectfully, I want to offer an alternative perspective on the impact of ADHD diagnosis. I have seen that many individuals suffer for years trying to understand and manage symptoms. When not properly diagnosed, their repeated failure to do so can become internalized. Unfortunately, this can be equally toxic to self-esteem and overall functioning as the cases you described at the start of your article. A person with ADHD believing that he/she is inherently “stupid,” “ditzy,” or “lazy,” rather than understanding their brain-based difference can also create learned helplessness.
For the majority of my clients with ADHD (and myself… I am a clinical psychologist with ADHD) getting an accurate diagnosis is not disempowering. Rather, it can be extremely empowering and validating to understand the missing piece of the puzzle. Using a diagnosis as an excuse is never healthy/okay… but the diagnosis should serve an important role as an explanation. The entire purpose of any DSM diagnosis is to provide a better understanding of impairing symptoms as well as the treatment avenues that might be helpful.
Aside from the discussion of whether the label is disempowering… I also want to mention that I noticed a few common myths embedded in your article. You’re definitely not alone in having these misconceptions… most clinicians and professionals (myself included) have received some outdated education in this area. For example, the ability to focus in certain contexts (eg videogames) but not others is entirely consistent with an ADHD symptom profile. The label ADHD is actually a misnomer as it is a disorder of executive regulation, not deficit. Additionally, the vast majority of well-controlled longitudinal studies on stimulants for ADHD actually demonstrate a significant reduction in the risk of future substance use. Those who are not effectively treated, however, are at significantly greater risk for developing substance use disorders. I noticed that the publication you cited was over 20 years old and had some significant limitations. If interested, please see Barkley (2019), Barkley et. al (2016), or Hinshaw (2016) for more updated, evidence-based perspectives in this area.
In any case, given your counseling/psychology background, I am hoping that you will try to be receptive to my critique. I’ve dedicated a great deal of my research, clinical work, and advocacy toward improving awareness of these issues.
Thanks so much and best wishes!
Beautiful Minds Wellness has a free course on psychiatric medications where Dr. Binus discusses recent studies on long-term affects of ADHD medications. Here’s where to find it http://bit.ly/2vtwLvF.