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ADHD is a Real Disorder, Being Lazy and Self-Entitled is Not

Posted Nov 04 2008 5:31am

My graduate school had its own clinic that provided free services to students and very low-fee services to the members of the community. Often undergraduates would come in seeking an evaluation for Attention Deficit-Hyperactivity Disorder (ADHD). Most people are familiar with the basics of the term and its symptoms but you can read a very good summary of it here. Students usually came in when they were struggling with course work and wanted certification they had a veritable condition. With documentation students were often given more time on tests, tutoring or other academic benefits. Often these concerns were perfectly legitimate and the students really suffered from ADHD, making it extremely difficult for them to succeed in the academic arena. Pinning down the problem for them so they could get help, both academically and psychologically, was not only rewarding but it also made you feel like a real doctor.

On other occasions something was wrong with the student but he didn't have ADHD; rather something such as anxiety or depression was the problem. Here the student was offered psychotherapy and/or medication to treat the issue.

A third possibility occurred when the students' complaints were a complete scam and the kid was just too damn lazy to pick up a book or go to her 8 AM Physics class. This happened a lot in the late 90's when Adult ADHD was becoming the "in diagnosis" and some students tried to exploit that by seeking out unnecessary special treatment or to get their hands on some ADHD-meds for recreational purposes:

Student: I just can't focus during my morning classes and my mom and I are pretty sure I have ADHD.
Rob: What time do you usually go to sleep at night?
Student: Around 5.
Rob: 5 AM? So you're getting about 2 hours of sleep per night. Why is that?
Student: I'm usually drunk and high until then.
Rob: So you're basically just hung over and tired in the mornings.
Student: Yes.
Rob: That's not ADHD.
Student: It isn't? Are you sure?
Rob: Quite.
Student: Oh. Can I still get some Ritalin?
Rob: What for?
Student: To get high.

Scenarios like these particularly annoying when a student's mother would follow up and call me at the clinic and offer a monetary sum (i.e., bribe) to "get Dakota the help she needs." [1] If you're not a morning person, don't register for those classes! I couldn't pass Physics if I tried but I'll be damned if I'm stupid enough to take a class that early. 'Wanting to Sleep In' is not a psychological disorder. I thought a profile was developing where the most likely fakers (also known as 'malingerers') were very wealthy and accustomed to using money as a way to solve problems but my training director said I was simply jealous that I was only middle class. Someday I'm going to revisit my theory.

ADHD is one of the more controversial diagnoses in mental health due to a lack of any scientific method of testing for it. Researchers and clinicians have attempted to develop objective tests but none have proven to be valid or reliable. Professional decorum prohibits me from going into detail about how a clinician fleshes out the real sufferers from the poseurs, but make no mistake: if you come to my practice, showing no symptoms, looking for paperwork that says you don't have to take the SAT's and should still be accepted to Yale, you will know my wrath. The form of this wrath is yet to be determined but could include a bill with an angry face on it.

[1] There are doctors who will trade diagnosis for payment. This is especially easy to do with ADHD because the symptoms are so broad and vague, thus making it easy to argue a case for it. I don't actually know any of these doctors personally, but colleagues have shared the fact that they know "hired guns" for these types of situations. Ritalin is certainly not cocaine, so I'm not claiming these doctors are ruining people's lives, but they certainly aren't challenging the argument that our society is over-diagnosed and overmedicated.

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