Because I heard an alternate explanation yesterday for this phenomenon in Johann Hari’s “Stolen Focus,” a story about ADHD at Salon caught my attention:
Longstanding stigma against mental illness permeates American culture, especially when it comes to cognitive functioning. Nevertheless, ADHD diagnoses have consistently increased since the 1990s. Roughly one out of every 10 children and adolescents between the ages of 3 and 17 living in the US have a current ADHD diagnosis. That number stands to grow further after many parents witnessed firsthand how their children struggled to stay attentive in remote classes.
The unanswered question is whether the condition is being under- or over-diagnosed.
When school moved online, Dr. Jonathan Cartsonis saw his 13-year-old son disengage from his studies. As an educator, Dr. Cartsonis understands the importance of experiential components of learning. Specializing in rural healthcare, he emphasizes individualized learning strategies and community engagement with his own medical students. Then the diagnosis came. It was for ADHD, but after in-person learning resumed Dr. Cartsonis thought otherwise.
“It was a byproduct of too many hours sitting at the computer, too much homework, not enough social engagement, and not enough exercise,” he wrote to Salon. “The supposed ADHD symptoms evaporated when he was back in person, in school.”
But that’s anecdotal. Was it really too much screen time and not enough social engagement or, in some cases, was it something else?
California’s first surgeon general, Dr. Nadine Burke Harris, saw a radical spike in ADHD diagnoses when she worked in a clinic in San Francisco’s low-income Bayview-Hunter’s Point. As Hari reports, kids saw friends killed, some women reported sleeping in their bathtubs for fear of being killed in their beds by stray bullets.
Harris saw a connection:
A study on youth trauma, known as Adverse Childhood Experiences, or ACES, was a landmark when it was published in 1998 by the Centers for Disease Control and Prevention and Kaiser Permanente. The study specified 10 categories of stressful or traumatic childhood events, including abuse, parental incarceration, and divorce or parental separation; its research showed that sustained stress caused biochemical changes in the brain and body and drastically increased the risk of developing mental illness and health problems.
“One thing that tipped me off was the number of kids being sent to me by schools — principals, teachers and administrators — with ADHD,” she said, referring to attention deficit hyperactivity disorder). “What I found was that many of the kids were experiencing signs of adversity, and there seemed to be a strong association between adversity and the trauma they experienced and school functioning.”
This finding spurred her to review the health records of over 700 of her patients. Her research team found that patients who had experienced severe trauma were 32 times more likely to be diagnosed with learning and behavioral problems than kids who had not.
Trauma in general leads to a surge in stress hormones. When this trauma goes unchecked and is sustained, it can disrupt a child’s brain development, interfering with functions children depend on in school such as memory recall, focus and impulse control.
Stress hormones released while being stuck inside for months with parents because of a deadly global pandemic, perhaps? Symptoms that subside when normal returns?
The typical diagnosis was ADHD and a Ritalin prescription for what Harris saw as a normal adaptive response — hypervigilence, the elevated state of constantly assessing potential threats around you — similar to behavior of people living in a war zone. It’s hard to focus on your sums, Hari observes, when you have to worry about going home to sexual abuse from your mother’s boyfriend.
One size does not fit all. It’s not that all ADHD can be chalked up to childhood trauma, but that some of it can. But rather than address the social stress systemic in how Americans live their lives, society tends to individualize our problems, Hari writes, rather than probe deeper questions about the structures and instabilities we’ve built into our culture. It’s rugged individualism gone bererk.
Hari told Vox in March 2020:
I’m very frustrated that whenever I turn on the news and they’re talking about what people should do about anxiety and depression, you have these mental health professionals who exclusively say things like “meditate” and “turn off the news.”
Now, that’s all fine — I’m doing that stuff. But the single biggest thing that will affect people’s anxiety is not knowing if you’re going to be thrown out of your home next month or how you’re going to feed your children. And I think there’s an element of cruel optimism in telling a country of people living paycheck to paycheck that they should be responding to the anxiety they’re experiencing this moment primarily by meditating and switching off the news. That’s not going to solve the problem. The single most important thing that has to be done to deal with people’s depression and anxiety is to deal with the financial insecurity they’re facing.
[…]
We need to radically expand our idea of what an antidepressant is. Anything that reduces depression and anxiety should be regarded as an antidepressant. For some people, that includes chemical antidepressants, but we need to radically expand that menu. I would argue that a high minimum wage is an antidepressant. A universal basic income (UBI) is an antidepressant. In one of the first UBI experiments ever in Dauphin, Canada, you saw an 8.5 percent decrease in hospitalizations due to mental health issues over three years — you won’t find any drug with that kind of effect.
Professionals examined children with attention issues in Bayview, precribed Ritalin, and moved on without probing deeper. Few, especially those in government, want to question the deeper premises behind the form of capitalism that’s created the world we struggle to live in. Stressed out and sick? Must be a personal problem.
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