ADHD or Attention Priority Difference?
by Dr Jeffrey Rubin
A few years ago I worked as a school psychologist. One day the mother of a 12-year old boy, who we’ll call Pete, explained to me that upon the urging of one of his teachers, she took him to his pediatrician to be evaluated for ADHD. The pediatrician asked this mother a few questions, diagnosed Pete as having ADHD, and then wrote him a prescription for Ritalin. After reading the possible side effects of the drug, the mother became concerned and spoke to Pete’s father.
Pete’s father and mother were divorced. Pete lived with his father on weekends, and the rest of the time he lived with his mother. Upon hearing about the prescription for Ritalin, Pete’s father was very much opposed to his son taking any drug for treating this concern. And so, now the mother wanted to know what I thought should be done.
I explained that before I could make any recommendations, I would have to carry out an evaluation. As a student in the district that I served, there would be no cost to the family. Pete’s mother agreed to the evaluation.
First, I requested that the mother, father and each of Pete’s teachers fill out standardized questionnaires. The results indicated that Pete’s physical education teacher, art teacher and his father viewed his activity level and ability to pay attention as falling within the average range. Pete’s mother and academic class teachers generally saw him as having some problems paying attention. His math teacher, who had been the one to urge Pete’s mother to take him to the pediatrician, rated Pete’s ability to attend to his assignments as being way below average.
After looking at the results of the standardized questionnaire, I spoke to Pete’s father. He confirmed that it was his impression that Pete had no difficulty with either his activity level or paying attention.
“Do you mind describing a typical day that you have with your son?” I asked.
“Well, let’s see. Last Saturday, when we woke up, we went to play golf.”
“Do you walk the course, or ride in a cart?”
“We walk.”
“Pete doesn’t mind?”
“Not at all. He loves doing physical stuff like that.”
“After golf, then what did you do?”
“We went back to my place, I made some sandwiches, and then I read the newspaper while Pete worked on his drawing. He loves to draw, and he’s pretty good. Then we went in the backyard. I have a basketball hoop set up there and we shot around for a while. Then we started to get supper together.”
“Does Pete help you with that?”
“Yes.”
“Does he get distracted in any way when you two work on supper?”
“Not at all. He’s very helpful. Then we ate supper, went down to the basement and played ping pong for maybe an hour. Then we went upstairs and watched a movie.”
“When he watches a movie with you, does he appear to have difficulty sitting through it?”
“Not usually. Occasionally, the movie strikes him as boring. After the movie, he went to bed.”
“Does he have any trouble sleeping when he stays with you?”
“No. We do a lot of physical stuff that tuckers him out, and he ends up sleeping soundly.”
I then spoke with Pete’s mom. Consistent with how she filled out the standardized questionnaire, she confirmed that it was her impression that Pete did have difficulty paying attention.
“Do you mind describing a typical day that you have with your son?” I asked her.
“Well, yesterday, I got him up at 7 so he could catch the school bus on time. He complained the whole time he got ready. He hates the ride to school.”
“How long a ride is it?”
“An hour, and he says he doesn’t get along with the kids he rides with.”
“I see. He has to sit on the bus for an hour with kids he doesn’t like, then he’s in school sitting most of the time doing school work. Then he takes the bus home, sitting for another hour with kids he doesn’t like. For a boy his age who loves to do physical activity stuff, I could see how this could be hard for him.”
“Yeah, but other kids do it.”
“Most do. Please tell me what happened when he got home.”
“Well, I got home a little after he did. I started preparing supper, and that’s when I have him doing his homework. I sit him at the kitchen table where I can keep an eye on him while I prepare the meal. And he gets very distracted. He starts an assignment one minute, and I look over and I catch him doodling. Over and over again he gets distracted.”
“I see. After sitting most of the day, you have him sit and do his homework?”
“Yes. That’s when I can best keep my eyes on him.”
“How about the rest of the evening?”
“He’s fine then. Besides doing his homework, the only other time I have trouble with him is when I try to get him to clean up his room. He starts to do it, but when I look in a few minutes later, he has become distracted with something else.”
Next, I interviewed Pete. After some pleasant discussion I said, “Your math teacher says you have trouble paying attention in class. What’s up with that?”
“Aaaaa, he makes us fill out these worksheets doing the same problems over and over again. If I know how to do it, why do I have to keep doing 20 more of them? It’s so boring.”
“I see. Say, I hear that you like to draw. Would you mind drawing something for me.?”
Pete’s eyes light up. “Sure. What do you want me to draw?”
