ADHD Does Not Exist

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One doctor's opinion:

http://time.com/25370/doctor-adhd-does-not-exist/?hpt=hp_t3

Thoughts?

This is the opinion of many doctors.

The opinion of many doctors who are wrong.

Also, did anyone teach this doctor to not "beg the question?" What are they learning in medical school?

I am not going to bother reading the article, been reading them for years, what I think it is, is left overs from our hunter gatherer days, where such attributes were seen more as survival skills.

Indeed

I mean he's not wrong that a lot of disorders can in fact mimic ADHD, but part of the point of ADHD diagnosis is excluding those things. Or determining if ADHD is comorbid.

He's not being entirely accurate when he says it only takes five symptoms to be diagnosed. He forgot that you need to have displayed those systems since childhood, and that they need to represent clinically significant impairments. Yes, everyone forgets things sometimes and everyone basically does everything on the symptom list at some point, but for ADHD it's continuous and causes serious problems.

I am not in the medical profession, rather an electrical engineer, and I know that one really needs to keep an open mind between the difference between cause and effect.

I read about the first four paragraphs of the article and I think what he is saying is ADHD is an effect, not a cause.

And one giant case in point, good grief people, you are posting on a board for Autism Spectrum whatever-you-want-to-put-here, couldn't your autism be the cause, and the effect is not being able to concentrate? That is, for the most part, we are posting here because we were either diagnosed or believe to have some sort of autism?

In my case, coffee and the caffeine in it can make me shakey and not be able to concentrate. Another personal example. I need to get new glasses (bifocals - ouch nothing screams old fart). If you can't see it, how can you concentrate.

The doctor could be right. In my professional experience, I have found that I need to keep an open mind that others might be right and I am wrong. That instead of saying "It is this way?" instead "Could it be this way?" Or, praise and thank the other person for their opinion, and file in it the back of my brain to be "regurgitated" and "chewed on" like a cow.

(Sorry for the goofed up train of thought, but it has been with me for my life)

Yes, that is what he is saying. He's wrong, and using true information (that several disorders can resemble ADHD) to obfuscate reality (that despite this, ADHD does exist and is a separate thing).

Keeping an open mind doesn't mean accepting every opinion as valid.



According to research I've read, a significant number of autistic people meet the criteria for ADHD. Also, autistic people who also meet the criteria for ADHD tend to have more severe impairments than people with just one of those two conditions. Further, they tend to have impairments not observed in people who have just one of those two conditions.



In my case if I don't have some kind of stimulant, my ability to concentrate, to think straight, goes out the window. I drink caffeine which helps me focus. Which is probably a good thing because without it I tend to be entirely tangential. I self-medicated for approximately seven years on ephedra because I discovered that I could actually finish what I started



I've read too much on the topic to be able to take an assertion that ADHD does not exist at face value, to even take it as something that has a possibility of being true. What I mean is, that ADHD's existence is falsifiable, like any other scientific theory. Thus far, it's been demonstrated to exist rather thoroughly what with being one of the most studied disorders ever.

The thing is that he is not entirely wrong. Yes, those conditions can mimic ADHD. His problem is that he concludes that because those conditions can mimic ADHD that ADHD itself does not truly exist. The thing is that ADHD is one of the most highly heritable conditions, apparently even more hereditary than height and at least in the same range as autism.

He's also misrepresenting data: His commentary on addiction, for example. The reality is that once medicated, people with ADHD tend not to turn to substance abuse. Prior to that, many turn to illicit substances for self medication because the first time you try a stimulant and you have ADHD, it's like someone just flipped a switch in your brain. As in, things that were ridiculously hard just became almost effortlessly easy. So, how easy is it to keep taking something that helps you function? I mean, that's not the only possibility, just one of many.

Essentially, there is no way to reconcile his observations with existing data. He's not the first doctor to assert that ADHD isn't real, and he won't be the last. And like those who came before him, he doesn't seem to have a particularly broad or deep understanding of the disorder.

