Is ADHD a Disease of Civilization?

Many kids we diagnose would be fine hunter-gatherers.

childgroup-c02reducedDuring my two years of research on children among the Kalahari San, or Bushmen, I watched kids scramble over huge termite hills, chase each other around the scrub brush in the savanna, practice dance steps, stop to dig up a tasty tuber, pick some berries, or throw a rock at a hapless bird or turtle which they could then cook and eat. I often wondered how many of them might be called inattentive or hyperactive in a classroom setting.

The answer, I think, is not none, but very few—certainly fewer than the three to six percent who get diagnosed in American schools. My friend Peter Gray has posted on this discrepancy, which he learned about by interviewing fieldworkers who had studied hunter-gatherers. In anthropology we call it the discordance or “mismatch” model. We as humans evolved in a certain context—the environment of evolutionary adaptedness. This crucible formed our genes.

Then most of us entered a completely different environment, that of settled agriculture, a mere 10,000 years ago. But let’s say that’s enough time for some genetic change. We then shoved ourselves into yet another, even more different environment, the modern industrial/postindustrial state. No way our genes could have changed fast enough to adapt. The mismatch between genes and environment has brought us big increases in obesity, diabetes, heart disease, stroke, some cancers, and even dental caries—“diseases of civilization.”

Is ADHD one of them? There are reasons to say yes. First, some forty percent of kids diagnosed with it have had pressure from teachers to get evaluation and treatment, and this is by far the most common source of referrals. These kids stick out like sore thumbs in classrooms where you have to sit still all day, pay attention continuously to activities you haven’t chosen, and remember pesky details on command.

It’s not that hunter-gatherer children and adults didn’t have to concentrate intensely, control restlessness, and remember many fine details, they did. No man could succeed as a hunter who couldn’t keep still and quiet, no woman could feed her family without a prodigious memory for the details of a landscape and the appearance of countless edible plants in all seasons. Survival depended on doing these things well.

But they did them in the course of moving around in a vast, wild world they felt comfortable in, and when they stopped to focus in utter silence on a kudu’s trail or match a slim brown vine on a bush with the retrieved memory of an underground succulent root, these skills were part of the natural course of a day’s events, moving through the savanna, responding appropriately to compelling stimuli as they arose.

There was no question in this world as to the relevance of what they needed to do, even for children. There was no years-long slog through sedentary activities many of which seemed irrelevant to life. There was no call to trade a huge part of your childhood for a future return that was difficult to imagine. Play merged with learning to survive.

So many of the children who would now be diagnosed with ADHD or at least ADD would have gotten a pass, and some of our academic stars would have been worse off—enjoying sitting still rather than getting up and moving for instance, or ignoring a stray distraction in the stimulus envelope that might turn out to be dinner or a leopard.

To be sure, the kid who is proverbially bouncing off the walls or unable to focus attention even for short periods would be poorly adapted in any culture, even one without walls. But most kids who get the diagnosis in our culture would be fine—normal. There’s a bell-shaped curve of genetic tendency toward inattentiveness and overactivity, and the modern world lops off a much bigger chunk of one tail and deems it maladapted than would have been the case for our ancestors.

Still, we do want our kids to adapt to our culture. Both medical and behavioral treatments for ADHD have proven themselves, and the diagnosis is not a plot to control rebellious kids and adults (One paradox is that non-Hispanic whites are more likely to get treated than Hispanic or African-American kids.)

But we also need to think about the environment. Alternative schools with open classrooms have been around for decades and have allowed children to learn in ways that are more like the hunter-gatherer world we evolved in.

Meanwhile, No Child Left Behind with its relentless narrow testing programs, combined with an economic downturn, have caused schools throughout the country to abolish recess, cut way back on art and music, and dismantle playgrounds. It’s not rocket science to predict an increase in ADHD. We’re just making the mismatch worse.

Note: By invitation, I’ve started a blog on the Psychology Today website, and my latest post can be read there or here, although different comments may be  posted there. This one produced some strong reactions .


  1. Henry says:

    I escaped the compulsory education system just two short years ago, and I still have nightmares putting me back in high school. Do you think we’ll eventually see a swing of the pendulum in society away from things like the infamous “No Child Left Behind” towards a more stimulating sort of school environment, or when my kids are ready for school (in like, fifteen years or whenever I’m supposed to have kids) should I consider homeschooling? I just don’t think anybody should have to go through the same system I did, and my life-experience is probably too limited to make sweeping claims about the trends of education.

  2. nick says:

    Hello, my name is nick, im 19 and i have ADD, ADHD, APD and dyslexia. I had a hell of a time in school due to this but i got by just fine. Although i have these problems, it does not effect my life in a negative way for the most part. Yes, school is harder for me, but i excel more then most kids my age. This includes work, learning, sports and just making correct decisions. Although im young, im a nurse technician at a comprehensive dialysis center, i have a gorgeous sports car ( 2004 Crossfire ), a fiance thats going to be a doctor and i am far more intellectual then half of the adults i know. I use my ADHD to help myself be successful and i dont really ever run out of energy. The biggest problem in my opinion is self discipline. I can sit and not move and listen to an individual sound for hours or focus on multiple tasks at once. You just need to train yourself. So i find it to be a gift more then a curse. Also my success is all done by me, i have had a very horrible childhood, and i moved out at 18, so there was nothing handed to me at all. I dont know if that helps at all but just thought i would share my story. Thank you for your time.

  3. Mel Konner says:

    Thank you all for your comments.

    Diana: Civilization has cured more diseases than it has caused, not to mention given us Shakespeare and Mozart, so let’s not get carried away : ) We just need to look out for the down side.

    Henry: Your question is a very good one, but it can’t be answered 15 years in advance! Whenever the time comes that you decide to have kids of your own, you’ll be able to look around and thoughtfully assess the educational options open to them. There may be a new wave of more kid-sensitive education, or charter school choices, or private schools of various kinds if you can afford them. Home schooling is quite challenging to do, but it works for many people.

    Nick: Your story is powerful and important, and it shows what sheer will and character can accomplish in the face of heavy odds. I agree (and the evolutionary perspective confirms) that there are ways in which ADHD can be harnessed to a person’s advantage, for example by supplying great energy as you say. However, every person is different, and there are people who are quite debilitated and held back by these conditions.

    Best wishes and thanks again for your thoughts,

    Mel Konner

    • Anthony Martin says:

      You show empathy and responsibility by replying to sincere attempts to share and discuss.
      I am sad to say that such courtesy and constructive behavior is rarer each week on the Web.
      I heard you on the Gary Null Show discussing “Women After All”, and that is why I came to your website.
      You remind me of my best professors and teachers.

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