Attention Deficit Hyperactivity Disorder as a Disability Category: A Critique
Reid, Robert, Maag, John W., Vasa, Stanley F., Exceptional Children
Not since the establishment of learning disability as a special education category has a condition so captivated both the professional community and general public as has attention deficit hyperactivity disorder (ADHD). A quick glance at the title of published articles affirms the popularity of ADHD as a topic of study. Special issues on ADHD have appeared in various journals, including School Psychology Review (Teeter, 1991) and, more recently, Exceptional Children (Hocutt, McKinney, & Montague, 1993). The voluminous body of literature amassed on this topic has evolved into a kind of ADHD paradigm in which a series of unquestioned assumptions have become accepted dogma. Yet like its predecessors, leaning disability and minimal brain dysfunction (MBD), ADHD is plagued by numerous definitional and diagnostic problems. Consequently, procedures for identifying, assessing, and treating this disorder have been embroiled in controversy (Divoky, 1989; Kohn, 1989).
ADHD has recently become relevant to educators because of efforts by advocacy groups to have ADHD recognized as a disability category under the Individuals with Disabilities Education Act (Parker, 1990). Many questions and problems with the construct of ADHD, however, have received little if any attention in the literature, and should be addressed if we are to make a rational decision concerning the advisability of making ADHD a separate category. We present a compendium of criticisms that argue against the assertion that ADHD should become a separate disability category, thereby making all students identified as ADHD eligible for special education services. Our intention is not to simply restate currently accepted perspectives. These viewpoints are amply represented; instead we aim to present criticisms drawn from the ADHD literature that are largely ignored, and highlight gaps in this literature that speak to potential problems of adopting ADHD as a separate category. Our aim is twofold: First, we hope to create a healthy scientific skepticism toward the construct of ADHD that we believe has been noticeably lacking. Second, and more important, we hope to spark debate on the educational implications of ADHD as a separate disability category. Debate on this issue is critical because the special education literature has rarely addressed the educational ramifications of ADHD as a disability category.
We first present a brief overview of ADHD as a disability category. Next, we examine the validity of ADHD as a psychiatric disorder by challenging the assumptions (a) that the process of differential diagnosis, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), is useful for classifying ADHD and differentiating it from other conditions, (b) that behavior rating scales provide a reliable method for identifying students with ADHD, and (c) that ADHD has a biologic etiology. After contesting the validity of ADHD as a psychiatric disorder, we address the need for special education services for students with ADHD. Specifically, we examine whether students with ADHD have educational problems that are not currently being addressed under existing categories, challenge the reliability of estimates used to justify need for additional services, and ascertain whether any treatment interventions are specific to ADHD, thereby necessitating the creation of an additional disability category. Finally, we briefly examine the cultural and societal factors that, in our opinion, also impel this issue.
ADHD AS A DISABILITY CATEGORY
People currently diagnosed as having ADHD are recognized as having a disability under Section 504 of the Rehabilitation Act and, consequently, are entitled to a free appropriate public education, due process, and related services ("New OCR Rulings," 1991). However, concerns about the adequacy of services for children with ADHD remain, and advocates for children with ADHD proposed adding this disorder as a disability category during deliberations on the IDEA legislation (Aleman, 1991). …