“Anything you like.”
Pete begins, and I notice he appears to become completely absorbed in the task. I start to try to distract him by making some extraneous sounds. He glances up to see what the commotion is all about, sees it’s nothing serious, and resumes work on his drawing.
A half hour later, he shows me what he has created. It’s an imaginative otherworldly drawing with spaceships and fascinating creatures. There is an excellent sense of shadowing. It’s far superior to anything I can create in the drawing department.
When I finished my evaluation, I informed the parents that in my opinion it is not in Pete’s best interest to view the concern that has been expressed about his attention as due to ADHD. A more apt description is to view Pete as having an “Attention Priority Difference.” School work was not a huge priority for him. He much preferred to draw and do more physically active tasks then is currently provided at school. These preferences may turn out to be his greatest values. He may someday find work that he truly loves in a field where his artistic interest and talent are crucial. And his interest in physical activity may keep him far more healthier than the many sedentary Americans who are at an increased risk of a number of real illnesses.
“Well,” said the mother, “will Ritalin help Pete with his Attention Priority Difference?”
To which I replied, “Consider an analogous situation. Suppose we identified a group of children who are not doing as well as most kids in physical education. Would it make sense to make up a pathological sounding term for these low-performing students, such as “Muscular Deficit Disorder” and then have doctors prescribe steroids for them?
“In my view, people have different interests and talents. This is a wonderful thing, not something that should be pathologized. We don’t just need every person in America sitting in ivory towers. We need, as well, artists, computer experts, magnificent athletes, hairdressers, and on and on.
“When I hear of a child placed on Ritalin, I become concerned about the child’s stomach, nerves, and brain. Drugs that have been said to be safe have turned out to be far more toxic than anyone ever dreamed of. I become concerned about the social misery that goes along with being singled out as a child that must take a pill to fix him. More than a few kids have told me that this became a dreaded experience.
“I believe that teaching children to turn to drugs when they are dissatisfied with their behavior or mood runs counter to a healthy lifestyle.
“I prefer to put forth a view that encourages us to teach our youth about the blessings of keeping our bodies in lifelong possession of its full youthful state by keeping their blood free of stimulants and narcotics. I wish to teach our kids that it is possible that the morning sun, air and dew can be sufficient powerful intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being—these are the directions I wish we would point to when we guide a child toward a more fulfilling life.”
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
Amen! I love this article!
I have been trying to figure out why we take young people packed with natural energy and curiosity and make them sit so darn still to “learn.” This type of teaching really isn’t effective with active kids. Sure, they might learn some here and there. Sure, they might make good grades by learning the tricks taking tests, but tests are not accurate at measuring learning.
I appreciate all different types of people. I have never told my son he should go to college. I told him if he needs to go to college to do what he wants then he may want to go.
Hi Cindy Forish, much thanks for your kind words of support. They mean a great deal to me. And, yes, like you, I think there are far better ways to teach children to learn than what is typically occurring in American schools.
Thank you for supporting these American boys with a professional voice. There are genuine cases where prescription medications are appropriate, but they are very rare when compared to the number of young lives that have been tortured and tormented with these kinds of medications.
Hi Mark Leavenworth, it’s always wonderful to hear from those who, like yourself, are very concerned about how these drugs are being prescribed.
I am a college writing teacher and the mother of an 11 year old gifted boy. Your article concurs with many of my observations. I have also seen that my developmental writing students tend to have better inter and intra personal skills as well as kinesthetic knowledge. I have found ways to get them all moving as much as possible including doing “writing” workshops where we walk all over campus and students map out their writing projects then draft back in class or outside somewhere.
Hi Gwendolyn Alley, I love the way that you have found to teach important skills in a manner that includes getting out of seats. I taught my two sons the multiplication tables by having them throw a ball against the steps of our front entrance of our house and each time they caught the ball with only one bounce they earned two points. So, the first catch they had earned 2 points. The second catch they were up to 4 points, the third catch they were up to 6 points. When they became smooth at counting by 2s, we changed the game so they could earn 3 points for each catch. In this way they learned how to count by 3s, then 4s, etc. They loved it and learned the tables up to 10s quickly, and it combined a physical activity with learning. There are lots of ways to do this. Much thanks for your comment.
Excellent article and viewpoint!
Thanks Linda.
