ATTENTION DEFICIT/ HYPERACTIVITY DISORDER (ADHD)

Attention Deficit/Hyperactivity Disorder (ADHD)

Bowlby, J. (1980). Attachment and loss. Vol. 3: Loss, sadness, and Thompson, R. A. (1998). Early sociopersonality development. In
depression. New York: Basic Books. W. Damon (Series Ed.) and N. Eisenberg (Vol. Ed.),
Cassidy, J. (1994). Emotion regulation: Influences of attachment Handbook of child psychology. Vol. 3: Social, emotional, and
relationships. In N. A. Fox (Ed.), The development of personality development (5th ed.) (pp. 25–104). New York:
emotion regulation: Biological and behavioral considerations. Wiley.
Monographs of the Society for Research in Child Development, Van den Boom, D. C. (1994). The influence of temperament
59(240), 228–249. and mothering on attachment and exploration: An
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attachment: Theory, research, and clinical applications. New lower-class mothers with irritable infants. Child Development,
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continuity and change in pattern of attachment. In P. M. Attachment, intelligence, and language: A meta-analysis.
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343–357). Cambridge, U.K., and New York: Cambridge cultural patterns of attachment: A meta-analysis of the strange
University Press. situation. Child Development, 59(1), 147–156.
De Wolff, M. S., & van IJzendoorn, M. H. (1997). Sensitivity Waters, E., Hamilton, C. E., & Weinfield, N.S. (2000). The
and attachment: A meta-analysis on parental antecedents of stability of attachment security from infancy to adolescence
infant attachment. Child Development, 68(4), 571–591. and early adulthood: General introduction. Child
Fonagy, P., & Target, M. (1997). Attachment and reflective Development, 71(3), 678–683.
function: Their role in self-organization. Development and
Psychopathology, 9, 679–700.
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in protection: Arguments for a narrow definition of
attachment. Journal of Family Psychology, 13(4), 475–483.
Hazan, C., & Shaver, P. R. (1994). Attachment as an
organizational framework for research on close relationships.
Psychological Inquiry, 5(1), 1–22.
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ATTENTION DEFICIT/
childhood, and adulthood: A move to the level of HYPERACTIVITY
representation. In I. Bretherton & E. Waters (Eds.), Growing DISORDER (ADHD)
points of attachment theory and research. Monographs of the
Society for Research in Child Development, 50(1–2), 66–104. According to the Diagnostic and Statistical Manual
Main, M., & Solomon, J. (1990). Procedures for identifying (fourth edition, text revision [DSM–IV–TR]; 2000),
infants as disorganized/disoriented during the Ainsworth Attention deficit hyperactivity disorder (ADHD) is char-
Strange Situation. In M. T. Greenberg, D. Cicchetti, & E. M. acterized by a pervasive and persistent lack of attention
Cummings (Eds.), Attachment in the preschool years: Theory, and/or heightened activity level. Children with ADHD
research, and intervention (pp. 121–160). Chicago: University are defined as quantifiably distinct from their peers as
of Chicago Press.
they have problems paying attention, staying on task, and
Main, M. & Weston, D. R. (1981). The quality of the toddler’s
relationship to mother and to father: Related to conflict remaining sedentary. These particular behavioral patterns
behavior and the readiness to establish new relationships. are especially problematic in the school setting as chil-
Child Development, 52(3) 932–940. dren displaying ADHD traits produce work that is dis-
McElwain, N. L., & Booth-LaForce, C. (2006). Maternal organized and incomplete and they are easily distracted
sensitivity to infant distress and nondistress as predictors of by extraneous stimuli. Symptoms of hyperactivity include
infant-mother attachment security. Journal of Family fidgeting, squirming in one’s seat, talking excessively,
Psychology, 20(2), 247–255. and/or acting as though one is driven by a motor (Amer-
NICHD Early Child Care Research Network. (1997). The effects
ican Psychiatric Association [APA], 2000).
of infant child care on infant-mother attachment security:
Results of the NICHD Study of Early Child Care. Child ADHD diagnoses have risen steadily since the 1970s
Development, 68(5), 860–879. in the United States, yet many other countries report little,
Oppenheim, D., & Goldsmith, D. F. (2007). Attachment theory if any, ADHD among child and adolescent populations
in clinical work with children: Bridging the gap between research (Breggin, 2002). Historically speaking, ADHD is a rela-
and practice. New York: Guilford Press. tively new phenomenon, and although millions of Amer-
Schneider, B. H., Atkinson, L., & Tardiff, C. (2001). Child- ican children now carry the ADHD label, this was not
parent attachment and children’s peer relations: A
always the case. In the 1950s, ADHD did not exist in the
quantitative review. Developmental Psychology, 37(1), 86–100.
Sroufe, L. A., & Fleeson, J. (1986). Attachment and the
United States. In the 1970s, an estimated 2,000 American
construction of relationships. In W. W. Hartup & Z. Rubin children (the vast majority of whom were boys) were
(Eds.), Relationships and development (pp. 51–71). Hillsdale, diagnosed as ‘‘hyperactive’’ and the standard method of
NJ: L. Erlbaum Associates. treatment was behavior-modification therapies. In 2003

ENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT 35


the Centers for Disease Control and Prevention reported a psychiatric disorder by the APA and, as such, was
approximately 4.4 million American children had been included in the DSM until 1978. Defining homosexual-
diagnosed with ADHD (again, the majority are boys), ity as a mental disorder clearly illustrates the subjective
and the accepted method of treatment was daily doses of nature of the DSM and clarifies that perceptions of what
Methylphenidate (MPH), often referred to by the brand constitutes a legitimate mental disorder can change over
name of Ritalin (Breggin, 2002; Stolzer, 2005). time. Despite the combined efforts by the APA and the
Although it is accurate to report that ADHD diag- pharmaceutical industry, which both actively promote
noses are increasing in many westernized countries, ADHD as a neurologically based brain disorder, there
scholars have pointed out that 80 to 90% of MPH exists no scientific evidence to substantiate this claim
produced worldwide is prescribed for American children (Baughman, 2006; Breggin, 2002). No neurological or
in order to control behaviors that have just recently been metabolic tests are performed to confirm the existence of
classified as pathological (Leo, 2000). Relatively recently, ADHD. Rather, diagnostic testing typically follows a
typical childhood behaviors such as not paying attention prescribed pattern:
and being physically active in confined classrooms has
been classified by the DSM–IV–TR as a verifiable mental 1. The child is having difficulty in school;
disorder. According to the DSM–IV–TR (APA, 2000), 2. The parents are called in for a conference and are
symptoms of ADHD include ‘‘fidgeting,’’ ‘‘running or informed that in order to get the child the help he/
climbing excessively,’’ ‘‘often has difficulty playing qui- she needs, a formal assessment must be conducted;
etly,’’ and ‘‘often fails to give close attention to details or
makes careless mistakes in schoolwork.’’ Symptoms must 3. The formal ADHD assessment is done using a
be present in two or more settings (e.g., home, school, or standardized checklist of behaviors for the specified
various social settings), although it is unlikely that the child;
child will display the same level of dysfunction in all 4. The child is then referred to a physician (most often
settings as symptoms typically worsen in environments that to a general practitioner);
require ‘‘monotonous’’ and ‘‘repetitive’’ tasks (p. 86).
Conversely, ADHD symptoms are minimal (or absent) 5. The physician relies on a standardized ADHD
when the child is receiving positive reinforcement, is under behavior checklist, and if the child exhibits six out of
close supervision, is in an interesting environment, and/or nine of the ADHD behavior patterns, he/she is
is engaged in an activity that they find enjoyable. Typically, formally diagnosed with ADHD;
symptoms of ADHD are present before the age of 7 6. Psychotropic medication is the prescribed treatment
(APA, 2000). plan.

