Recently, my comments on Twitter and popular podcasts sparked controversy and caused quite a stir. So let me repeat it again…
“THERE IS NO SUCH THING AS ADHD!”
Ok… now that I have your attention (no pun intended) please let me explain.
Attention Deficit Hyperactivity Disorder (ADHD) is NOT a discrete medical illness. In medicine, diagnoses are part of a system of classification based on explanation. What we are referring to as ‘diagnoses’ in psychiatry are descriptive classifications with no explanatory powers and therefore, strictly speaking, not a diagnosis.
You won’t receive a blood test, MRI, or a throat swab. I could write an entire article on how people have been mislead about biological origins of ADHD based on bold claims from junk science.
The search for a defining abnormality in ADHD remains elusive, leaving us without any biological markers or brain scans to aid in diagnosis. The absence of evidence regarding dopamine levels challenges the prevailing chemical imbalance theory, which gained traction mostly due to aggressive marketing by manufacturers of drugs that aim to increase these brain chemicals.
ADHD is a Modern Social Construction
Instead, ADHD is a social construct that attempts to capture a range of behavioral traits and challenges related to attention and hyperactivity. It’s a constellation of “symptoms” (I use this term loosely) that first appeared in the 3rd edition of the Diagnostic Statistical Manual of Mental Disorders (DSM) in 1980.
ADHD is not a condition someone “has”, like the flu or strep throat. It was initially designed as a short hand descriptor to assist with the classification of behaviors that may require clinical attention.
In the not-too-distant past, the diagnosis of ADHD was handled with utmost caution and meticulous deliberation. Psychiatric labels were bestowed sparingly, reserved only for those who exhibited the most severe impairments. The weight of such a designation was not taken lightly, as professionals recognized the profound impact it could have on an individual's life.
During this era, the prevailing mindset acknowledged that human behavior exists on a vast spectrum, with natural variations and differences in attention and focus. The threshold for diagnosing ADHD was set high, ensuring that only those who truly experienced significant challenges in functioning were classified as such. This approach aimed to avoid overdiagnosis and the potential consequences of unnecessarily pathologizing ordinary human traits. We have deviated far off this course.
Traditionally, this diagnosis was controversial and was seldom applied due to its significant implications. It was primarily given to young boys exhibiting severe behavioral problems. However, it raised significant ethical questions that are just not being asked today: Are we suggesting that these boys have a disorder with clear biological origins that hinder their ability to learn self-regulation, complete tasks, manage impulses, and focus on relevant activities? Are we implying that this 'disorder' will indefinitely limit their potential, is similar to a lifelong condition such as diabetes, and they must find ways to manage it? What is the trajectory of children diagnosed with ADHD? Could the label be misunderstood and prevent the identification of other legitimate problems influencing focus, impulsivity or other behavioral problems.
From a Provisional Classification To a Disease
ADHD was originally regarded as a provisional diagnosis, indicating efforts were made to explore legitimate factors contributing to the behavioral problems. This is prior to the pharmaceutical industry obtaining complete control over our medical community.
Potential considerations included a neglectful home environment, parenting concerns, trauma, medical illnesses, nutrient deficiencies, learning disabilities, sedentary lifestyle requiring increased exercise, as well as the child's responsiveness to behavioral interventions, which may indicate the need for structure and discipline.
When someone has a fever, we focus on investigating the underlying pathology that is causing the symptoms rather than diagnosing them with a 'Fever Disorder' and prescribing daily “fever reducing medication”. ADHD has become just that.
Over time, a notable shift occurred in the landscape of psychiatric diagnosis. Influenced by various factors, most notably, increased financial incentives and evolving societal expectations, the criteria for diagnosing ADHD underwent a transformation, becoming broader in scope. As a result, the prevalence of this label skyrocketed.
Influential figures, such as Russell Barkley, Ph.D., and Joseph Beiderman, MD, were generously compensated by the pharmaceutical industry to assert ADHD as a biological disease, suggesting ADHD was under-diagnosed and linking this “disease” to a range of behavioral, mental health, and substance abuse issues.
What was once a cautious and thoughtful assessment became a commonplace occurrence, raising concerns about the genuine nature of these diagnoses and the potential consequences of overdiagnosing and overtreating ADHD.