Dr Rubin,
I have a child with Asperger’s Syndrome. He is gifted and an amazingly fun, funny kiddo…yet he fails in the areas of focus and completion of tasks. (mainly in the areas of math and science) He is active when he wants to be or when we do things as a family, but he is easily distracted and has a hard time sleeping (when not in math class) My spouse is ready to put him on medication but I am completely against it. I wanted so badly for him to fit into all the parameters of the “attention priority difference” category, but I fear he may be more on the ADHD spectrum. What is a parent to do when co-parents don’t agree?
Hi Tara, it is difficult for me to give specific recommendations to a family when I know so little about what is going on. That said, I have written several other articles on ADHD. One of them (“The Myth of Ritalin’s Effectiveness”) might help you and your spouse to get a better sense of what the drugs really do. Another post (Treating ADHD: If Not Drugs, Then What?) can provide alternatives to drug treatment. Consider asking your spouse if it would be OK if you both read these over and then have a follow-up conversation.
Thank you for this article. Very neat and easy to grasp for the parents.
I will contribute to this post by commenting a short speech from Thomas Szasz.
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Thomas Szasz
Remarks at the 35th Anniversary and Human Rights Award Dinner
Citizens Commission on Human Rights International
Beverly Hilton Hotel, Beverly Hills, California
February 28, 2004.
Ladies and Gentlemen:
I want to thank Jan Eastgate, Bruce Wiseman, and everyone at the Citizens Commission on Human Rights for establishing an annual award in my name, “The Thomas Szasz Award for Outstanding Contributions to the Struggle Against the Therapeutic State.” It is a great honor and I deeply appreciate it.
It gives me great pleasure to salute Dr. Anatoly Prokopenko for his courageous opposition to psychiatric oppression in post-Communist Russia and to congratulate him as the inaugural recipient of the Citizens Commission on Human Rights’ Thomas Szasz Award.
“The trouble with people” — said Josh Billings (Henry Wheeler Shaw, 1818?1885), the great nineteenth-century American humorist — “is not what they don’t know but that they know so much that ain’t so.” That people “know so much that ain’t so” is precisely the trouble with respect to what Americans know about psychiatry. After a decades-long propaganda war, waged by an unholy alliance of psychiatry and the state, people now “know” that mental illness is like any other illness and that psychiatric practices are like other medical practices. This just ain’t so.
When I was a young doctor, most people knew better: They recognized that mental hospitals were prisons not medical hospitals and called them “snake pits.” They knew that psychiatrists were jailers, not healers.
Since then, the image of psychiatry has become transformed from the administration of snake pits to the prescription of psychiatric miracle drugs. It’s another con-game. Antipsychotic drugs resemble antibiotic drugs like mental hospitals resemble medical hospitals, that is, not at all. The name of the game is still coercion.
A few decades ago, mental patients could be confined only in mental hospitals. Now, they can be confined in drug-induced disability as well, a punishment called “outpatient commitment.”
Another lamentable development is the claim that millions of children suffer from a mental illness called “attention deficit hyperactivity disorder” (ADHD) and that Ritalin — administered to the child often against the will of the parent — is a treatment for it. Of course, it is always administered against the will of the child. What child wants to be stigmatized as crazy?
When school authorities tell a mother that her son is sick and needs to be on drugs, how is she to know that that’s a lie? How is she to know that what experts call Attention Deficit Hyperactivity Disorder is not a disease?
Bedazzled by psychiatric jargon, she does not realize that diagnoses are not diseases.
She is not expert in the history of psychiatry. She does not know that psychiatrists have always used diagnostic terms to stigmatize and control people — for example
* black slaves who ran away to freedom suffered from drapetomania;
* women who rebelled against being controlled by men suffered from hysteria;
* until only a few years ago, men and women who engaged in sexual acts with members of their own sex suffered from the dread disease of homosexuality.
Of course, none of those behaviors was a disease. ADHD is not a disease.
Nor is Attention Deficit Hyperactivity Disorder a disease.
No behavior or misbehavior is a disease or can be a disease. There is no mental disease. Period.
Don’t forget that, not long ago, psychiatry’s two favorite mental illnesses were masturbatory insanity and homosexuality. They are no longer mental illnesses. Why not?
Because people stopped believing that “self?abuse” causes insanity and that homosexuality is a perversion that ought to be treated as a disease and also punished as a crime.
However, that did not end the horrors. On the contrary, it was the beginnings of worse horrors. No sooner do psychiatrists “declare” that a mental illness is not an illness than they “discover” ?? that is to say, invent ?? a host of new mental illnesses.
When I went to medical school, sixty years ago, there were only a handful of mental illnesses. Now there are more than three hundred, with new ones “discovered” every year.