Many scientists have actively refuted the reliability
SCIENCE BEHIND THE FINDINGS
and validity of current ADHD assessment procedures
Scholars have suggested that the DSM ’s diagnostic criteria (Baughman, 2006; Carey, 2002; Stolzer, 2007). Accord-
have serious scientific flaws. Fred Baughman (2006) asked: ing to published research, ADHD assessment tests are
At what point does hyperactivity become ‘‘persistent’’? How highly subjective and vary tremendously from one rater
does one tell the difference between ‘‘normal’’ childhood to the next (Carey, 2002). The answers contained on the
behavior and pathology? Baughman also asked: What is assessment tests are limited to never, rarely, sometimes,
‘‘typical’’? typical for a particular classroom? a particular often, and always. Scientifically speaking, these are not
geographical location? or perhaps a particular culture? Also, operationally defined terms and clearly carry multiple
the DSM–IV–TR does not in any way control for gender meanings depending on the perceptions of a specific
differences in behavior patterns—differences that can rater. At the present time, these terms are not universally
be quantified across cultures, across historical time, and quantified, and this fact most certainly decreases both the
across mammalian species (Bjorklund & Pellegrini, 2002; reliability and validity of the ADHD diagnostic process
Stolzer, 2005). (Breggin, 2002; Carey, 2002). Other scholars have sug-
As is the case with all psychiatric disorders, members gested that the status of the rater (e.g., the teacher,
of the APA vote on which disorders meet the criteria for parent, or physician) is not considered in the course of
inclusion in the latest DSM. ‘‘The Purpose of the DSM is assessment. Tolerance level, understanding of normative
to provide clear descriptions of diagnostic categories in developmental processes, gender, age, personality type,
order to enable clinicians and investigators to diagnose, education, and cultural background are variables that
communicate about, study, and treat people with various heavily influence rater perception, yet these variables are
mental disorders’’ (APA, 2000, p. xxxvii). It is interesting not controlled for in any quantifiable way (Carey, 2002;
to note that homosexuality was for many years defined as Stolzer, 2007).

36 ENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT


ECONOMIC CONTEXT natural elements, and are expected to remain sedentary
Any discussion of ADHD must address the economic for hours at a time (Stolzer, 2005; Wilson, 1993). A
context surrounding this disorder. In 1975, Americans review of the literature indicates that aggression, hyper-
enacted legislation (often referred to as the Mainstream- activity, and inattentiveness decrease when children are
ing Act) that allowed children with physical disabilities exposed to the outdoors, have freedom to engage in large
access to the public school system. In 1991, children with motor activity, are interested in the subject matter, and
behavioral and/or learning disabilities were included in are involved in one-on-one interaction with a caring and
this amendment, and since that time, ADHD diagnoses competent adult (Breggin, 2002). Although the DSM–
have skyrocketed across America (albeit this is not the IV–TR currently classifies ADHD-typed behaviors as
situation in other countries). Under the 1991 American pathological, Breggin insisted that inattentiveness,
amendment, schools that enroll students with disorders disorganization, high activity level, and getting bored
such as ADHD receive federal funding. That is, the more easily with mundane tasks is not only developmentally
children who are diagnosed with behavioral disorders, appropriate but is in fact observable across cultures and
the more money the individual school receives. It is also across historical time with regard to child populations.
interesting to note the disparities that exist with regard
