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Myth #5: Poor Parenting Causes AD/HDThis misconception may be the most difficult to dispel because parenting characteristics (i.e., being critical, commanding, negative) and poor management do exacerbate AD/HD. Studies exploring the contribution of environmental factors (e.g., parenting practices, parental psychopathology) find that genetic factors and not a shared environment account for the greatest variance in AD/HD symptoms — about 80 percent. While management difficulties influence parent-child conflicts and the maintenance of hyperactivity and oppositional problems in young children, "theories of causation of AD/HD can no longer be based solely or even primarily on social factors, such as parental characteristics, caregiving abilities, child management, or other family environmental factors."
Other factors may play a causal role, including exposure to environmental toxins (e.g., elevated blood lead, prenatal exposure to alcohol and tobacco smoke), but not all children exposed to these risk factors have high rates of hyperactivity, nor do all children with AD/HD have these risk factors. Although other factors (e.g., family adversity, poverty, educational/occupational status, home environment, poor nutrition, environmental toxins, ineffective childrearing practices) do not appear to have a significant contribution to the development of AD/HD symptoms these factors contribute to comorbid disorders and complicate treatment effectiveness.
Researchers identified a number of inaccurate or non-scientifically based parent beliefs about the causes of AD/HD including: allergic reactions or sensitivity to foods, family problems like alcoholism or marital discord, high sugar consumption, ineffective discipline, lazy learning habits, a lack of motivation, etc. Inaccurate or "false beliefs" were associated with parental attributions that children were responsible for their AD/HD symptoms (symptoms are intentional and children can control their symptoms), and with the use of less effective treatment (e.g., diet control).
Myth #6: Minority Children Are Over-Diagnosed with AD/HD and Are Over-Medicated Access to diagnosis and treatment of mental health illnesses varies depending on gender, race and social economic status, but not in the way one might predict. Research investigating AD/HD in African American youths is sparse. A study of public school children and youths in Florida found that service delivery to African American children was deficient even though there was no evidence that the incidence rate of AD/HD was lower than those reported in whites. Researchers found that: (1) only 50 percent of children with AD/HD were receiving treatment, (2) girls were underserved at a rate three times lower than boys, and (3) whites were three times more likely to be referred compared to African American children. In the few studies exploring medication rates across races, ethnic minority children are 2 to 2.5 times less likely to be medicated for AD/HD compared to white children.
Access to treatment is affected by: (1) a lack of perceived need; (2) system barriers including availability, cost and language; (3) concerns that their children would be taken from the home if parents seek services; (4) stigma associated with seeking help for mental illnesses; and, (5) cost of treatment, lack of adequate reimbursement, length of treatment and cost of medication. Furthermore, African Americans are more likely to leave mental health treatment prematurely, and are less likely to receive care. Evidence suggests that minority children are not over medicated and may be underserved for AD/HD.
Myth #7: Girls Have Lower Rates and Less Severe AD/HD than BoysAccording to the Surgeon General's Report on Mental Health (2001) girls are less likely to receive a diagnosis of and treatment for AD/HD compared to boys despite need. Girls with AD/HD have greater intellectual impairment, but lower rates of hyperactivity and externalizing disorders compared to boys. Girls with AD/HD have more severe internalizing disorders than boys. Girls with AD/HD were more likely to have conduct problems, mood and anxiety disorders, lower IQ, and more impairment on social, family and school functioning than non-referred girls. However, conduct problems were lower in girls than in males with AD/HD, which may account for lower referral rates in community and school samples.
Compared to boys with AD/HD, girls with AD/HD reported higher rates of overall distress, anxiety and depression, and demonstrated more hyperactivity, conduct and cognitive deficits. Parents and teachers noted higher rates of inattention, hyperactivity, oppositional defiance, conduct problems, social difficulties, depression and anxiety. Girls may report more distress than boys, and they "may be more affected by environmental factors than males with AD/HD."
Myths and inaccurate information about AD/HD should be dispelled by scientific findings. However, popularly held "false beliefs," which are often perpetuated by emotional or unexamined arguments, do more harm than good. They do little to advance our knowledge and do a lot to discourage individuals from seeking help and from using effective treatments for AD/HD that have undergone rigorous scientific scrutiny.
Phyllis Anne Teeter Ellison, Ed.D., is chair of the editorial advisory board and a member of CHADD's executive committee.
This excerpt, reprinted with permission, is from an article which originally appeared in the June 2003 issue of Attention! magazine. To read the full article and list of references, visit http://www.help4adhd.org/en/about/myths