I agree he's partly wrong about ADHD. Although I have to admit that I'm quite ignorant about this subject. He says that the second group can be treated once their real problems are found. But in this second group of his, people with learning disabilities are included, so how would he treat them??

I have attention problems and I know they're severe. But I see them as part of my diagnosis.

Last edited by Acedia on 20 Mar 2014, 11:43 am, edited 1 time in total.

While the idea that ADHD does not exist is a ridiculous one. The article does highlight some important things. Those being that it's important for doctors to do their homework and make sure they are making the correct diagnosis. I've found many doctors don't want to take the time to really understand their patients problems and this can lead to mistakes in diagnosis. Their are also a segment of people who go looking on the internet to find something wrong with them and insist they have ADHD but ignore the fact they are heavy drinkers or use a lot of drugs. I'm sure doctors see a lot of this as well. The unfortunate outcome is when someone comes in with valid complaints they are not taken seriously.

I'm sure there was a thread on this like a month ago.

I am certain that ADHD exists. Yes, hyperactivity can be a personality trait to an extent, but there is still a difference between a hyperactive child and a child with behavioural and attention problems without being related to the parenting. And ADHD affects adults too.

http://www.russellbarkley.org/factsheet ... us2002.pdf

International Consensus Statement on ADHD
January 2002


We, the undersigned consortium of international scientists, are deeply concerned about the periodic inaccurate portrayal of attention deficit hyperactivity disorder (ADHD) in media reports. This is a disorder with which we are all very familiar and toward which many of us have dedicated scientific studies if not entire careers. We fear that inaccurate stories rendering ADHD as myth, fraud, or benign condition may cause thousands of sufferers not to seek treatment for their disorder. It also leaves the public with a general sense that this disorder is not valid or real or consists of a rather trivial affliction.

We have created this consensus statement on ADHD as a reference on the status of the scientific findings concerning this disorder, its validity, and its adverse impact on the lives of those diagnosed with the disorder as of this writing (January 2002). Occasional coverage of the disorder casts the story in the form of a sporting event with evenly matched competitors. The views of a handful of nonexpert doctors that ADHD does not exist are contrasted against mainstream scientific views that it does, as if both views had equal merit. Such attempts at balance give the public the impression that there is substantial scientific disagreement over whether ADHD is a real medical condition. In fact, there is no such disagreement—at least no more so than there is over whether smoking causes cancer, for example, or whether a virus causes HIV/AIDS.

The U.S. Surgeon General, the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, and the American Academy of Pediatrics, among others, all recognize ADHD as a valid disorder. Although some of these organizations have issued guidelines for evaluation and management of the disorder for their membership, this is the first consensus statement issued by an independent consortium of leading scientists concerning the status of the disorder. Among scientists who have devoted years, if not entire careers, to the study of this disorder there is no controversy regarding its existence.

ADHD and Science

We cannot overemphasize the point that, as a matter of science, the notion that ADHD does not exist is simply wrong. All of the major medical associations and government health agencies recognize ADHD as a genuine disorder because the scientific evidence indicating it is so overwhelming.

Various approaches have been used to establish whether a condition rises to the level of a valid medical or psychiatric disorder. A very useful one stipulates that there must be scientifically established evidence that those suffering the condition have a serious deficiency in or failure of a physical or psychological mechanism that is universal to humans. That is, all humans normally would be expected, regardless of culture, to have developed that mental ability.

And there must be equally incontrovertible scientific evidence that this serious deficiency leads to harm to the individual. Harm is established through evidence of increased mortality, morbidity, or impairment in the major life activities required of one’s developmental stage in life. Major life activities are those domains of functioning such as education, social relationships, family functioning, independence and self-sufficiency, and occupational functioning that all humans of that developmental level are expected to perform.

