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  • January 19, 2015
  • By Don Kerson

Badly Named and Poorly Defined

This is an excerpt from Dr. Kerson's book, Getting Unstuck. The first chapter is available here. You can sign up for Dr. Don's newsletter to get Chapter 3. Or buy the book to get it all.

ADD is confusing for a number of reasons. It has a very varied presentation, and it often coexists in complicated ways with a wide range of other conditions. More to the point, both its name and its current diagnostic criteria are unintentionally more than somewhat misleading.

Its name is misleading because, despite a huge body of psychological research looking for it, an absolute or measurable deficit in pure attention has never been shown to exist. Context is everything. Under the proper circumstances, attention in children and adults with ADD can be more than adequate. In fact, overfocus can be as much of a problem for people with ADD as underfocus. Attention Regulation Disorder or Attention Modulation Disorder might be a more accurate name. It's not just paying attention that is the issue, it’s facility in the shifting of attention: paying attention to the right thing at the right time.

The diagnostic criteria are misleading because they overemphasize dysfunction at key developmental junctures. Children who compensate well never get noticed. Individuals with a wide range of balancing gifts are routinely overlooked in both educational and therapeutic contexts.

Some portion of the confusion about ADD is due to the inherent limitations in the delicate process of negotiation and validation that has, over the last thirty-five years, spurred the rapid growth of reliable, modern psychiatric diagnosis. The Diagnostic and Statistical Manual of Psychiatry, vol. 3 (DSM-III) and The Diagnostic and Statistical Manual of Psychiatry, vol. 4 (DSM-IV) are essentially identical when it comes to ADD, and although it is my understanding that the next edition will be improved, it is the criteria the DSM presents that have both informed and clouded the debates about ADD over the past twenty-five years.

The inherent limitations to which I refer include the fact that the diagnostic criteria are intentionally atheoretical (without theory). This is because, in the absence of definitive proof, the drafters and revisers of the criteria avoid expressing bias concerning the underlying causes of the condition, instead focusing entirely on external, observable behaviors. This complete focus on behavior misses large groups of people who are more mildly affected and better at compensating, and therefore leads to an underestimation of the presence of ADD in the adult population.

This is an excerpt from Dr. Kerson's book, Getting Unstuck. The first chapter is available here. You can sign up for Dr. Don's newsletter to get Chapter 3. Or buy the book to get it all.

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