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Pay Attention


By Dan Gordon '85

Published Jan 1, 2009 8:05 AM

Illustration by Brian Stauffer '93.

Attention deficit hyperactivity disorder — ADHD — gets a lot of bad press. But it's no illusion, and it isn't a smokescreen for bad parenting. ADHD is a real, biologically driven condition, and it is widespread. We clear up the myths surrounding this controversial disorder and discuss the symptoms parents shouldn't ignore.

The biggest among several myths surrounding attention deficit hyperactivity disorder (ADHD) is that it doesn't really exist — or that it is, at best, an arbitrary social construct we use to define rambunctious or exuberant children and adolescents, mostly boys.

In fact, says Dr. James McGough M.S. '03, professor of clinical psychiatry and director of the UCLA ADHD Clinic, overwhelming evidence indicates that ADHD is a real, biologically driven condition — and that not treating it exposes a child to potential problems that go well beyond inappropriate behavior.

Focus on the ADHD Family

The UCLA ADHD Clinic offers comprehensive evaluations for ADD/ADHD, learning disabilities and emotional and behavioral disorders, plus parent training, behavior management, social skills training, medication intervention and other resources, including tips on how to recognize ADHD and access to doctors. Get more info from the adult and children's ADHD Clinics.

"Children growing up with ADHD are more likely to have a harder time in school, a harder time with friendships, problems with self-esteem, and long-term difficulties with depression and anxiety," McGough says. "They are also at greater risk for becoming addicted to nicotine and for early experimentation with alcohol and recreational drugs."

The medications commonly prescribed for ADHD reduce these risks. And yet, many children either are never diagnosed or fail to start and stay on the drugs that could help them. And that's a big societal problem: Studies show that 5-10 percent of school-age children and 4-5 percent of U.S. adults are affected by ADHD. Yet the number of people treated falls well short of the number believed to have the disorder.

Although in some cases it might make sense not to medicate, most of the time the academic and social benefits of ADHD treatment outweigh any concerns about drugs that are viewed by health professionals as extremely safe, McGough says. Thus, he stresses that parents shouldn't ignore symptoms in their child that might include restlessness, being easily distracted or rushing through schoolwork and making careless mistakes.

McGough cautions that commonly held beliefs about ADHD don't hold up to scrutiny:

It isn't real.
In both genetic and neuroimaging studies, significant differences have been found between people diagnosed with ADHD and those who do not have the condition. ADHD runs in families, and growing evidence points to specific genetic patterns in people with the disorder. In addition, numerous neuroimaging studies have shown structural characteristics unique to ADHD brains. Most recently, for example, studies found that there is about a three-year delay in brain maturation in children with ADHD, specifically in areas related to attention and impulse control.

It's overdiagnosed.
Yes and no. ADHD is much more likely to be diagnosed in affluent areas, perhaps because those parents believe an ADHD diagnosis can help their kids in school, and they are more likely to push for it. On the other hand, lack of awareness about the biological basis of ADHD and a lingering social stigma around mental illness may contribute to underdiagnosis, particularly in less affluent communities.

It's caused by parenting.
"No one 'gets' ADHD because of their parenting," McGough says. Parents shouldn't blame themselves if their child is diagnosed with the condition, but they should realize that there is much they can do to help, or hurt, their child's cause. Minimizing distractions is particularly important. More than other children, those with ADHD thrive when there is consistency, clear expectations, rewards for good behavior and appropriate consequences for poor behavior. Difficulties at home can worsen the symptoms; children who have structured, stable home and school environments tend to fare best.

We're overmedicating.
ADHD medications are among the most widely studied for children — many have a 60-year history of use with few problems. Yes, creating a stable, distraction-free environment helps. But most children diagnosed with ADHD stand to gain a great deal from the added benefit of medication, McGough says. The most commonly prescribed ADHD drugs are stimulants that act on control centers in the brain, reducing symptoms of hyperactivity, impulsivity and inattention. These are more effective than non-stimulants, although they do have the highest risk of side effects, including appetite loss, sleep disturbance and the potential for growth delay. Non-stimulants can be effective for some patients and are less likely to produce side effects.

Alternative treatments are as good.
There is no good scientific evidence that neurofeedback, a popular (and expensive) alternative to medication, is helpful in treating ADHD symptoms. Similarly, diet and herbal supplementation have not been found to have any proven positive impact on the disorder.

Children will outgrow it.
Some will, but the latest evidence suggests that about half of school-age children diagnosed with ADHD continue to have difficulties in young adulthood. Then there are adults who show ADHD symptoms that never seemed apparent when they were kids. Most experts believe there were probably earlier signs that went unrecognized — masked, perhaps, by the individual's intelligence and other abilities.

Diagnosis is guesswork.
An ADHD diagnosis is based on symptoms, not imaging or a blood test. But "this approach isn't unique to ADHD or even psychiatry," McGough says, adding, "People think there is a lot of ambiguity, and on the margins there may be some differences of opinion, but by and large, given the same child, the likelihood that different doctors trained to recognize ADHD will come to the same conclusion about whether the child has the disorder is very high."