to ADHD rates among American students. Private IMPORTANT PREDICTORS
American schools receive no federal money for children OF ADHD
diagnosed with ADHD and typically have extremely
ADHD is diagnosed by particular behavioral patterns that
low rates of ADHD among their student populations.
include fidgeting, excessive running or climbing, not pay-
Conversely, public schools receive federal money for
ing attention to instructions, and difficulty playing quietly.
each child diagnosed, and the rates of ADHD among
These behaviors must be persistent and must be displayed
public school students are as high as 60% in some
more frequently and more severely than is typically
American school districts (Baughman, 2006).
observed in individuals who do not have ADHD (APA,
2000). However, according to the Surgeon General of the
GENDERED AND DEVELOPMENTAL United States (1999), diagnosing an individual with a
INFLUENCES mental disorder is open to many different interpretations
Throughout human history, males and females have fol- that are rooted in value judgments that may vary across
lowed very different developmental trajectories. Accord- cultures. The Surgeon General also stated that diagnosing a
ing to Peter Jensen and colleagues (1997), males evolved disorder such as ADHD is rather precarious, as there are no
in an environment that required elevated activity levels. definitive markers (e.g., lesions, lab tests, or brain abnor-
As males perfected this ‘‘hyperactive’’ way of being, this mality) that can positively identify a particular mental
distinct and valuable male trait was not only highly disorder. According to Peter Jensen and James Cooper
desirable but was in fact integral to the survival of the (2000), the belief that ADHD is neurological in nature is
human species. As compulsory schooling became the norm not supported by scientific evidence as current assessment
in most societies, uniquely male traits were not at all procedures ignore the complex and diverse range of varia-
adaptive in the newly constructed classroom setting. bles associated with particular childhood behaviors. Fur-
According to Bjorklund and Pellegrini (2002), the high thermore, researchers have pointed out that drawing precise
activity levels currently in observed children can be directly and accurate boundaries between typical child behavior and
linked to humanity’s ancient and evolutionary past. School abnormal behavior patterns is difficult at best. The science
systems in the modern era require sedentary learning (e.g., of accurately diagnosing ADHD is especially problematic
sitting in desks for extended periods of time), and these because of the ongoing processes of cognitive, emotional,
relatively new expectations coupled with the proliferation and physical development. By their very nature, children
of new childhood psychiatric disorders has, according to are ever changing, thus making stable measurements and/or
Jensen and colleagues, fueled the unprecedented rise of diagnoses extremely complex. Using adult criteria for men-
ADHD diagnoses across much of the United States. tal illness in children and adolescents is also scientifically
questionable as many of the symptoms of adult pathology
From a developmental perspective, childhood has are characteristics of normal development in child popula-
been altered dramatically over a relatively short time tions (Surgeon General of the United States, 1999).
period. The unstructured, outdoor roaming of the past
has been replaced by sedentary, adult-monitored play.
Television, computers, and electronic video games now KEY DISPARITIES IN THE CAUSES
engulf children at every developmental stage. Children AND TREATMENT OF ADHD
are continually immersed in artificial light and temper- Proponents of the ‘‘disordered brain’’ hypothesis insist
ature, are surrounded by four walls with no access to the that ADHD is the result of an atypical neurological