George Washington warned: “Government is not reason; it is not eloquence. It is power. Like fire, it is a dangerous servant and a fearful master.” Psychiatry is a part of the government.
This is what parents who are told that their child suffers from Attention Deficit Hyperactivity Disorder must never forget. They must never forget that school personnel and child psychiatrists and psychologists are government agents. Their job is to control children, not to care for their health or well-being.
Caring for the health and well-being of children is the parents’ job. Government, as Washington said, is not reason. It is unreason.
Labeling a child as mentally ill is stigmatization, not diagnosis. Giving a child a psychiatric drug is poisoning, not treatment.
I have long maintained that the child psychiatrist is one of the most dangerous enemies not only of children, but also of adults who care for the two most precious and most vulnerable things in life — children and liberty.
Adults have physical and political power over children. This is why sexual relations between adults and children are outlawed and the act is called “statutory rape.” For the same reason, we ought to outlaw psychiatric relations between adults children and call child psychiatry by its correct name, “psychiatric rape.”
Child psychiatry — like all of psychiatric slavery — cannot be reformed. It must be abolished.
How can parents protect their children from the therapeutic state, that is, from the alliance of government and psychiatry?
They can do so only by disabusing themselves of the idea that what ails an unhappy or misbehaving child is a mental illness, and that so-called psychiatric treatment can help him.
They can do so only if they recognize that bringing up children is no picnic — that, in fact, it is the hardest and least publicly rewarded job in the world, bar none. Raising children is tough. It has always been and always will be tough.
I agree with Josh Billings. It is not a good idea to know things that ain’t so. If we want to avoid such false knowledge, we must speak clearly and think clearly. Diseases are malfunctions of the human body, of the heart, the liver, the kidney, the brain.
Typhoid fever is a disease. Spring fever is not a disease; it is a figure of speech, a metaphoric disease. All mental diseases are metaphoric diseases, misrepresented as real diseases and mistaken for real diseases.
It is time to conclude. The task we set ourselves — to combat psychiatric coercion — is important.
It is a noble task in the pursuit of which we must, regardless of obstacles, persevere. Our conscience commands that we do no less.
Thank you very much.
In almost 30 years of teaching, I had two students who had ADHD. When I began teaching, my first teacher’s aide told me most of my fourth grade boys had ADD or ADHD and so did most of the older teachers. I didn’t meet my first truly ADHD kid until I began teaching high school English after teaching the lower grades for almost 18 years. Justin was a wiry and thin boy who would unscrew the bolts holding his desk/chair together and the first time I heard one part drop, I was kind of startled and he looked up and said, “Don’t worry, Mrs. Smith. I know how to put it back together.” He did this almost every day and looking back, had I been a better something, I would have known he had ADHD and given him an erector set or Lincoln Logs or something useful for Justin. He was in 9th grade English and bored to the point of dismantling his desk daily. My second ADHD student was a four year old on medication. From the day I met him, he was my favorite kid because he was so helpful. But, every single day before lunch, he would get wild and out of control. After lunch, the nurse gave him his medication and within 30 or 40 minutes, he would be back to what I thought was normal. I would never ever suggest that he be given more medication because he didn’t need more. Those boys who had parents that believed in teachers and teacher aides diagnosing their children were put on medication and it was sad to see because, when you do not have ADD/ADHD and are on Ritalin, you become zombie-like. I saw my boys become zombies and they lost the shine in their eyes. When ADD first came out, I was in tenth grade and my health teacher diagnosed me with ADD because I fell asleep in his class daily. It was hot in his room, we were learning about sex education, and it was my last class of the day. I don’t know if I ever had ADD but I DO KNOW I WAS 21 WHEN I HAD MY FIRST MANIC EPISODE. I do know I have manic depression. That’s a fact.
I love all of the above.
Very Interesting post! Thank you. I completely agree that most of the time there is really a Attention Priority Difference. Really, I think the APD and even ADD/ADHD is just symptomology of an organism’s response to an environment that they do not know how to process: either it is not stimulating enough or too stimulating. Are you aware of the research on this; If so, I would love to read it. If this is true, it seems that changing the environment would be more appropriate, especially since we know how difficult it is for youth to change mindset and assert self-control.
Two other points or concerns:
1. The current rating scales for ADHD do not do a good job ruling out APD vs ADD/ADHD. If there is one please let me know and I will start using it. Otherwise, the scale just says distracted.
2. Doctors are diagnosing, maybe prescribing, based on a parents report, in a 10 minute visit, with no real evaluation or data. Healthcare is a broken system, yada yada yada…