Of all the mental health disorders, Christians have had a particular beef with the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).
The claim is that ADHD is a matter of a) lazy parents who won’t tell their kids to “sit still” b) improper discipline that, if corrected, would “make kids sit still” or c) just a general breakdown of order in society.
There’s compelling, indisputable science that ADHD is a real neurological phenomenon, and there’s considerable debate over how ubiquitous it is.
It could be that there’s a balanced approach to the debate, and that’s exactly what Dr. Ralph Lewis provides in a fascinating overview of the history of ADHD and a conclusion that those with ADHD fall on a continuum.
But here are some highlights from Lewis’ piece.
a. ADHD is not a new phenomenon. An 18th century Scottish doctor wrote of “a disease of inattention” that rendered its victims the “incapacity of attending with a necessary degree of constancy to any one object.”
b. The same phenomenon was described in the early 1900s by an English pediatrician.
For no apparent reason, there were kids who just had trouble paying sustained attention to anything. So much so that it led to all kinds of behavioral problems, compared to peers.
c. Post World War 1, there was a worldwide encephalitis lethargica epidemic, and many of the afflicted children started showing new displays of hyperactivity and were disruptive in school. That made scientists think, “Mmmm. Maybe brain damage can lead to hyperactivity” and maybe the stuff we’ve been seeing and reading about for a hundred years could be explained by brain abnormalities.
From there, scientists began to study the phenomenon in earnest and formulated drugs that helped stimulate sustained concentration and motivation.
Along the way, there were changes in understand and categorization, but the biggest and most important findings came in the 1990s and 2000s.
And this is what I hope skeptical Christians particularly are open to — concrete science, because it’s difficult to argue with.
Lewis writes of recent advances:
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“Structural and functional brain imaging studies identified specific neural abnormalities in ADHD.
Several genetic associations were identified for the disorder, which had been shown from family, twin, and adoption studies to be strongly heritable.
People with ADHD were found to have underactivity of dopamine in their brains, which fits with the theory that their brains are “understimulated” or underaroused, requiring higher levels of external stimulation and novelty to activate their attentional and reward systems.”
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End quote.
Okay, so let’s look at one of those studies pointing to neural abnormalities.
In 2006, a group of scientists and physicians at Harvard, MIT, and other institutions in the area published a paper in Cerebral Cortex.
That paper built on previous neuroimaging studies that showed differences in the brains between those with ADHD and those without the condition.
Specifically, they found that adults with ADHD had thinner cortex in the cortical networks that moderate attention and executive function.
This added to prior research the group published on abnormalities.
From Cerebral Cortex Magazine:
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Volumetric studies in children identify abnormalities in cortical, striatal, callosal, and cerebellar regions. In a prior volumetric study, we found that ADHD adults had significantly smaller overall cortical gray matter, prefrontal, and anterior cingulate volumes than matched controls.
Thickness and surface area are additional indicators of integrity of cytoarchitecture in the cortex. To expand upon our earlier results and further refine the regions of structural abnormality, we carried out a structural magnetic resonance imaging study of cortical thickness in the same sample of adults with ADHD (n = 24) and controls (n = 18), hypothesizing that the cortical networks underlying attention and executive function (EF) would be most affected.
Compared with healthy adults, adults with ADHD showed selective thinning of cerebral cortex in the networks that subserve attention and EF. In the present study, we found significant cortical thinning in ADHD in a distinct cortical network supporting attention especially in the right hemisphere involving the inferior parietal lobule, the dorsolateral prefrontal, and the anterior cingulate cortices.
This is the first documentation that ADHD in adults is associated with thinner cortex in the cortical networks that modulate attention and EF.
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That’s indisputable.
Christians who have a beef with ADHD should pick a fight with neuroimaging.
You have to say that either neurology is fake, or agree that it shows that something abnormal is, indeed, going on in brains with ADHD. (Kind of the mental health equivalent of CS Lewis’ famous either Jesus was a delusional liar or the Son of God argument).
