Myth and ADHD

Keith McCurdy
Keith McCurdy

There is no doubt that the ADHD diagnosis has been well established among the mental health community for some time.  It has survived a few revisions in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and remains one of the most widely diagnosed disorders among children today. 

Yes, the diagnosis has its issues to be sure.  The symptom picture is very loosely defined and to date there does not exist a single definitive “test” or evaluation for the current diagnosis.  ADHD like all of the mental disorders and conditions in the DSM has not been reached by research, but rather by consensus.  In other words, a group of individuals in or related to the mental health profession meet and decide what they “believe” certain symptoms and related issues mean.

Ultimately, the diagnosis of ADHD is and always has been subjective.  Now, to those in the mental health field, this is not a surprise.  Ask any well-seasoned mental health professional and they will tell you that this subjective approach to mental health diagnosis is nothing new.  Quite the contrary, most of the diagnoses that are given regularly are based on subjective interpretation by a professional of subjective information provided by an individual. And when specifically considering an ADHD diagnosis, it is most often a subjective interpretation of information reported by “observers” of the child being diagnosed.  Typically by “observers” who are annoyed or bothered by the behaviors (symptoms) of the specific child.

This article is also not about the idea that ADHD is over diagnosed.  In all honesty, if the criteria established in the DSM are the basis for the diagnosis of ADHD……I would suggest that it is woefully under diagnosed.  I would go as far as to suggest that most children between the ages of 2 and 5 years of age meet this diagnosis easily.  If you want to see a great description of a toddler……take a look at the symptom picture of ADHD, or ODD (Oppositional Defiant Disorder) for that matter.

The “myth” I am referring to is one that I read recently in a local publication in an article on mental health.  It is nothing new and I have seen it repeated in print and heard out of the mouths of professionals, teachers, and parents for years.  The myth is that ADHD is a neurobiological disorder.

This description suggests that ADHD falls into a “disease” model.  A disease model suggests that it has been determined that there is something structurally or functionally wrong in the genetics, neurology, or biology of the individual.  This position is mentioned and quite frankly pushed by many…..but without evidence.

There are many in the mental health world that will often claim this link, and I am told by patients regularly that they have been informed of such things as ADHD having a neurobiological cause, it is due to a genetic issue usually passed on by “Dad”, or is related to a chemical imbalance in the brain, and so on…..but you need only take a step or two into the world of the research geneticists, biologists, and neurologists to find the evidence woefully absent.

Prior to writing this article I did an online literature review to see if there had been any new studies supporting this link.  Not only could I not locate any but was  overwhelmed with the growing body of evidence that has been pointing another direction…….to a “developmental” model.

A developmental model simply supports the idea that many things play into the “development” of a child’s functioning and behavior…….history, experiences, parenting, responsibilities, choices, education, technology exposure, etc.  We have study upon study that show links to functioning and all of these areas.

If we could find a neurobiological cause to ADHD issues, that would be great.  That would then direct a very clear course of treatment and we would have expected outcomes as we do for most truly “disease” based conditions in the medical community.  Until that day it is important that we deal with truth.  We have to be honest about what research does and does not support and relay that to parents.

When a parent is told that ADHD has an “unproven” neurobiological basis, they immediately are more inclined to seek a “medical” intervention……medication.  More importantly, they also begin to have a more helpless attitude about their ability to help their child.  This is not what we want.

Our goal should be to empower parents to help their children.  The only way to do this is with the truth.  Here are some ideas about what could be good to communicate:

We don’t know what causes ADHD, there is a lot of speculation, but nothing has been proven yet.  Medication may help to calm a child and increase attention span.  Stimulant medication does this for the vast majority of individuals when given in a “therapeutic” dose, whether they have ADHD or not.

However, research regarding the long-term benefits of stimulant medication use for ADHD is unclear at this time and there are many side-effects.   Interventions that directly relate to influences in the life of a child have major effects in how they function and there is much research supporting the effects of such things….TV, technology, nutrition, educational environment, and parenting to mention just a few.

When dealing with a child who struggles with attention and impulsivity, whether or not a medication is part of the mix, remember that parenting effectively is the vital key.  This does not blame parents for related ADHD difficulties, it empowers them to help their children.  Parenting has and always will be the most important influence in the life of a developing child…..that is the truth.

 – Keith McCurdy

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3 COMMENTS

  1. Another problem you failed to mention in this field of study is the number of confounding variables that could be present in an experiment. What these variables are that are influencing the outcome of the experiment can be just about anything, and very subtle influences or differences can have a huge outcome on that experiment.

    For instance, consider that findings show thin brain tissue is present in most people with ADHD but not all the patients. Brain tissue can grow from drinking milk or getting calcium. Then say they find a gene that prevents calcium from going to the brain that causes ADHD. Then if they are on ADHD medication, the prescription for the upset tummy caused by that medication is milk. People that don’t have the gene but thin brain tissue would get better. The people that have the gene that prevents calcium from going to the brain won’t. Then to my knowledge no one has preformed an experiment where this was taken into account. It may just be an issue of an unaccounted for variable that is just preventing them from proving it once and for all.

  2. Mike thanks for reading and the comments. I am very familiar with both Biederman and especially Russell Barkley. All would agree that both, especially Barkley, is strongly in the ADHD camp and yet as he even reports on his “fact” sheet for ADHD from his website, Barkley states clearly “ADHD has very strong biological contributions to its occurrence. While precise causes have not yet been identified, there is little question that heredity/genetics makes the largest contribution to the expression of the disorder in the population.” Barkley who is considered by most to be the foremost advocate for ADHD issues cannot demonstrate causality. I do believe that if a biological cause is ever identified he is likely the one to be involved in that research.
    The confusion is that we have gotten into murky waters by blurring words and using terms such as “contributions”, “connections”, “underpinnings”, etc. In much of the interpretation of research on ADHD correlation is often reported as causality….or causality is implied when only degrees of correlation have been established. This type of misrepresentation of causality, regardless of the issue being studied, is considered by most in the research community as “fraudulent.”
    Interestingly though is when the actual studies themselves are reviewed, most of the researchers don’t make that mistake…..such as Barkley. Barkley has a very strong “belief” of this basis, but admits he or anyone else has never proven it. When you take a look at other researchers such as Jerome Kagan of Harvard, considered one of the most eminent psychologists of the 20th century, you get a very different “belief” about causality of things like ADHD, as well as diagnosis. There are many very qualified individuals that differ on their “beliefs” about the causality issue, but all admit it has not been established.
    Consider that of all of the studies to date regarding ADHD over the past 30 plus years, none have proven causality or any biological basis…..according to experts such as Barkley. Wouldn’t a reasonable interpretation be that maybe it isn’t in the genes? Should we continue the research?… Absolutely! Should we be accurate about the outcomes?… Absolutely! There is nothing wrong to say to parents “we aren’t sure about this.”
    The true “due diligence” is required of the professionals who treat children and families struggling with these issues. When we imply causality when only correlation exists….that is problematic and possibly unethical. When we report causality when there is only correlation….it is at best misleading….at worst unethical. The agenda I hope we all would share as clinicians about this very hot button issue is that we are accurate with the facts and relay them in a correct manner to parents. Only then can there be confidence and hope in the treatment.
    Thanks again for the comments as this is a very important issue.

  3. Thanks for the comments. Great article and one that I am very familiar with. The authors of the study themselves acknowledge in the full write-up that no causality of any kind is established in the research. Their hope, as well as mine, is that if there is a true genetic/biological/neurological cause, that it will be found. Until then they admit none exists which is consistent with research done over the past 30+ years.

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