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Dr. Kacir's ADHD Blog

Is ADHD "just" an extreme of active behavior?

I just read the summary of an article supporting the theory that ADHD is an extreme of the hyperactive behavior seen in "normal" children.  The support was based on 
images of the brains of ADHD patients compared to non-ADHD children without hyperactive behavior and then to non-ADHD children with some hyperactive behavior.  The authors stated that since the findings in the last group of children were in between those of the other two, ADHD was actually just one end of a "dimensional" spectrum.  I was not impressed with the summary of their study, but I do think that their premise is useful to consider.  (One of my major objections to the study was their focus only on hyperactive behavior.  What about inattention?)
Many parents have questioned the validity of using ADHD symptoms to "qualify" for the diagnosis of ADHD by saying "everybody does that sometimes!"  Some have even asked if it is possible to have "just a little bit of ADHD."  Agreeing with these two statements would imply that ADHD is merely an excess of "normal" behaviors.
In most cases of ADHD the difference between "normal" and "ADHD" is very clear: there are definitely more than 6 symptoms of either inattention or hyperactivity/impulsivity.  However, what should be done for someone who has only 5 symptoms and yet is not doing as well as he or she would like in school and has to work twice as long as siblings do to accomplish chores?  Purists would claim that such a person does not have a "disorder" because he or she did not fulfill the definition by which the diagnosis is made.  Given that determination, a physician would not be able to prescribe medication since the patient did not have a disease.  Indeed, some would say that allowing such a patient to take stimulants would be equivalent to prescribing "performance enhancing drugs" to an athlete. 
I am not such a purist.  I think that it is possible to have "just a little bit of ADHD."  If a person has some symptoms and is experiencing problems in two areas of life, I think that a trial of ADHD medicine is useful.  Of course, a medicine should not be used if it causes side effects nor should it be used just for testing or for big projects.  (The latter use is typical of how stimulants are abused by college students for whom it is not prescribed.)  As with any medical intervention, the benefits must outweigh the risks both to the patient and to society.

38 Comments to Is ADHD "just" an extreme of active behavior?:

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Robert Lee on Tuesday, April 19, 2011 10:21 AM
I agree wholeheartedly Dr. Kacir! All my life I have been known as the 'hyper' person; but not the 'detail' person! My hyper condition wasn't debilitating, it was my failure to follow through, get the details right and complete the project. For most of my career this was okay, and at times, even a benefit. However, as I progressed professionally my performance began to decline when my new responsibilities required much more detail oriented thinking, planning and action. Postulating that hyperactivity is 'just' the extreme of normal behavior may be accurate, but if it is debilitating isn't that considered a disease? At what point does overeating ('just' the extreme of normal eating) become a disorder? Or, for that matter, sleeping, talking...? Are all 'normal' people hyper at some point, or even distracted? Of course they are, but they are not debilitated by these normally temporary conditions; I was, and I think that is the main difference between normal and having a disorder. After 37 years of life, I can say your 'non-purest' approach has helped me to achieve goals previously out of my reach! 7hanks, rl
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resumespice reviews on Tuesday, October 2, 2018 2:01 AM
Well, that is really nerve-cracking. But, I guess, we should just respect those people who are suffering from this kind of illness whether or not it is just an extreme of active behavior. We all know that suffering from this kind of disorder is very difficult for one to overcome, especially if that person really wants to get out of that disorder. I just want to say that no matter what happens, or whatever type of person we might encounter, we must always respect them. Nonetheless, it is still a great post.

Dr. Kacir on Tuesday, April 19, 2011 4:11 PM
I'm glad that my approach has been helpful for you. I also really appreciate your posting a commment on my blog. I wasn't sure anyone was actually reading it! Your point about the parallels between the extremes of activity as compared to eating, sleeping and talking is a good one. Indeed, there are even prescriptions used for disordered eating and sleeping -- although I don't know of any used for talking too much. (My dad used to suggest duct tape.) Hmmm. Actually, those medications are often the same ones used for ADHD. Maybe you have hit upon a new theory. If the same chemical corrects different extremes of behavior, the underlying mechanism of the disorders resulting from those extremes may be more similar than has been postulated. I should look for more evidence of that parallel. Thank you for giving me more food for thought!
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I agree, not all hyper persons have ADHD symptoms or having ADHD. They are just their normal selves, by being hyper and active at the same time. I have a friend who is always active and I can say that she is just her normal self. She is even not an attention-seeker because she is close to her family. Sometimes behavior should not be the basis on how to identify what kin a person is. We need to know them first and learn to go along with them.
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The topic is really intriguing and there are lots of debates, talks, and conferences being held about this. ADHD is somehow or most often being mistaken as the term for hyperactivity, or a child's state or capacity to be really active and to be able to do a lot of things. In anyways children with ADHD should not be deprived of their rights to learn, go to school, have fun and enjoy their life. Thank you so much for sharing your thoughts. This article is really eye-opening
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Having an ADHD is not a joke. It is not as simple as hyperactivity. NO! It does not simply translates to over and hyperactivity. Those are two different things. Children who are usually diagnosed with ADHD suffer from having difficulties in focusing on things. It is hard to live with this kind of situations. I am a teacher and a doctor as well, a pediatrician to be exact. I have dealt with so many cases of ADHD in Colorado the same with when I moved to Utah. There were cases that children do not really know what to do. I should say it is really difficult to be diagnosed with ADHD
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