From Disruptive Behavior Disorder to Neurodevelopmental Disorder: DSM 5
Posted by Dr. Vollmer on April 27, 2016
The powers that be in psychiatry have moved ADHD from a “disruptive disorder” to a “neurodevelopmental disorder”. Let’s pause for a moment. Not all ADHD children or adults are disruptive. Girls, mostly, and some boys, suffer from the “inattentive subtype” which means they quietly sit there and count the tiles on the ceiling, not learning because they cannot focus, but they do not cause a disruption. So, indeed, the nomenclature needed to change. Welcome ‘neurodevelopmental disorder’ and new problems arise. To the extent we understand ADHD as an immature brain, a brain which has trouble with executive functioning, sustained attention, and impulse control, then it is certainly a “neuro” disorder. On the other hand, the role of development is not clear except to say that certain children will outgrow ADHD, implying they are slow to mature, or late bloomers, as I like to tell parents. Some, however, do not outgrow it, and they suffer a lifetime with poor focus and poor executive functioning. For them it is not a developmental disorder, but a straight up disorder. If we think of brain functioning like circuits and some people lack critical circuits for functioning, then in the future, perhaps we will call ADHD a “circuit disorder”. As Russell Barkley explains, the problem with the circuit is a failure of inhibition, such that the ADHD patient is constantly vulnerable to whatever pops into his mind at that moment, leaving him or her unable to complete tasks, especially those which have little inherent interest. Further, he or she is also vulnerable to losing key items, not remembering details of a project, and failing to do daily chores, as the sudden thought, whatever that might be, overrides routine or “boring” activities. So, by my way of thinking ADHD is a brain problem, not always related to development. No one wants to think of themselves and worse yet, their children, as having a “brain problem” so I don’t think my idea would sell well, but I think it is the most efficient way to communicate our current level of understanding of this common disorder.