Part 1: How can you diagnose something you don’t believe exists?
In 1902 they called it “Morbid Defect of Moral Control.” It was renamed Post-encephalitic Behavior Disorders in 1922. In 1960 it was called Minimal Brain Dysfunction and in 1968 it got another name change to Hyperkinetic Reaction. And finally in 1980 they settled on the more familiar name of Attention Deficit Disorder +/- Hyperactivity. Today, you’re probably familiar with the initials ADHD.
It was in the 1930s that amphetamines were first prescribed to treat hyperactive children, and Ritalin, still widely used today, was introduced in 1956. And it wasn’t until 1996 that Adderal, a second drug to treat ADHD, was introduced. Today there are several drugs prescribed, including Strattera, the first non-stimulant, approved in 2002.
The American Medical Association has called ADHD the most widely researched behavioral disorder, and yet it is still the most widely misunderstood, and often misunderstood on purpose.
Far too many people still think it’s “all in their mind,” still living in the ignorance of 1902 that it’s a moral defect. “Why can’t they just control themselves?” Others think that it’s an overused (read: unnecessary) diagnosis made to appease parents who can’t handle active children, that somehow these children are normal and it’s the parents who push drugs on their kids simply to calm them down. Much of this disinformation came from a religious group in the 1980s that ignorantly refused to believe in Attention Deficit Disorder and demonized the use of Ritalin. Something like 20% of Americans think ADHD is a bogus disease.
As a child of the 1960s, most of us with ADHD were thought to be “impulsive,” and “hyperactive.” It was a moral deficiency, a character flaw, and since research was still pretty much in its infancy, not given the serious diagnosis or treatment is should have.
My grades weren’t the best. I’d get bored easily. I was unfocused in class. If I had to sharpen my pencil, I’d walk around the entire room, disturbing all the other children. My report cards often said things like: “Does not use his time wisely in class,” “needs to pay attention in class,” “has difficulty following directions,” “is too easily distracted,” and “is disruptive,” to name a few.
My parents wanted to find out why so my mom took me to Chicago to see a psychologist. I guess back then they didn’t have any in Milwaukee. I was fascinated by the tall buildings and his office was high up in a downtown building with a fairly impressive view. Or I assume it was. It was 40+ years ago.
What do I remember of the visit? Not much really. I’m sure he asked me a lot of questions. I think he gave me that “put the round peg in the square hole” test. The one thing I do remember was he had an electric letter opener and I was drawn to it. So much so that in order to keep me focused on what he was asking, he had to give me several envelopes to run through the letter opener.
Then he made his diagnosis. I did not suffer from hyperactivity. Or Minimal Brain Dysfunction or Hyperkinetic Reaction. Or whatever they referred to it at the time. I’m not sure how he came to that diagnosis. Considering all I remember of his place was his big mahogany desk. And the letter opener and nothing of the actual testing, I’d say myself that I was something.
My mom many years later told me that psychologist didn’t believe in hyperactivity as a disorder anyway.
So what was the point of taking me there? To ensure you’d get a diagnosis that there was nothing wrong with me? Seems not only a waste of money, but a horrible disservice.
And I remember having to take these tiny, bitter pills. My mom, years later, finally admitted they did try Ritalin on me, but it had made me worse. I wonder. Looking at the side effects, one of them is nervousness. Another is “mania.” Maybe the dosage had been too high. Maybe if they had regulated the dosage, it might have worked.
Maybe if they’d taken me to a competent psychologist instead of a quack, one who actually studied and understood the disorder instead of dismissing it out of hand, if they had tried different dosages of the medication instead of giving up, maybe my life wouldn’t have been one long disordered struggle.
Maybe. I understand the inherent pitfall of woulda-shoulda-coulda and that second guessing your life probably isn’t healthy, but sometimes you can’t help but wonder — what if?
end of part 1
Edited June 15, 2011 to Add: After discussing the matter with my mother I learned that it wasn’t the Chicago psychologist who didn’t believe in the disorder. He did. He came to the conclusion I had it. He subscribed Ritalin. It was my pediatrician who did not believe. So when I had a reaction to the Ritalin, became “more hyper” as my mom tells me, he decided to just take me off the drug and do nothing further, coming to the conclusion that I couldn’t possibly have a disorder that he didn’t believe in.
Thanks, Doctor Thompson.