The subject of kids with alleged ADHD/ADD and related focus problems is an interesting and important discussion for parents to have before quickly signing up for psychostimulant drugs — like adderall. Specifically, it is important to unpack the concept of focus, including what focus is, what is “normal” when it comes to focus, and the effects drugs like adderall have on focus (including side effects). Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) are incredibly common diagnoses today, but they are also controversial in that they are often quickly prescribed drugs without formal diagnosis, have potential side effects, and are designed to help improve focus even when there isn’t a legitimate problem with focus. Many kids today proactively seek drugs like adderall because they like the feeling the drug gives them, as well as the irregular “boost” in focus that goes beyond what most people would consider normal. It is for these reasons that parents might benefit from a deep dive into all the aspects relating to ADHD/ADD and the drugs often prescribed.
The definition of focus is sustained, quality attention directed toward a specific target(s). Learning how to improve focus is a very desirable endeavor, as better focus contributes to increased learning and knowledge acquisition. The problem, however, is that focus naturally shifts, waxes, and wanes, and that suspending attention toward a target while tamping down outside distractions (i.e. your cell phone) is no easy task. In fact, from my view as a professor and clinician I see far many more kids naturally struggle to develop their focus, and that these challenges are very normal, not abnormal. Building from this, the more boring the task, the even greater challenges kids have with focus. Is this psychopathology and mental illness, or simply a normal life challenge to improve upon — like learning how to develop memory techniques for a test.
Over the last 20-30 years there has been a dramatic paradigm shift in America where we are now left to believe that if your child isn’t good at focus, he/she is battling ADHD/ADD and needs a drug to overcome the problem. The truth, however, is that developing focus is a life skill, and it is both normal for kids to struggle with focus, and abnormal (statistically speaking) when we see kids with naturally strong focus. Put another way, watch a group of elementary school kids in class and over time you will naturally see most kids shift attention, squirm in their seats, whisper to friends, laugh, and do all sorts of things that clearly display challenges with attention (and these characteristics dramatically increase the more mundane and boring the task — a correlation worth noting). These kids are not all “mentally ill,” but far too many of them are being diagnosed as such and treated as though they are, in fact, mentally ill.
I have heard countless clients of mine over the years rave about their adderall, and talk about the recreational joy they receive from using, as well as the hyper-focus the drug produces. When I hear these claims, I wonder, is this what we should be doing — especially with kids? Why have we created a paradigm that leads parents to believe that if their kid isn’t laser-focused, he/she is deeply flawed with focus problems?
Situational focus problems
Another important direct clinical observation I have made over the years is that kids who struggle with focus struggle only with things they don’t find interesting — again, is this mental illness?? If a kid has trouble focusing in calculus class but no difficulty focusing on his sport, a video game, or even another class, isn’t this evidence of a varying interest problem, not an organic, biological mental illness? Another way of looking at this problem is to note the lack of constancy with situations when examining ADHD/ADD compared to other mental and physical disorders. Specifically, while a kid’s attention might shift dramatically from math to science class, you don’t see these shifts with someone who has cancer, a torn ACL, the flu, or just about any other condition you can identify. If a diagnosis is largely, if not exclusively, derived based on subjective human interest level, is this really psychopathology??
Is “super focus” the end goal?
When kids claim that their focus on drugs like adderall becomes far superior to “normal,” we must ask ourselves what the true goal is when placing kids on psychostimulants? Using another example, some athletes secretly use steroids for physical strength advances, but these muscle gains go far beyond what normal physical training provides. Is placing a kid on adderall similar to the athlete on steroids where both gain unusual, almost super-human advances while on a drug? The point here is that while helping a kid improve from poor focus to normal may seem like a reasonable pursuit, what about providing focus drugs to kids who already have a “normal” focus (read: their attention drifts regularly) so that they enjoy a steroid-like cognitive improvement over the competition? Is this the end goal, to provide drugs to kids so that they not just level the playing field, but artificially surpass the competition through the means of drug intervention.
If drugs like adderall increase focus beyond “normal” to abnormal (hyper-focus) levels, is that a healthy thing to do? And for kids who struggle with focus, would it be better to teach kids how to improve upon the natural challenges humans have with focus, and how focus can be improved by learning life skills rather than taking drugs? When I hear young people at my office describe the recreational effects of their adderall to be like cocaine, does this suggest to you as it does to me that we’re doing this wrong? There’s been an ongoing, pharmaceutically-driven paradigm shift for several decades suggesting that normal challenges with focus are, in fact, evidence of mental illness. Perhaps the time has come to reverse that trend and reset the paradigm to what it should be: Focus is a challenging skill to develop, but can be improved upon without the label of mental illness or drugs but instead through love, support, encouragement, and skill-building. Is this an easy process? In most cases no, but that still doesn’t make it psychopathology, either.