As attested to by the numerous scientists signing this document, there is no question among the world’s leading clinical researchers that ADHD involves a serious deficiency in a set of psychological abilities and that these deficiencies pose serious harm to most individuals possessing the disorder. Current evidence indicates that deficits in behavioral inhibition and sustained attention are central to this disorder—facts demonstrated through hundreds of scientific studies. And there is no doubt that ADHD leads to impairments in major life activities, including social relations, education, family functioning, occupational functioning, self-sufficiency, and adherence to social rules, norms, and laws. Evidence also indicates that those with ADHD are more prone to physical injury and accidental poisonings. This is why no professional medical, psychological, or scientific organization doubts the existence of ADHD as a legitimate disorder.

The central psychological deficits in those with ADHD have now been linked through numerous studies using various scientific methods to several specific brain regions (the frontal lobe, its connections to the basal ganglia, and their relationship to the central aspects of the cerebellum). Most neurological studies find that as a group those with ADHD have less brain electrical activity and show less reactivity to stimulation in one or more of these regions. And neuro-imaging studies of groups of those with ADHD also demonstrate relatively smaller areas of brain matter and less metabolic activity of this brain matter than is the case in control groups used in these studies.

These same psychological deficits in inhibition and attention have been found in numerous studies of identical and fraternal twins conducted across various countries (US, Great Britain, Norway, Australia, etc.) to be primarily inherited. The genetic contribution to these traits is routinely found to be among the highest for any psychiatric disorder (70–95% of trait variation in the population), nearly approaching the genetic contribution to human height. One gene has recently been reliably demonstrated to be associated with this disorder and the search for more is underway by more than 12 different scientific teams worldwide at this time.

Numerous studies of twins demonstrate that family environment makes no significant separate contribution to these traits. This is not to say that the home environment, parental management abilities, stressful life events, or deviant peer relationships are unimportant or have no influence on individuals having this disorder, as they certainly do. Genetic tendencies are expressed in interaction with the environment. Also, those having ADHD often have other associated disorders and problems, some of which are clearly related to their social environments. But it is to say that the underlying psychological deficits that comprise ADHD itself are not solely or primarily the result of these environmental factors.

This is why leading international scientists, such as the signers below, recognize the mounting evidence of neurological and genetic contributions to this disorder. This evidence, coupled with countless studies on the harm posed by the disorder and hundreds of studies on the effectiveness of medication, buttresses the need in many, though by no means all, cases for management of the disorder with multiple therapies. These include medication combined with educational, family, and other social accommodations. This is in striking contrast to the wholly unscientific views of some social critics in periodic media accounts that ADHD constitutes a fraud, that medicating those afflicted is questionable if not reprehensible, and that any behavior problems associated with ADHD are merely the result of problems in the home, excessive viewing of TV or playing of video games, diet, lack of love and attention, or teacher/school intolerance.

ADHD is not a benign disorder. For those it afflicts, ADHD can cause devastating problems. Follow-up studies of clinical samples suggest that sufferers are far more likely than normal people to drop out of school (32–40%), to rarely complete college (5–10%), to have few or no friends (50–70%), to underperform at work (70–80%), to engage in antisocial activities (40–50%), and to use tobacco or illicit drugs more than normal. Moreover, children growing up with ADHD are more likely to experience teen pregnancy (40%) and sexually transmitted diseases (16%), to speed excessively and have multiple car accidents, to experience depression (20–30%) and personality disorders (18–25%) as adults, and in hundreds of other ways mismanage and endanger their lives.

Yet despite these serious consequences, studies indicate that less than half of those with the disorder are receiving treatment. The media can help substantially to improve these circumstances. It can do so by portraying ADHD and the science about it as accurately and responsibly as possible while not purveying the propaganda of some social critics and fringe doctors whose political agenda would have you and the public believe there is no real disorder here. To publish stories that ADHD is a fictitious disorder or merely a conflict between today’s Huckleberry Finns and their caregivers is tantamount to declaring the earth flat, the laws of gravity debatable, and the periodic table in chemistry a fraud. ADHD should be depicted in the media as realistically and accurately as it is depicted in science—as a valid disorder having varied and substantial adverse impact on those who may suffer from it through no fault of their own or their parents and teachers.