DSM Diagnoses Are Not Medical Diseases
The psychiatric classification system is entangled in a profound predicament: diagnosing disorders based on symptoms that blur the boundary between normal human reactions and true pathology. This web of overlapping diagnoses challenges the very essence of psychiatric clarity. Are we truly understanding the depths of human experiences, or are we merely trapping ourselves in a labyrinth of uncertainty?
The absence of explanatory power in most psychiatric diagnoses is a profound problem. Without understanding the underlying factors driving symptoms, we are left with ineffective treatments (drugs) that fail to address the true causes.
Imagine concentration and hyperactivity stemming from nutrient deficiencies, yet the treatment remains oblivious to this nutritional aspect. Similarly, a neglectful home environment demands critical parent interventions for a developing child, but without recognizing this crucial factor, progress is hindered. A worrier is labeled as ADHD due to their “inattention”. Slapping on the label of ADHD often prevents the thoughtful investigation into legitimate problems when ADHD is assumed to be its own discrete disorder.
Startling revelations from research conducted in multiple countries expose a concerning trend: the youngest children in a class year bear a significantly heightened risk of being diagnosed with ADHD and prescribed medication compared to their older peers. Shockingly, this means that young kids might find themselves on amphetamines or other psychostimulants solely due to their relative immaturity compared to older classmates.
Everyone is ADHD (not really)
Neuroplasticity refers to the brain's ability to change and reorganize its structure, function, and connections in response to experiences, learning, and environmental stimuli. It is the brain's remarkable capacity to adapt and modify its neural pathways, synapses, and networks in order to optimize its performance and accommodate new information. Neuroplasticity plays a crucial role in learning, memory formation, recovery from brain injuries, and the development of new skills. It allows the brain to reshape itself throughout life, constantly adapting and rewiring in response to various stimuli and experiences.
In the modern technological age, our focus and attention are under constant siege. The proliferation of digital devices, social media platforms, and endless streams of information has created a landscape of perpetual distraction.
The allure of instant notifications, endless scrolling, and the constant need for connectivity has reshaped the way we engage with the world around us. However, this is not indicative of a medical disorder but rather a reflection of our brain's natural design.
The incessant bombardment of stimuli and the addictive allure of technology have reshaped our cognitive patterns, resulting in reduced attentional capacity for non-stimulating activities.
Parenting in the Technological Age
We find ourselves venturing into uncharted territory as we navigate the task of raising young children in an era defined by technology. Their developing brains are intricately adapting to the constant stimuli and digital landscape surrounding them, presenting both opportunities and challenges.
What complicates matters further is the vast array of parenting approaches when it comes to the use of technology. Some parents advocate for strict limitations, aiming to shield their children from the potential risks and negative influences, while others embrace technology as an essential part of their child's learning and socialization. Some parents are using I-Pads and phones to pacify young kids when they are misbehaving. How will these kids present in a structured school environment when teachers demand attention?
Is ADHD a legitimate disorder, or are we witnessing the natural spectrum of human behavior with its inherent variations in attention and focus? The complexity of focus, attention, and behavior intertwines with the crucial role of the environment in shaping these traits.
Diversity
What may be labeled as "disordered" in one setting could be a valuable skill or talent in another. It challenges us to reconsider our understanding of ADHD and embrace the idea that human diversity encompasses a wide range of abilities and strengths, at least partially shaped by environment.
It is important to acknowledge that not all children are inherently designed to excel within the traditional American classrooms, the environment where the ADHD epidemic has evolved and flourished.The complexity of our world necessitates a diverse range of skills and talents.
Unfortunately, our educational system has been slow to adapt and cater to the needs of active, hands-on learners who thrive through movement, connection with nature, and problem-solving experiences. It is crucial to recognize that struggling to sustain attention in one environment does not imply compromised attention in all situations. This is where the problem lies with the conceptualization of ADHD.
The Label Has Consequences
The dangers of Adderall and other psychostimulants on developing brains and child development are deeply concerning. These medications, while prescribed to treat conditions like ADHD, can have profound and lasting effects on the developing brain. The use of these stimulant drugs can disrupt normal brain development processes, potentially altering neural pathways and affecting critical cognitive functions. Long-term use or misuse of these substances may lead to dependency, cardiovascular problems, mood disturbances, sleep disruption, and hindered growth.
Stimulant medications are gateway drugs into the mental health system. The wide range of human reactions to prescription drugs is a testament to the remarkable diversity of our biological makeup. Each individual's response to medication can vary significantly, influenced by factors such as genetics, metabolism, underlying health conditions, and personal sensitivities. While some individuals may experience the intended therapeutic effects and benefit from the prescribed medication, in the short term, others may encounter adverse reactions or lack the expected response.
