Shirah Vollmer MD

The Musings of Dr. Vollmer

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.

7 Responses to “From Disruptive Behavior Disorder to Neurodevelopmental Disorder: DSM 5”

  1. Shelly said

    I agree with you. It certainly does depend on how you define “disruption.” To the child in a teacher’s class, disruption may mean constant attempts at causing others to laugh (such as jumping on tables, cracking jokes, wisecracks, etc.), or the inability to stop talking or focus. To the child, to stare off into space instead of paying attention to the board or lesson. To the parent, trying to get the child to stop playing video games and do their homework or do chores, go to sleep or shower, or even stop doing dangerous things like running into the street can be very, very challenging. Adult ADHD has its own challenges, perhaps causing failed marriages, hurt feelings, loss of income or jobs. Brain problems indeed!

  2. As a parent with an ADHD kid (age 5, also with SPD, ODD, and anxiety) I concur. The wires are certainly all mixed up, and some days we simply can’t figure out what’s triggering him. I think I prefer the term circuit disorder because it helps us laypeople understand how things are or are not working in there.

  3. Judith Magee said

    Hi Dr. Vollmer: I wish you I could consult with you about all the ADHD behavior I have in the classroom. Of all the eligible disabilities in the classroom that I observe, and for those for whom this disorder affects, I have found it to be the most disruptive–off task, talking non-stop, constantly moving and touching, etc. I think medication helps but how do you broach the topic of medication with parents?

    Also, you present an interesting observation–perhaps the child may experience traumatic experiences at home (hunger, domestic violence, drug abuse) that causes the inability to focus, rather than just a chemical imbalance. And this brings up another question–is it a chemical imbalance or a neurological deficit? Does it get inherited in families?

    Thanks.

    Judith Magee

    • Yes, the issue of talking to parents about medication is delicate. The first step is education about ADHD and childhood trauma. Once parents understand that certain kids have inherited focus difficulties, and fortunately, we have medication to help this, and if the parents feel a sense of trust, then they will proceed with a medication trial. The work of informed consent takes time and patience; two entities found so rarely in public schools. Thanks again.

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