Sincerely,
Russell A. Barkley, PhD
Professor
Departments of Psychiatry and Neurology
University of Massachusetts Medical School
55 Lake Avenue North
Worcester, MA 01655

[plus many more names, please see the link to view all who signed]

I think it would be a fair point if the author had said, the DSM criteria for ADHD might not be as comprehensive as it could be, especially in regard to diagnosing adults, and it badly needs an overhaul. But he didn't say that. He said that he believes ADHD as defined by the DSM "does not exist." That's a fallacious argument.

Scientific research has shown that people with ADHD have specific brain abnormalities in common (some of these were mentioned in the article I posted above). The fact that other disorders and conditions can present with similar or overlapping symptoms, does NOT mean that ADHD does not exist as a disorder in its own right.



The point Dr. Saul made that ADHD does not exist as understood in the public imagination might be a fair one. ADHD is a very misunderstood disorder. However, he shows sign in his article that he has the same misconceptions about ADHD that are typical of the "public imagination."



This is a fair point, I agree, and Dr. Russell Barkley has made similar criticisms of the name "ADHD." However Dr. Barkley makes it very clear that the problem is the name of the disorder, because it is misleading and trivializes the disorder. There is much more to it than "attention disorder" Problems with impulse control and disinhibition underlie the attention problems, and are far more characteristic of the disorder.

Also, hyperactivity and restlessness are not valid diagnostic criteria for adults. All people become less active as they get older, and people with ADHD become less active at the same rate as those without it. Restlessness is more often a sign of an anxiety disorder in adults. Again, the real issue is impulse control, which can manifest in many ways besides restlessness or hyperactivity.



Yes I am certain that everyone experiences some of these symptoms at some point in their life. So of course many people will read a list of symptoms and feel that is describes some aspects of their life.

However the DSM also states that the symptoms must be a persistent pattern, present since childhood, inappropriate for the age of the person, present in two or more settings of the person's life, and must interfere with the ability to function. This completely rules out those who experience the symptoms as a "normal part of the human condition."

It is totally incorrect for Dr. Saul to say that "the entire U.S. population could potentially qualify" for an ADHD diagnosis.



It's worth noting first off that people who have bipolar disorder are highly likely to have co-morbid ADHD. So it would be no wonder that they had ADHD symptoms.

Also, any of those conditions could co-exist with ADHD and potentially exacerbate, not cause, the symptoms.

He goes on to say...



Really? Anyone? Hold on. Let's read this carefully. Take a second look at the list of conditions he named as having ADHD symptoms: sleep disorders, vision and hearing problems, substance abuse, iron deficiency, allergies, bipolar disorder, major depressive disorder, OCD, learning disabilities.

Is he saying that anyone with those conditions will have a persistent pattern of ADHD symptoms since before the age of 12? Because that is what the DSM outlines as a requirement to fit the criteria. Persistent pattern. Before age 12.

This is most glaringly incorrect in reference to substance abuse, unless he wants to say that "anyone" with a substance abuse problem started abusing before the age of 12. Some of the other conditions he listed can also have an onset well beyond the age of 12.

The DSM also makes it clear that the symptoms must not be better accounted for by another mental disorder. So for instance a patient with major depression would not necessarily qualify for an ADHD diagnosis, even if the symptoms were present since childhood.

Dr. Saul uses a lot of inflammatory statements to make it sound as if "anyone" could qualify for an ADHD diagnosis, maybe even "the entire U.S. population," but what he is really demonstrating here is that he does not understand the diagnostic criteria set forth by the DSM.




Has he actually documented these cases in a scientific way to back up his claims? Or is this just anecdotal, based on his personal views, drawn from memory and his blatant misunderstanding of the DSM criteria?

Great posts, Dianthus. I appreciate you putting that work into this.

I was trying to say similar, but was not very organized or clear about it.

Thank you! I didn't really feel like dealing with it today, too tired, but I couldn't let that article stand without addressing it point by point.

I thought your posts were very clear and well said, as usual.