When I was in school, ADHD hadn’t been invented. There were kids who didn’t pay attention for a good part of the day, or who couldn’t sit in their seats, but the first activity was called day-dreaming and the second “shpilkas” or “ants in your pants.” These problems were recognized but were considered “normal.” Though we were sometimes disorderly, the cause wasn’t labeled a disorder. It’s now an epidemic.

There were always plenty of kids, me included, who were day-dreamers. Mostly these were boys who would get bored after a while and would start to look around the room, or doodle, or gaze into space thinking of this or that. Perhaps I’d do some writing or math in the margin of a notebook while listening with one ear; perhaps I’d work on my handwriting, or I’d read something in another textbook. This was not called a disorder or even an attention deficit (AD), but rather day-dreaming, wool-gathering, napping, or just not paying attention. Sometimes teachers got annoyed, other times not. They went on teaching, but sometimes tossed chalk or erasers at us to get us to wake up. Kids like me took enough notes to do OK on tests and homework, though I was never at the top of the class in elementary or middle school. The report cards tended to say things like “he could do better if he really concentrated.”  It’s something that could apply to everyone.

Then there were the boys who would now be labeled HD, or “hyperactive disordered.” These were always boys: those who didn’t sit well in their chairs, or fidgeted, or were motor mouths and got up and walked about, or got into fights, or went to the bathroom; these were the class clowns, and the trouble makers — not me except for the fidgeting. Girls would fidget or talk too, and they’d pass notes to each other, but they didn’t get into fights, and they weren’t as disruptive. They tended to have great handwriting, and took lots of notes in class: every single word from the board, plus quite a bit more.

There are different measures of education, if you measure a fish’s skill level by the ability to climb a tree you’ll conclude the fish is ADD or worse.

Elementary and middle schools had activities to work out the excess energy that caused hyper-activity. We had dancing, shop, fire drills, art, some music, and sports. None of these helped all that much, but they did some good. I think the fire drills helped the most because we all went outside even in the winter, and eventually we calmed down without drugs. Sometimes a kid didn’t calm down, got worse, and did real damage; these kids were not called hyperactive disordered, but “bad kids” or “juvenile delinquents.” Nowadays, schools have far less art and music, and no shop or dancing. There are a lot more hyperactive kids, and the claim nowadays is that these hyperactive kids, violent or not, are disordered, ADHD, and should be given drugs. With drugs, the daydreamers take better notes, the nappers wake up, and the hyperactive kids calm down. Today about 30% of high-school seniors are given either a version of amphetamine, e.g. Adderall, or of Methylphenidate (Ritalin, etc.) The violent ones, the juvenile delinquents, are given stronger versions of the same drugs, e.g. methamphetamine, the drug at the heart of “breaking bad.”

Giving drugs to the kids seems to help the teacher a lot more than it helps the kids. According to a famous joke, giving the Ritalin to the teacher would be the best solution. When the kids are given drugs the disorderly boys (it’s usually given to boys) begin to act more like “goodie goodies”. They sit better and pay attention more; they take better notes and don’t interrupt, but I’m not sure they are learning more, or that the class is, or that they are socializing any better than before. The “goodie-goodies” in elementary school (mostly girls) did great in the early grades, but their good habits seemed to hold them back later. They worked too hard to please and tended to not notice, or pretended to not notice, when the teacher said nonsense. When it came time for independent or creative endeavors, their diligent acceptance of authority stood in the way of excellence.

The hyperactive and daydreamers were more used to thinking for themselves, a prerequisite of leadership. The AD ones had gotten used to half-ignoring the teacher, and the HD ones were more openly opinionated and oppositional: obstreperous, in a word. Those bright enough to get by got more out of their education, perhaps because it was more theirs. To the extent that education was supposed to make you a leader and a thinker, the goodie-goodie behavior was a distraction and a disorder. This might be expected if education is supposed to be the lighting of a fire, not the filling of a pit. If everyone thinks the same, it’s a sign that few are thinking.

Map of ADHD variation with location for US kids ages 6-18, Scrips Research. Boys are 2-3 times more often diagnosed as ADHD; diagnosis and medication increase with grade, peaking currently in early college.

This is not to say that there is no such disorder as ADHD, or no benefit from the drugs. My sense, though, is that the label is given too widely, and that the drugs are given too freely. Today drugs are pushed on virtually any kid who’s distracted, napping or hyperactive — to all the members of the big circles in the Venn diagram above, plus to athletes and others who feign ADD to get these, otherwise illegal, performance enhancing drugs. Currently, about 10% of US kids between 6 and 18 are diagnosed ADHD and given drugs, see figure. The numbers higher for boys than girls, higher in the US than abroad, and higher as the kids progress through school. It’s estimated that about 25% of US, 12th grade boys are given amphetamine or Ritalin and its homologs. My sense is that only a small fraction of these deserve drugs, only those with severe social problems, the violent or narcoleptic: those in the smaller circles of the Venn diagram. The test should not be that the kid’s behavior improves on them. Everyone’s attention improves when taking speed. ADHD appears more as an epidemic of overworked, undertrained, underfunded teachers, and a lack of outlets, not of disordered kids, or of real learning, and real learning is never pretty or easy (on all involved).

Robert Buxbaum, April 18, 2014. In general, I think people would be happier if they’d do more art, music, dance and shop, and if they’d embrace their inner weirdo. It would also help if doctors and teachers would use words rather than initials to describe people. It’s far better to be told you’re hyperactive, or that you’re not paying attention, then to be called ADD, HD, or ADHD. There’s far more room for gradation and improvement. I’m not an expert, just an observant observer.