ADHD and the factors that cause it: the case of parent’s unreasonable expectations

We have previously written blog posts on media coverage of the factors that have been suggested to cause mental health conditions, especially childhood disorders such as Attention Deficit Hyperactivity Disorder (ADHD) and autism spectrum disorder (ASD). A great sensitivity clearly needs to be taken when speculating (and even more so when attributing evidence) to potential factors that may cause these conditions in media reports. Many parents of children with these conditions will read these articles and will attribute evidence that they read to their own situation, which can of course include personal blame.

I was aghast then to see a series of articles in the media over the last 24 hours suggesting that ‘Adult’s unreasonable expectations could be to blame for surge in diagnoses’ and worse still the headline ‘Are you to blame for your child’s ADHD?’ Putting the issue of sensitive reporting aside for a moment, is there any merit to these claims?

The research letter published in JAMA Pediatrics that outlines these findings examined the time children spent on academic tasks through searching educational and public policy literature between 1981 and 1997. In their letter, the researchers – Jeffrey Brosco and Anna Bona from the University of Miami – reported that there was a substantial increase in the number of hours children spent on academic activities such as homework and reading and a corresponding decrease in time spent playing and in leisure activity during the timeframe examined.

The authors note that these changes coincide with an increase in the prevalence of ADHD. The studies that the researchers are reporting on therefore were not designed to examine the factors underlying ADHD. ADHD wasn’t actually examined in any direct way within this study. These researchers pulled together data which together seems to suggest that children are increasingly spending more time on academic activities and which they link quite randomly with the known increase in ADHD diagnoses.

Here we have a classic case of two variables which MAY share some relationship being discussed as if one directly caused the other. We have previously spoken about this in our ‘How to Research the Headlines series’. In that post we discussed the example of a correlation between the global average temperature and the approximate number of people engaged in piracy. There may be a correlation (association) between the two but we would be skeptical of anyone who proposes a causal link.  Although they are related, encouraging piracy would not decrease global temperatures!

Often another factor (what we call a confound) can explain the relationship between two variables. Indeed, there are a number of other factors that have been proposed to explain the increase in the prevalence of ADHD within the time period mentioned above -most notably changes in the way ADHD is assessed and the diagnostic systems used.

It was also disturbing to see that other inaccuracies have crept into the reporting that could also fuel the perception that an ADHD diagnosis is very easy to come by. The Daily Mail reports that ‘an ADHD diagnosis is based primarily on reports from caregivers and teachers – which are influenced by expectations of certain behaviors‘. Firstly, it should be noted that confirmation of ADHD symptoms from both parents and teachers is an essential requirement before a child receives an ADHD diagnosis. Assessment of symptoms is typically thorough, involving a range of questionnaires, cognitive tests and a lengthy interview with a specialist psychiatrist or paediatrician which involves both the child and caregivers. This is of course no different to the way other childhood and adult mental health conditions, such as depression and schizophrenia, are assessed.

On a final note, the lack of sensitivity in the wording of some of these headline is appalling. Asking the question ‘Are you to blame for your child’s ADHD?’ whether there was any evidence to support it or not (not in this case) is extremely insensitive and potentially highly damaging to children with ADHD and their families.

Brosco, J. P., Bona, A. (2016). Changes in Academic Demands and Attention-Deficit/Hyperactivity Disorder in Young Children. JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2015.4132