Dr. Corinne Masur

In 2011 more than 10,000 2- and 3-year-olds were taking medication for Attention Deficit Hyperactivity Disorder.

But how do you tell if a toddler has ADHD?

All parents worry about their children. And when they have very active children, these days they worry about whether their children may be “hyperactive.” But what IS hyperactivity and what is “normally” active when you talk about a two or three year old? Children of this age love to run around, climb on things and seek novel stimuli. It is NORMAL for them to be distractible and to go from one activity to another. This is what being toddler is all about.

So how does a parent know when a child of 2 or 3 is hyperactive? And WHAT is ADHD, anyway?

If you ask most pediatricians, even most psychiatrists, they will tell you that ADHD is a neurodevelopment psychiatric disorder affecting 11% of all children. Symptoms include: impulsivity, problems with focus, problems with attention and overactivity. Most often, treatment involves a combination of medication and behavioral treatment.

But is ADHD actually a disease? If 11% of children have this set of symptoms, is it a disease? Or is it a variant of normal?

Recent research shows that people with ADHD are novelty seeking, a trait that had definite survival value over much of the course of human pre-history. Such people get bored easily; they are impatient when things get routine. These traits offer an advantage in a hunter-gather society where the ability to run after prey at a moment’s notice guarantees dinner. However, it does not match the expectations of modern day educational facilities where children have to sit at a desk for most of the day and focus on what the teacher is saying. These days, children with these traits may even have a hard time in day care and preschool where large parts of the day are spent in circle time and didactic lessons rather than in free play.

To parents and teachers, children of this type look like they have a hard time with attention and focus. They seem impulsive.

So what is the neuroscience behind this trait?

The sensitivity of the reward circuit of the brain varies widely amongst different individuals. What is stimulating to one person may be overwhelmingly exciting to another and boring to the next. Dr. Nora Volkow, Director of The National Institute on Drug Abuse has found that the brains of adults diagnosed with ADHD contain fewer dopamine receptors. And she found that the lower the number of receptors, the greater the symptoms of inattention. This makes normally interesting activities seem dull and may explain why routine activities seem intolerable for people with symptoms of what we call ADHD.

If you think about it, this trait would be beneficial for human beings who lived in the hunter gatherer society mentioned earlier. For those people who sought stimulation and novelty, hunting would be very rewarding – and they would be good at it. It would not be until later in our history when humans took up agriculture and ceased being nomadic, that the ability to focus and attend would become more valuable.

In fact, these ideas are born out in the research of anthropologist, Dan T. Eisenberg who found that a tribe in Kenya split at some point in history with one group staying nomadic and the other becoming agriculturally based. It was found that the nomadic men who had the gene for the ADHD-like symptoms (novelty seeking, etc) were better nourished than their friends who did not have the gene. But in the sedentary group who practiced agriculture, the men in the tribe who did NOT have the gene for the ADHD-like traits were better nourished. Of course, this makes sense. Certain abilities are more valuable than others depending on the demands of your daily life.

Dr. Richard Friedman believes that the recent rise in prevalence of ADHD in children has to do with the increasingly dramatic difference between school and the electronic world. The digital world is highly stimulating and immediately gratifying while school….is not. Many children love the on-line world and feel bored at school. Those with the symptoms of ADHD have to work hard to find novelty for themselves at school – they doodle, fiddle, rock in their chairs, pester their classmates, pass notes, etc. For them, this is a way to keep their brains stimulated. As a result, they get in trouble, they get sent to psychiatrists and they get medicated.

So what is the answer?

Do we give our kids medication so they can sit for longer and focus better on the teacher? Or do we change our school curriculum to provide more active play and hands on experience?

And do toddlers EVER need stimulant medication? Or do we as parents and day care administrators and pre-school teachers need to provide more stimulation for their growing brains by giving them lots of time to run and play and explore?

IS ADHD a trait that we need to identify and then provide the correct environmental stimuli for? Or is it an illness which we need to treat?

What do you think?

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Research for this entry utilized NYT article by Richard Friedman, MD, 11/2/14