ADHD, Parenting, and the Brain

You're reading this book because you want something in your family's life to be different. Maybe you know your child has attention deficit hyperactivity disorder (ADHD), or you suspect it. Perhaps a parent, teacher, or close friend has drawn your attention to what they feel is a problem with your child's behavior. Or you believe your child is absolutely perfect as they are—but you would like them to be more at ease outside the family.

Maybe your child has been acting out. Or they are well behaved but struggling in school, and no one can explain exactly why. Even if you've received an ADHD diagnosis and some kind of plan, life may feel out of control. Perhaps you're wondering why, in spite of doing everything you can imagine, the same behavioral and academic problems persist. You've read every book and followed the advice of more people than you can remember, and still another call comes from the teacher: Your child is brilliant but never hands in their work. Your child pushed someone at recess again.

Maybe you're not overwhelmed and you have an easy relationship with your child, but you wish that life could be easier for them. You're sure they have the potential to succeed without so much effort or without so much support from you and their teachers. You're looking for a different perspective, and there's a nagging sense that life does not have to be so hard.

The Politics of ADHD

Attention deficit hyperactivity disorder, often called ADHD or ADD, is one of the most common behavioral conditions affecting children today—and one of the most polarizing. Parents of children who struggle in school and have behavior issues are swamped with information—and misinformation—about ADHD. There is a deluge of unsubstantiated lore about the most effective ways to treat symptoms that often hint that parents or society are to blame. You may have been led to think that if only you could parent better, your child's ADHD symptoms would vanish. Poof. Just like that. But ADHD is a medical condition—would anyone expect asthma to disappear because of parenting changes?

ADHD care has devolved into factions. Some people, ranging from doctors to psychologists to news personalities and neighbors, believe ADHD is a myth, nothing more than a catch-all label for badly behaved children. Others suggest to parents—often aggressively—that medications are dangerous and they'll turn children into zombies. Parent groups and Internet sites swear that only their particular behavioral or alternative option will work safely—and suggest that other choices are useless.

And to complicate matters, what is ADHD anyway? Some people say it's real. Some people say it isn't. But as a developmental pediatrician specializing in children with behavioral disorders, I will tell you that ADHD is real—very real.

Decades of research have defined what ADHD is (a specific biological condition) and what it is not (a deficit of parenting or a figment of our collective imagination). Nevertheless, a morass of misinformation has muddled the perception of ADHD in the modern world.

Sensationalist authors make broad claims that a certain lifestyle intervention will "cure" ADHD, suggesting that our modern culture is perhaps the cause. Or that like fragile flowers, children with ADHD blossom only when raised "well"—whatever that means. Yet there are endless numbers of well-meaning, hard-working parents raising children who battle problems with focus, impulsivity, hyperactivity, and all the related disruptions ADHD triggers—and it has nothing to do with anything that happened or failed to happen at home. Because of these baseless societal claims, parents often end up blaming themselves: If only I could come up with a new plan, or figure out how to motivate my child, ADHD would go away. Through no fault of their own, parents often become blinded to the straightforward biological facts.

Stepping beyond the politics requires a return to the basics, with a clear vision of ADHD science. ADHD is a medical condition in which the part of the brain responsible for monitoring behavior and thoughts isn't working efficiently. ADHD is far more than a behavioral or academic problem; it has the potential to disrupt relationships, lower self-esteem, hinder social skills, and interfere with many other areas of life. Only through understanding the underlying biology of ADHD and its effects on brain development can you begin to make clear choices for your child.

ADHD by the Numbers

ADHD is not a product of our modern society; descriptions date back to the early 1900s. More recently, various studies in the United States show that around one in twenty children have ADHD, regardless of socioeconomic class or location. Other studies show this average, to be slightly higher, rarely slightly lower, but, it is always close to this number.

Wherever ADHD has been tracked—in Europe, South America, the United States, and most everywhere else—the incidence is near 5 percent. How could an environmentally caused or culturally biased diagnosis have such a similar pattern, however and wherever children are raised? It is unlikely that a behavioral phenomenon could be so consistent.

Compared to the general population, when someone in the immediate family has ADHD, their parents and siblings have a three- or four-fold increased risk of the same. An identical twin lives with at least a fifty-fifty chance of ADHD when the other twin has it, and most studies suggest an even greater likelihood. This increased incidence persists even if they were not raised in the same household, revealing that the tendency is genetic. Non-identical twins have a one in three chance—again, even when raised separately. Even the fact that boys are several times more likely to have ADHD than girls points us toward a genetic cause.

Through tracking ADHD in families, scientists have begun to identify genetic markers for the condition. Genes have been found that increase the likelihood that someone will develop ADHD, and others may one day predict responses to different treatments. Just as some kids are born destined to be tall, or develop asthma or seasonal allergies, some children are born destined to have ADHD. Genetic evidence continues to mount; a 2010 study found a much higher risk of chromosomal variants in people with ADHD, compared to the general population. However, as dozens of genes influence brain development, there is...