Diagnosing ADHD
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection was the DSM-5 specifically in the section Neurodevelopment Disorders on Attention-Deficit/Hyperactivity Disorder (ADHD). I have included my reflection below.
Diagnosing ADHD
This week, I am reflecting on the content from the DSM-5, specifically in the section Neurodevelopment Disorders on Attention-Deficit/Hyperactivity Disorder (ADHD). As I read the DSM more, I am starting to really appreciate its value. It is surprisingly clear to read and succinct in getting straight to the important pieces of information. I can see how it would be very useful as a handbook in the field. The section on ADHD begins, like other sections, with a quick reference to diagnostic criteria; for ADHD, this includes patterns of inattention, hyperactivity, and impulsivity and some examples of each, as well as notice that an individual should have multiple symptoms at once, symptoms must be present in childhood, the symptoms must reduce the quality of life.
I also appreciate the description of ADHD behaviors such as emotional dysregulation and impulsivity, hyperactivity, being quick to anger or easily frustrated, and deficits in working memory, reaction time, and planning and organization, for example. I was also somewhat surprised to learn that 7.2% of children have ADHD and 2.5% of adults. It was also interesting to learn that certain prognostic factors are associated with ADHD prevalence, such as low birth weight, smoking, or exposure to other toxins by the parent while the child is in the womb. I was also interested in how heritable ADHD seems, with 74% heritability.
From a cultural perspective, it was interesting to learn that there is a lower diagnosis in African-American and Latinx cultures but that this could be due to mislabeling bias in diagnosis. There is a similar higher prevalence in boys, at 2-3 times more than girls, and girls display more features of inattention. It was also interesting to note that females with higher ADHD have higher comorbidity with other disorders, such as oppositional defiant disorder and others. I was very interested in some of the consequences of ADHD for individuals, for example, rejection by peers, being called lazy or irresponsible, difficulty finding work, and low self-esteem.
As stated above, my major reaction was that this information was useful, easy to access, and very succinct. I have had a little experience with ADHD; a few people in my life, such as acquaintances and extended family members, suffer from ADHD. As I begin to learn more about it, especially from this reading, it makes me feel sad how much social rejection the individual with ADHD must have received and how this lowers their self-esteem. With this new knowledge, I now reflect on those individuals I know with ADHD with much more compassion. There were times when I did not know what ADHD really was (maybe five or more years ago). There were times also I did not know people had it, who I have since learned do have ADHD. I used to think these people were just bizarre, agitated, and disordered individuals. As my learning progresses, so too has my awareness. I would say that now I do have a deep compassion and sympathy for folks with ADHD. I do wish society at large had more information on this disorder, and I wish those with ADHD could admit it openly and we could accommodate them the same way we would if we saw someone in a wheelchair.
Last semester, I did a research proposal and literature review on ADHD, specifically how the disorder may manifest differently in girls. I have questions when I contrast the literature review we did with the brief DSM section. When I did my literature review, I learned there is a lot of uncertainty still in the field of ADHD; different studies are showing different results and do not seem to agree, especially in how ADHD affects girls and boys differently. I also did a historical review of ADHD and learned it has undergone many changes since its first identification as "defective moral control" by George Still in 1902. My question then comes about when I consider how factual, succinct, and certain the DSM appears, compared to the much more complex, nuanced, and undecided the field appeared when I did a literature review. Are we conveying too much simplicity and certainty in the DSM?
As I reflect, I believe I did learn from reading the DSM, but I also need to be aware that a simplified summary in the DSM is just that and that an entire field of complex research exists, so I should not draw exact conclusions from the simple descriptions in the DSM. More than anything, I feel a developed sense of deep compassion for individuals with ADHD. I would like to work with them in my practice. As someone who potentially is on the Autism Spectrum Disorder (ASD), I now see my friends with ADHD as allies and even as a sibling spectrum. Both those with ASD and ADHD face many challenges in society. I respect people with ADHD quite a lot because, as someone who potentially has ASD and who finds it hard to read social cues, my friends with ADHD are obvious, loud, direct, and easy for me to comprehend. So I appreciate them.
As a counselor, I think I may even like to specialize in neurodevelopmental disorders with a focus on ASD and ADHD. Specializing this way may also allow me to align with prison populations, homeless, and drug-addicted folks, probably many of whom have ADHD. If we can remove the stigma in society regarding these disorders, it would really be excellent for me. I hope to work with prison populations as I believe people do not do wrong; they just had a bad situation and had no other options; this concept rings most true for me when I consider someone with ADHD struggling to find acceptance, connection, and a place for themselves in society.
