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."
