For some time now, people and experts have been wondering, why are more and more people being diagnosed with ADHD (Attention deficit hyperactivity disorder)? Many theories are thrown into answering the question but perhaps no one is really paying attention to a more obvious problem. As a part of my research on this subject, I decided to read two very informative texts: An article published in The New York Times by Dr. Vatsal G. Thakkar entitled “Diagnosing the Wrong Deficit” and an article published in The Huffington Post by Dr. Michael J. Breus entitled, “ADHD or Sleep Disorder: Are We Getting It Wrong?”. In his article, Dr. Thakkar, who is also a clinical assistant professor of psychiatry at NYU Langone Medical Center, explores the increasing diagnosis of ADHD in children and adults. He argues that there might be a very possible correlation between sleep disorders and the increased diagnosis of ADHD in the last twenty years. In his article, “ADHD or Sleep Disorder: Are We Getting It Wrong?” Dr. Breus , who is also a clinical psychologist and board certified sleep specialist, explores the possible misdiagnoses of ADHD in people who might actually be suffering from a sleep deficit. He argues the different causes for such misdiagnose and offers some possible solutions to prevent that from happening. Although both Thakkar and Breus explore the misdiagnosis of ADHD and sleep disorders through the use of numerous studies, Thakkar relies on professional experience, a humorous tone, personal anecdotes and implications of the misdiagnosis while Breus focuses more on possible causes for the problem, reference to his professional experience and a professional tone. Both articles made me think of how fine the line between two diagnoses can be and how much of a danger such a “little” mistake may mean for people.
Even though Dr. Thakkar and Dr. Breus both agree the increasing diagnoses of ADHD in the last decades is due to the increasing misdiagnosis of sleep disorders and overlap in certain points, they present their arguments differently. Thakkar mostly appeals to logos to support his argument about the misdiagnosis of both deficits through studies. For example, he claims that according to a study “the number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011.” (Thakkar 1). He also states that“a number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing…” (Thakkar 1).The way he keeps making reference to different studies supporting the subject throughout the article adds consistency to his argument while appealing to logos.
Additionally, Thakkar supports his argument appealing to ethos. He appeals to it by including his own professional experience. For example, when Thakkar says “a new patient came to see me to find out if he had attention-deficit hyperactivity disorder.” “but one thing was unusual. His symptoms had started only two years earlier, when he was 31.”(Thakkar 1). He also has plenty of professional experience treating patients with ADHD. For example, he shows that when he mentions “Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood.” (Thakkar 2). Also, Thakkar employs a humorous tone throughout his article making him sound likable. An example of this is when he says “I got through my medical school exams only by the grace of good memorization skills and the fact that ephedra was still a legal supplement.”(Thakkar 2) Or when he says “My recovery has been amazing (though my wife would argue that weekend mornings are still tough — she picks up the slack with our two kids).”(Thakkar 3). In those two statements, he intends to create a humorous tone in order to get close to his audience and eventually earn their trust in some way. Thakkar uses mostly the combination of these two aspects to appeal to ethos.
Thakkar also appeals to pathos making reference to his own personal experiences in relationship to the subject that is being discussed. For example, he mentions that he has “a personal interest in A.D.H.D and sleep disorders.” since he was “misdiagnosed with various maladies, including A.D.H.D.” and then he “underwent two sleep studies and, finally, was found to have an atypical form of narcolepsy” (Thakkar 2). Also, he focuses on the implications that the lack of proper sleep might have on people. Thakkar mentions “Cronic delta sleep deficits in humans are implicated in many diseases…” (Thakkar 2) and among those diseases he mentions there is hypertension, diabetes and depression. In addition, he discusses car accidents related to fatigue as a possible implication as well. Furthermore, he criticizes that more research needs to be done in the area of sleep disorders. Also, he mentions that there is not enough monetary investment on the subject by the National Institutes of Health unlike in other sectors such as psychiatry or cardiology (Thakkar 3). This creates a feeling of disappointment in the reader since they are informed many negative implications are involved and not enough attention is paid to the issue of sleep deficit. Focusing mostly on these things, Thakkar appeals to pathos.
On the other hand, Dr. Breus presents his argument about the confusion in diagnoses between ADHD and sleep disorders in a different way. Breus supports his argument appealing to logos by making use of some supporting studies on the subject. For example, he makes use of a study on sleep breathing difficulties on children which found these kids had “had higher rates of behavioral problems including difficulty paying attention, hyperactivity, communication problems, and aggressiveness.”(Breus 8) and were more likely to be diagnosed with ADHD due to the similarity of the symptoms. Also, Breus offers some possible causes that lead to the main problem. According to him most of the time patients fail to inform their physicians about their sleep problems; he talks about a survey done saying “fewer than 1 in 4 of them had talked with physicians about their sleep problems.”(Breus 12) which eventually leads to the confusion of ADHD with sleep deficit since sleep problems are not acknowledged. He also says that the use of technologies such as laptops and phones may be a cause for sleep loss. Breus says “The nighttime exposure to light they emit interferes with the body’s release of melatonin, disrupting sleep cycles…” (Breus 14). Appealing to logos this way creates support and credibility for his argument.