system and that pharmaceutical drug intervention is nec- dysfunction, hepatic coma, angina, and toxic psychosis
essary to correct a chemical imbalance within the brain. (Breggin, 1999; Novartis, 2006).
The pharmaceutical industry has a vested economic inter- According to the pharmaceutical firm Novartis
est in promoting this disordered brain hypothesis and has (2006), MPH is a central nervous system stimulant;
been quite successful in using a multimedia advertising however, the mode of therapeutic action in ADHD is
campaign. Parenting magazines, television, and physi- not known. Novartis openly states that the specific etiol-
cian offices routinely distribute materials that refer to ogy or cause of ADHD is unknown and that no single
ADHD as a brain disorder, although no scientific data diagnostic test can definitively diagnose ADHD. Novar-
supports this assertion (Baughman, 2006; Breggin, tis acknowledges that the effectiveness of MPH for long-
2002; Jensen & Cooper, 2000; Surgeon General of the term use (i.e., more than two weeks) has not been estab-
United States, 1999). lished in controlled trials and has stated unequivocally
Jensen and Cooper (2000) postulated that ADHD- that the safety of long-term use of the drug in child
typed behavior is highly adaptive and served human populations has not yet been determined.
beings well until the advent of compulsory schooling.
Baughman (2006) hypothesized that ADHD assessment LABELING EFFECTS
tests actually measure adults’ frustrations with typical and
For more than 40 years, social scientists have been aware
historically documented child behaviors. According to
of the deleterious effects of labeling children and adoles-
Baughman, a respected pediatric neurologist, ‘‘In the
cents. Once an official label is affixed, adults’ perceptions
overwhelming majority of cases, the underlying issue is
of the individual child can actually bring about expected
either a clash between a normal child and the require-
behavior via a process called the ‘‘self-fulfilling prophecy’’
ments of his adult controlled environment or the product
(Feldman, 2007; Rosenthal & Jacobson, 1968). With
of diagnostic zeal in a newly deputized teacher-turned-
regard to the ADHD label, the problem is assumed to
deputy brain diagnostician’’ (p. 215). Baughman clearly
be within the individual child, requiring no alteration of
pointed out the controversial nature of ADHD: Is this
the familial, contextual, physical, or socioemotional var-
disorder a brain malfunction requiring pharmaceutical
iables that surround the child. The children are not
intervention? Or is ADHD a remnant of an evolutionary
taught that they themselves can control their behavior
past that does not fit in with the rigid structure of the
(e.g., develop an internal locus of control). Rather, the
American school system?
child is convinced by adults that the only way to control
behavior is through pharmaceutical intervention. In this
MEDICATION way, individual self-efficacy is compromised, and behav-
The overwhelming majority of children diagnosed with ior is collectively defined as being outside of the child’s
ADHD are prescribed MPH in order to control undesir- control.
able behaviors (Baughman, 2006). Although it is well
known that MPH can reduce disruptive behaviors and FUTURE DIRECTION
increase compliance and sustained attention, very seldom OF ADHD RESEARCH
are the dangerous effects of this drug discussed openly The pharmaceutical industry currently monopolizes
(Stolzer, 2007). The Food and Drug Administration ADHD research by systematically promoting ADHD as
(FDA) has classified MPH as a Schedule II drug along a neurological disorder, funding major medical confer-
with morphine, opium, and barbiturates as these types of ences relating to ADHD, funding ADHD research,
drugs have been proven to be highly addictive and to providing financial incentives for physicians who pre-
cause a wide range of physiological atrophy (Breggin, scribe specific ADHD drugs, and funding groups such
2002). as CHADD (Children and Adults with Attention Deficit
MPH has been found to produce severe withdrawal Disorder) who openly promote psychotropic drug use
symptoms, irritability, suicidal feelings, headaches, and in child populations (Breggin, 2002; Jureidini & Mans-
Tourette’s syndrome, a condition that causes both phys- field, 2001). In the future, it is imperative that unbiased,
ical and verbal ‘‘tics’’ (Breggin, 1999; Novartis Pharma- empirical research is conducted to increase our under-
ceutical Corporation, 2006). The drug also has been standing of the highly varied nature of ADHD. Further-
associated with weight loss, disorientation, personality more, laws must be enacted that guarantee that
changes, apathy, social isolation, depression, insomnia, scientifically based, objective research is guiding conven-
increased blood pressure, cardiac arrhythmia, tremors, tional therapeutic practice (Stolzer, 2007). Certainly, it is
weakened immunity, growth suppression, agitation, easier to medicate children than to collectively address
fatigue, accelerated resting pulse rate, visual disturbances, the wide-ranging factors that are affecting child and
drug dependency, anorexia, nervousness, aggression, liver adolescent populations in the modern era. Perhaps future