Of course, this doesn’t even get into other research on ADHD, which as Lewis notes, includes an underactive dopamine system.
This is not the stuff of “bad parenting” or “bad kids these days.”
There are real neurological and chemical underpinnings to this disorder.
Now beyond that, it’s important to bring up a few points.
It might be that Protestant Work Ethic America has so idolized order and structure and productivity that it’s left kids and adults with ADHD at a distinct disadvantage and so that’s why the phenomenon is just being recognized compared to, say, the depression of King David.
Perhaps people with ADHD need medicine to sustain attention and thrive in today’s world, because it’s more about how we’ve organized our society than “behavioral problems.”
We’ve prioritized things that require superior executive function — even at a very early age. It’s not kids’ faults. It’s parents and their unrealistic expectations.
My son just started kindergarten, and I’m amazed at the level of executive function they presume of 5 and 6 years olds.
Most kids aren’t ready to sit and learn the whole day. They’re built to play and learn through that play.
Unfortunately, “good schools” are all about testing, about initiating reading, writing and arithmetic as early as possible.
By sitting in class like 40 year olds at a TED talk.
Thus, the apparent explosion in ADHD could, in fact, be a matter of over-diagnosis (as some have claimed), but it’s because we’ve demanded too much of our children.
We’ve demanded they become adults at a very young age.
This is a particular problem among Christians who tend to want to produce polished products that show just how different and superior our parenting is.
“Those other kids can’t sit and listen. But ours sit and listen to 2 hour sermons on the doctrine of original sin.”
That’s a) probably not good parenting to put your kids through that, but b) more a function of kids who have more advanced levels of executive function than their peers.
As we move through life, all parents are squeamish about the brand new set of trials that teenagers bring.
And so some Christian parents have decided that they’ll call teenagers “young adults.” Again, it’s a matter of branding. Of turning kids into products, and not acknowledging they’re people.
“If we call them ‘young adults,’ they’ll behave like young adults.”
But a leopard can’t change his spots, and teenagers are gonna teenage.
Their brains are completely different from those of adults.
The University of Rochester explains:
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“It doesn’t matter how smart teens are or how well they scored on the SAT or ACT. Good judgment isn’t something they can excel in, at least not yet.
The rational part of a teen’s brain isn’t fully developed and won’t be until age 25 or so.
In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part.
In teens’ brains, the connections between the emotional part of the brain and the decision-making center are still developing—and not always at the same rate. That’s why when teens have overwhelming emotional input, they can’t explain later what they were thinking. They weren’t thinking as much as they were feeling.”
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And this goes back to the original point.
We can’t impose an adult’s brain onto that of a child’s or a teenager’s.
We can’t expect that they’ll behave the way we want or the way we would, and if we do force them into a box, they will break out of it and all kinds of sorrow will follow.
And consequently, if we have a child with ADHD, the solution isn’t to force or impose our brain and its unique structure onto them.
It’s to find ways for them to thrive within the world that is their brain. And if they need it, get medication.
Finally, as to the point of thriving within a world, Lewis points out that many of the “troublesome” traits associated with ADHD wouldn’t have been considered troublesome thousands of years ago.
Back then, the classroom was the field and running through it. Teenagers were warriors and kind of nuts. Toddlers didn’t have to sit through TED Talks or long sermons about original sin.
The modern world hasn’t created ADHD, so much as it has turned it into a more severe issue by the society we’ve created (hence, New York City in the picture).
ADHD is real, as neuroimaging has shown. But its impact is more severe in a Protestant Work Ethic Society that values superior executive function from the moment of a baby’s first cry.
It could be that medication or therapy is necessary. And it could also be that shifting expectations according to our children is the front-line of treatment.
It’s okay for kids to color and play with toys and be squirrely during church. It’s not misbehavior. It’s the behavior of kids!