However, Breus also appeals to ethos referring to his own professional experience to support his argument. For example, he says he has written “about the dangers of sleep-disordered breathing in children, which is linked to a range of developmental and behavioral problems” (Breus 7) himself. He also comments that he has written about the cognitive challenges presented in adults due to insufficiency of sleep which according to him include “Difficulty concentrating, trouble completing tasks, problems with organization, and memory lapses” (Breus 10). Adding more credibility to his argument, Breus always keeps a professional tone when talking about it. He never makes use of any humoristic phrase or sentence; instead he sticks to a professional tone which creates a sense of seriousness and professionalism. Breus’ use of these two strategies appealing to ethos adds credibility to his argument.
Even though both Thakkar and Breus strongly believe and argue that the increase in ADHD diagnoses is due to the confusion with sleep deficit, they differ in the way they deliver their arguments to the audiences. I perceive Thakkar’s way to express his argument is very likable due to his use of humor. Also, the way he uses both his professional and personal experience is very supporting for his credibility. Besides that, he is right in the fact not enough attention is being paid to the issue of ADHD and sleep deficit. However, when he says “…consider the drug clonidine.”(Thakkar 3) he may be, perhaps, unintentionally encouraging his audience to go ahead and try a drug without consulting a doctor first. Even though Thakkar is an expert in the subject, people must individually consult their physicians since the treatment for each of them may vary. The fact that he is an expert on the subject should make him know better. Despite Thakkar had a very well developed argument; he failed in offering practical solutions to the issue.
Breus’s argument is close to Thakkar’s to the point of even making reference to him. For example, in one section he mentions Thakkar by stating “As Dr. Thakkar points out…”(Breus 3). But as I previously stated, they still deliver their arguments differently. Breus always maintains a professional tone throughout his argument which makes him sound very credible. Also, he entirely relies on professional experience only to present his testimony about the subject and expands more on technology as a possible cause for sleep deficits as well. In addition, he wraps up his argument stating its overall goal which is “to make the right diagnosis — whether ADHD or sleep problems — and pursue the most effective treatment.” (Breus 15). Breus’ views strike me as more professional than Thakkar’s. He presents the argument to the audience in a way they can understand but sticking to a professional tone and also encouraging them to identify the right diagnosis and treatment and not jumping into generalized prescriptions.
After reading these two articles, I have gathered more knowledge about why the number of people diagnosed with ADHD seems to be growing exponentially. We live in a society in which people are always rushing. Everyone goes about the world worrying about taking care of their personal situations to the point in which sleep goes to the bottom of the list. Is it not wrong that it has gotten to that point? Breus also makes us realize that technology may also be a big part of the problem and we live in a world in which people are constantly staring at their phones. Would the knowledge that their own precious phones may be affecting their sleep make people use them any less? Also, if a physician diagnoses a patient with the wrong deficit and this causes something that affects the patient even further can he just be like “Sorry, wrong deficit”? If they know that symptoms caused by sleep deficit are so similar to those of ADHD why not screen for both deficits before jumping directly into one? Thakkar and Breus have made raise all these questions that everyone should consider.
Reading these articles made me think that we should pay more attention to our sleep habits. I remember something my sister told me one day. She told me that once she pulled an all-nighter. She was just all night on the computer chatting with some friends of hers that were living abroad at that moment. She was watching soap operas online all night as well. When my sister came to realize, it was already around 6 in the morning and it was almost time for her to get ready to go to school. She told me that she just got dressed up for school and left without even sleeping for five minutes. However, she said she felt just fine.
On the other hand, I have had some similar experiences of my own. I usually go to bed at 11:00 PM after doing all I have to do and there have been many times in which I just do not feel sleepy by that time. Since I cannot seem to sleep I have gotten my phone and gone on Netflix to watch shows, thinking that it is going to make me sleepy somehow. I stop after watching some episodes and go back to trying to get some sleep but it just does not seem to work. I have just rolled on the bed from one side to the other until I finally fall asleep somehow like around 3 in the morning. What is even worse is that I have to get up for school at around 5:30 AM on the same day I have fallen asleep which means I have only been able to get about three hours of sleep. Despite this, I have felt perfectly fine in the morning when that happens as if I had slept normally and I also feel full of energy but I could not focus at school. Also, that rush of energy has only lasted until the afternoon when I finally knock out completely– which makes me think my sister did not tell me the full story. These similar experiences that I have had with sleep have made me think about Thakkar’s and Breus’ arguments about how the symptoms of a deficit in sleep can be so similar to those of ADHD.
Dr. Thakkar and Dr. Breus give us a wake-up call to realize that there is something very wrong with us. We have taken something very essential for every single one of us as granted. Despite sleep is very essential we have given it very little importance. It has become so unimportant that not even enough research is done on the issue of sleep deficit as much as it is done in other areas. This lack of attention to the subject has led to bigger problems such as confusing two different deficits. We do not know how much of a danger it is that a confusion which may seem insignificant at the moment may lead to greater repercussions down the road. Therefore, we must do as much as we can to change our sleep habits if what Thakkar and Breus argue sounds familiar. If that is the situation, we also must let our physicians know that our sleep is lacking and not wait until is too late, we are misdiagnosed with the wrong deficit, and they just tell us “Sorry, wrong deficit”.