Disease vs. Disorder
Because you may at one time or another deal with doctors, it is important to understand some of their jargon. Most important is the difference between a disorder and a disease. A disease, which is a breakdown in an organ system, has a lab associated with it such that 95% of the population doesn’t have that lab value.
I’ll give you a classic example that has bothered me since medical school. That is anemia. Anemia for a man or for a woman after menopause is a hemoglobin value of less than 13. Anemia for a woman who is still menstruating is less than 12. Why the difference? Because menstruation depletes more iron from the body than a normal American diet replaces.
Doctors have lowered the criteria because in America more than 5% of menstruating woman are iron deficient. Rather than treat iron-deficiency anemia in more than 5% of the female population, we lowered our criteria to get 95% of the women in that range. This leaves many mildly anemic women untreated until menopause, which is not healthy, but by definition is normal. This is a crucial definition. We define a disease as this: 95% of the population does not have this condition.
When I first learned this in my freshman year in medical school I said, “Are you telling me that if 95% of the population were crazy, that sanity would be a disease?”
My instructor replied, “Yes.”
(The strength of this definition is that it allows doctors to focus their research and their efforts. The weakness is that patients may have symptoms for years before they are out of whack enough to meet the criteria of 95%. What is important to remember about this is that just because you or your child doesn’t fit a diagnosis, this doesn’t mean “it’s all in your head.”)
If a disease is based on a laboratory test, what then is a disorder based on?
A series of symptoms that are often seen grouped together. These symptoms do not have a substantiating lab and do not meet the 95% criteria. In essence, they could be a variation of normal, but current thought is that they are a disorder. Over time some disorders will become a disease and others will be called normal variations.
Doctors cure diseases; but for disorders they suppress symptoms.
However, parents want a cure for the disorder. If there ever was one, this is a set up for misunderstanding and frustration. Most doctors would never even think about the two different treatment goals, nor would parents think to ask. Yet, without this understanding, the parents will either give up working with the medical world, or never be satisfied – and not know why!
Not only is there confusion, then, because of the difference between disease and disorder and the understanding that the parents and the doctors have of them, but also there is an additional complication:
ADHD is a Disorder Based on the Parent’s Viewpoint
The problem with childhood behavior disorders is that the parents have to answer the questions about the symptoms, not the child who is having them.
Because often from the child’s viewpoint, what they have is not a disorder at all. They like their behavior.
A disorder is a group of symptoms that interferes with the patient’s lifestyle. In essence, ADHD symptoms (the child’s behaviors) interfere with the parent’s lifestyle.
So how do you know if your treatment is effective and worth the cost in side effects and money? Only the child knows; and when the child reaches 18, the decision to continue treatment will rest solely in his hands. So, parents, if you have a child that doesn’t like the drugs, help him or her to develop non-drug solutions early on so these solutions become habits.
Read more about ADHD
As a medical doctor, author, and homeschooler, Stephen Guffanti, M.D., offers a unique background and tremendous insight, and communicates with warmth and humor. Not only is Stephen a physician, but he’s also dyslexic and ADHD, and from this unusual perspective he brings hope and understanding to families. Born with a passion for education as well as medicine, Dr. Steve has served as the medical director of a clinic specializing in learning disorders and has studied nutrition and its effects on learning.