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The Disorder vs. Temperament Debate

“Temperament implies the sum total of characteristics that are innate or inherent and the result of one’s physical or nervous organization.”

“Disorder – Sickness, ailment; to disturb the natural functions of body or mind; to derange.” (Webster’s Dictionary)

Most professionals in the medical community believe attention deficit disorder (ADD) is caused by a neurological “defect” and therefore constitutes a psychiatric disorder. This brain defect is believed to be largely hereditary and occurs in about 5% of the populations (estimates vary).

Some temperamental researchers believe ADD behavioral traits are simply expressions of normal temperamental variations within the population, although they agree that intervention of some type is often necessary. Modern life is radically different from the environment that humans evolved in.

Researchers who study gifted and creative children have noted that their subjects very often exhibit ADHD type behavior, including inattention, hyperactivity and impulsiveness. They warn about gifted and creative children being misdiagnosed with ADHD. A somewhat different theory suggests a common temperament which favors both creativity and ADHD. In this view, many highly creative individuals may simply be smart ADDers who were able to successfully apply their creativity (see the Coincidence of ADHD and Creativity). Highly creative individuals even appear to have the same type of brain differences as ADDers, and ADD children score higher on creativity tests. Researchers also note the examples of famous people, especially inventors such as Thomas Edison and Ben Franklin, who appeared to be successful partly because of their ADD tendencies.

None of these researchers suggest that ADD does not exist and that people do not suffer from it. Nor do they argue for the elimination of ADD medications. The temperament view is a more positive way of looking at ADD because it implies the ADDer may have strengths which have been overlooked and that often the ADDer is not necessarily “sick.” Rather, there is a mismatch between environment, expectations and temperament which naturally leads to behavior problems, anxiety and depression.

Most people receive their information from the medical community, CH.A.D.D., or the manufacturers of medication. The medical community is inherently biased towards viewing all behavioral difficulties as illnesses which require treatment. Drug manufacturers are obviously biased towards promoting their product. And CH.A.D.D. is funded by the makers of Ritalin.

What is the basis for ADD being called a neurological (or brain) defect?

Argument #1: The most common argument I have encountered so far is the following. “When a child who is hyperactive and inattentive in the classroom is given Ritalin, they behave like a normal child and can pay attention. Therefore, the child obviously has a brain defect.”

This is a flippant argument. Because a drug can change an undesirable trait does not prove the trait was a defect. Take short people, for example. Studies show that short people are generally discriminated against in this country, even on the job. If parents wanted their genetically short son to grow to be six feet tall, they could theoretically give him growth hormones and he would be taller.  Does this prove that his natural height of five feet is a defect?

Moreover, the same child who cannot pay attention in class will typically have a very long attention span and be easy to handle if he is doing something which interests him. So does the Ritalin actually increase the child’s attention span or does it simply allow the child to tolerate boredom?

Gifted children often display the exact same behavior problems in school as ADD children. If valium was effective in allowing the gifted child to tolerate a slower class and behave properly, would this prove the child had a brain defect?

Another example. Caffeine has been proven to increase alertness for most people, and they retain more information while under its affects. Does this prove that most people have a brain defect because they perform better when taking caffeine?

Argument #2: “The symptoms of ADD are occasionally duplicated by minor damage to the forebrain. If a few cases of ADD are known to result from brain damage, then this proves that all ADD is caused by damage or a defect of the brain.”

If malnutrition can cause someone to be short, does that prove that everyone who is short suffers from some sort of defect? Of course not. Environmental effects can and often do mimic genetic traits.

What is interesting about this argument is that mild brain damage has also been found to increase creativity. One theory is that the area of the brain damaged regulates the flow of information within the brain. Because the creative person has less regulation of this information, they receive more of it and are able to combine highly disparate pieces of information into new ideas and inventions. Could inventiveness be an asset to a population? How could it not be?

Argument #3: “Neurological differences have been found in the brains of ADDers. Therefore, ADD is caused by a neurological defect.”

Another very flippant argument. There are neurological differences between boys and girls, too. Girls tend to do better at some things and worse at other things than boys. For any increase in ability there is typically an equal decrease in some other ability. Every adaptation is a tradeoff. But both brain types are normal. Neither boys nor girls have a neurological defect which requires treatment (although it’s not uncommon for members of the opposite sex to believe so). Scientists argued for a long time that women were intellectually inferior, and they used their evidence of neurological differences as an argument. Now the same argument is being used again by the medical community to prove that ADDers are inferior.

The increase in creativity and inventiveness which many ADDers have may come at a cost, but that does not make ADD a brain defect, unless of course normal people have a brain defect because they are less creative.

If ADD may be thought of as a temperament, then is it a “disorder?”

If ADD is a temperament, then problems are naturally generated by the standard psychology approach which classifies all behavior problems in terms of mental illness or disorders. Generally speaking, any behavior which causes serious disruption to a person’s life is considered to be a disorder by psychologists. The same behavior, but to a lesser degree, is not considered to be an illness. This makes sense in many cases, such as for depression or anxiety, which all people experience to some degree.

An argument can be made that ADDers which have been referred for diagnosis generally do exhibit significant behavioral problems and therefore do have a disorder, regardless of whether ADD is a neurological defect or a temperament.

But in many cases, perhaps most, you could say ADD behavioral problems are a perfectly rational response to an unfavorable environment. It may be the sick child who does not act out when placed in such a miserable situation. And the anxiety and depression which referred ADDers often have is caused in large part by the negative feedback which ADDers have received by teachers, parents and others, not by the ADD itself. The associated family problems are often simply caused by ignorance.

A close parallel to this pattern is the behavior problems often associated with gifted children, who are disruptive in class, daydream and often do poorly in school. The problems are so similar to ADD-related problems that gifted children are often misdiagnosed with ADD. Gifted children have neurological differences, too, and these differences predictably lead to behavior problems when the child is place in a dull school setting. But giftedness is not defined as a psychiatric disorder. Rather, the child’s behavior is considered perfectly rational once it is understood.

There are some people who are apparently so extremely ADD that the term “disorder” may apply in the classical sense. If they cannot function under any setting simply because of their brain wiring, and this is not caused by environmental factors, such as schools which are too boring or a lack of discipline, then they truly do have a neurological defect, and the term “disorder” makes sense. But it seems that the typical ADD case of the 1990’s is simply one of a highly active boy with behavioral problems in a boring school.

A final comment: Our very identity is very closely tied to our unique temperament, introvert or extrovert, quiet or hyperactive, pensive or impulsive. To some extent, it is who we are. And when we see our temperament expressed in our children, we see ourselves. Researchers and mental health professionals should think about this before they reflexively label every deviation from the norm as a “brain defect.”

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