Why don’t you call this ADHD, like everyone else does?

Our understanding of attention problems has continued to evolve, and new information has come to light. There are actually multiple forms of attention problems, at highly variant levels of severity:

A clinical diagnosis of ADHD should be reserved for cases of the highest severity only. We have gotten into a habit of classifying all children as ADHD, regardless of severity, and this has created a number of problems. Part of the reason why this misclassification occurs is because clinicians currently have no diagnostic alternative.

Attention Deficit Hyperactivity Disorder (ADHD) is a clinical (serious) problem, the understanding of which has been around for over 200 years 1, and is in need of a modern update. Many children exhibit attentional challenges and hyperactivity at far lower severity. New language is needed to explain these lower severity challenges:

The language Short-Attention/High-Energy (SAHE) accurately describes what is actually occurring without using the word “disorder” (a term which should be reserved for serious impairments). Short-Attention/High-Energy kids have a completely different type of attention problem, at a lower level of severity, that is highly associated with the developmental process. In other words, having a limited attention span (and high energy) is largely part of just being a kid. These kids essentially “out grow” the majority of their attentional challenges, and have little difficulty functioning as an adult later on. When a problem is low-severity, and will be outgrown over time, the word “disorder” may not be an appropriate descriptor. Our Licensed Educational Psychologist was a SAHE child himself. Today as an adult, his attentional capacity is very strong. You would never know that he was SAHE as a child. His “attention problems” as a child were temporary (simply part of being a kid), and he outgrew these challenges. He was never on ADHD medication. Instead, his parent built a learning environment that was optimal for his learning style. Those ideal learning strategies, combined with just “growing up” was enough to fix the issue and help him thrive in adulthood.

We are hopeful that we will eventually be able to communicate with the talented folks who write the Diagnostic and Statistical Manual (DSM) to include this important distinction in the next DSM update. Presently, medical doctors and other clinicians are currently forced to diagnose ADHD, because no other appropriate alternative diagnosis exists. In the future, clinicians may be able to diagnosis this lower severity challenge instead, a more appropriate diagnosis for children whose attention problems will gradually lessen in severity along with maturation, and for whom a pharmacological intervention is less appropriate. If you agree that new language is needed, please help us spread the word and encourage this new understanding to start becoming common knowledge.

In the meantime, let’s start building the type of learning environment that so many kids need. Customized learning activity is the best first-line intervention for our Short-Attention/High-Energy kids, and this intervention has only beneficial effects, without deleterious side effects. From Dr. Michael Greger’s literature review, Treating ADHD Without Stimulants: “drugs ‘produce unwanted side effects, and have the potential for abuse. Exercise has been shown to be effective in controlling ADHD symptoms, and has essentially no side effects’, “…medications have a defined effect on ADHD symptoms alone, whereas exercise produces physical, mental, and emotional advantages that are far-reaching.” So, exercise does have side effects, but they’re all good.” (Treating ADHD Without Stimulants, NutritionFacts.org, Michael Greger, M.D., August 28, 2013).

Studies have shown that about 50% of children diagnosed with ADHD retain symptoms of ADHD into adulthood 2 (which means that 50% will not) and hyperactivity severity generally declines with age in most cases. 3 If 50% of kids will simply outgrow their attention problems do we really need to diagnose them with a disorder? Isn’t it more appropriate to explain the “problem” as a normal part of the developmental process? (with the word “disorder” being unnecessary). When a six-month-old child hasn’t started speaking yet, is it appropriate to diagnose the child with a speech disorder? Of course not. Even though some six-month-olds are already speaking, it is still developmentally appropriate for six-month-old to not be speaking. Likewise, for many children it is still developmentally appropriate to need to move around more, and not yet developmentally appropriate for the child to have robust attentional focus. These children are not “disordered”. They are kids. More developmental time is needed, while also building the type of learning environment that so many kids need. Customized learning activity is the best first-line intervention for our Short Attention High Energy kids, and this intervention has only beneficial effects, with no deleterious side effects.

I believe the day will come when the medical doctor can pull out his prescription pad, and write a script for “customized instruction for short-attention and high-energy”. This type of action will cause school districts to realize that new types of instruction are needed for unique learners. Unfortunately, it may take decades to achieve this, but we have to start somewhere. In the meantime, you can learn to deliver the type of instruction your child needs right in your own home.

1 Lange K (2010): The history of attention deficit hyperactivity disorder. ADHD Atten Def Hyp Disord 2:241-255

2 Okie S (2006): ADHD in adults. N Engl J Med 354:2637-2641

3 Davidson MA (2008): ADHD in adults. A review of the literature. J Atten Disord 11:628-641