38 ENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT

Autism

researchers will concentrate on the multitude of individ- Wilson, E. O. (1993). Biophilia and the conservation ethic. In S.
ual and society-level variables that affect developmental R. Kellert & E. O. Wilson (Eds.), The biophilia hypothesis.
processes and, in doing so, will significantly increase our Washington, DC: Island Press.
understanding of the vacillating complexities associated
with the ever-developing human. J.M. Stolzer
SEE ALSO Volume 1: Disability, Childhood and
Adolescence; Learning Disability.

BIBLIOGRAPHY
American Psychiatric Association. (2000). Diagnostic and
AUTISM
statistical manual of mental disorders (4th ed., rev.). Autism is one of five pervasive developmental disorders.
Washington, DC: Author. These developmental disorders were identified as perva-
Baughman, F. (2006). The ADHD fraud: How psychiatry makes sive because they affect more than one domain of devel-
‘‘patients’’ of normal children. Oxford, U.K.: Trafford. opment (as opposed to a specific developmental disorder
Bjorklund, D. F., & Pellegrini, A. D. (2002). The origins of that affects only one domain of development, such as a
human nature: Evolutionary developmental psychology. reading disorder). The other four pervasive developmen-
Washington, DC: American Psychiatric Association. tal disorders are Asperger’s Disorder, Pervasive Develop-
Breggin, P. (1999). Psychostimulants in the treatment of children mental Disorder–Not Otherwise Specified (PDD–NOS),
diagnosed with ADHD: Risks and mechanisms of action. Rett’s Disorder, and Childhood Disintegrative Disorder.
International Journal of Risk and Safety in Medicine, 12, 3–35. These disorders vary in terms of timing, severity, and
Breggin, P. R. (2002). The Ritalin fact book. Cambridge, MA: nature of symptoms. However, all pervasive developmen-
Perseus Books. tal disorders involve deficits in social functioning and
Carey, W. (2002). Is ADHD a valid disorder? In P. S. Jensen & repetitive behaviors.
J. R. Cooper (Eds.), Attention deficit hyperactivity disorder: Current prevalence estimates suggest that 1 in every
State of the science: Best practices. Kingston, NJ: Civic Research 150 children in the United States is affected by a pervasive
Institute. developmental disorder (Centers for Disease Control,
Feldman, R. S. (2007). Child development. (4th ed.). Upper 2007). Additionally, autism occurs four to five times more
Saddle River, NJ: Prentice Hall. often in boys than in girls (Volkmar, Szatmari, & Spar-
Jensen, P. S., & Cooper, J. R. (Eds.). (2000). Attention deficit row, 1993). Current estimates of prevalence in the United
hyperactivity disorder: State of the science, best practices. States are similar to those of other countries, though
Kingston, NJ: Civic Research Institute. significantly greater than in earlier decades. In 1979
Jensen, P. S., Mrazek, D., Knapp, P. K., Steinber, L., Pfeffer, C., autism prevalence was 2 to 5 children per every 10,000
& Schowalter, J. (1997). Evolution and revolution in child (Wing & Gould, 1979). The cause of this increase in
psychiatry: ADHD as a disorder of adaptation. Journal of the autism prevalence is widely debated. Some argue that this
American Academy of Child and Adolescent Psychiatry, 36(12),
1572–1679.
number reflects a true increase in cases of autism. Others
argue that the change in prevalence is because of increased
Jureidini, J., & Mansfield, P. (2001). Does drug promotion
awareness and more accurate diagnosis of autism (espe-
adversely influence doctor’s abilities to make the best
decisions for patients? Australasian Psychiatry, 9, 95–100. cially high-functioning autism). Researchers have not fully
resolved this debate.
Leo, J. (2000). Attention deficit disorder: Good science or good
marketing? Skeptic, 8(1), 63–69. Autism is a characterized by deficits in three areas:
Novartis Pharmaceuticals Corporation. (2006). Ritalin LA
(a) social interaction, (b) communication, and (c) repet-
(package insert). East Hanover, NJ: Elan Holdings. itive behaviors or interests. Although mental retardation
is more common in children with autism than in the
Rosenthal, R., & Jacobson, L. (1968). Pygmalion in the classroom:
Teacher expectations and pupils’ intellectual development. New general population, not all children with autism also have
York: Holt, Rinehart, & Winston. mental retardation. Furthermore, some experts have
argued that standard IQ tests, which rely heavily on
Stolzer, J. (2005). ADHD in America: A bioecological analysis.
Ethical Human Psychology and Psychiatry, 7(1), 65–75. language, underestimate the intelligence of children with
autism.
Stolzer, J. M. (2007). The ADHD epidemic in America. Ethical
Human Psychology and Psychiatry, 9(2), 37–50. Children with autism comprise a very heterogeneous
Surgeon General of the United States. (1999). Mental health: A
group, reflecting variability in the nature and severity of
report of the Surgeon General. Washington, DC: United States symptoms. For example, children with a severe presenta-
Department of Health and Human Services. Retrieved April tion of autism (e.g., low-functioning autism) may be (a)
16, 2008, from http://www.surgeongeneral.gov/library entirely uninterested in social interaction; (b) have no


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