I share deep concerns regarding the role of stimulant drugs as a potential gateway into the mental health system. All too frequently, common reactions to these drugs are misconstrued as symptoms of a newly diagnosed "mental illness." This misinterpretation can set off a cycle of escalating treatment, where the body strives for homeostasis, leading to increased dosages and the introduction of additional drugs to achieve the desired response. This reliance on escalating interventions raises questions about the appropriateness of the initial diagnosis and the potential long-term consequences of such practices.
A Dangerous Trend
In the age of social media, it is not uncommon to witness individuals leveraging an ADHD diagnosis as a foundation for building their personal brand online. By embracing this label, they tap into the widespread fascination with neurodiversity and capture the attention of a receptive audience.
Through creative storytelling and relatable content, they curate a digital persona that portrays the struggles and triumphs of living with “ADHD”. This strategic approach helps them attract followers, gain influence, and potentially monetize their online presence.
Influencers are employing a concerning tactic by leveraging an ADHD diagnosis to attain disability status and position themselves as part of an oppressed group. In doing so, they are erroneously communicating ADHD as a far more debilitating condition than it often is in reality. By exaggerating the challenges associated with ADHD, these influencers gain attention, sympathy, and a sense of belonging within a community that thrives on narratives of struggle.
By perpetuating an exaggerated image of ADHD, influencers risk diluting the understanding of the actual human diversity and of those who may truly require some assistance. This raises concerns about the potential exploitation of disability status and the misrepresentation of ADHD as a monolithic and uniformly disabling condition. Some have gone as far as to portray ADHD as a "debilitating" condition that impairs all aspects of their life. The misrepresentation of ADHD can be harmful, as it leads vulnerable teenagers to attribute typical struggles with boredom, focus, or academic problems as if it’s a medical condition.
The dangers of smartphone dependence and excessive social media use among teenagers have been extensively studied and documented. These habits can have detrimental effects on various aspects of their lives, particularly their academic success. Achieving academic excellence requires developing skills such as structure, discipline, and sustained focus on non-stimulating tasks. Yes, you can improve your ability to sustain focus, it’s a skill to be developed.
In certain circles, ADHD has transformed into more than just a medical condition; it has become a personal identity and a way for individuals to present themselves to the world. For some, ADHD has become a defining characteristic that shapes their sense of self and influences how they perceive their place in society. This identification with ADHD can stem from various factors, including the desire for validation, a need for understanding and support, or the influence of social narratives surrounding ADHD.
Restoring Sanity
The diagnosis of ADHD has unfortunately lost much of its value in today's society. While the original intent may have been to shed light on a small minority of children who faced challenges in adapting to the classroom environment, its implications have become distorted over time. The role of the pharmaceutical industry in shaping this narrative is clear. More diagnoses of ADHD, more customers.
ADHD has now become an umbrella term that is often misrepresented and misinterpreted, leading individuals to believe that they have a medical condition that hinders their ability to succeed in a world that demands skills that may not align with their natural makeup.
This misrepresentation of ADHD is particularly dangerous as it drives young people to view their own experiences as inherently disordered. Instead of recognizing their unique strengths and finding alternative paths to success, they may internalize the belief that they are fundamentally flawed. To compound the issue, the prevailing narrative often promotes the use of prescription stimulant drugs as the primary solution, despite the range of adverse consequences and potential for addiction associated with these medications.
We must fight back against these dangerous ideas.
No more bystanders.
P.S. A heartfelt thank you to all my subscribers! While I offer all my articles for free, your support through donations would be greatly appreciated. Your generosity helps me continue delivering valuable content. Thank you for being a part of this incredible community! If you are interested in more thought provoking conversations please subscribe and download the Radically Genuine Podcast with Dr. Roger McFillin.
One of the oddest parts of all this (everyone has ADHD) to me is when leading pro-ADHD voices put so much effort into destigmatizing it, in books like Driven to Distraction, by highlighting all the famous historical figures who likely had ADHD. The list usually includes Mozart, Edison, Churchill, and other luminaries. The activists’ point is “hey, you’re not weird to have ADHD, lots of people had it, including amazing people like Edison,” etc etc. My reaction has always been one of utter disbelief: “Do you not realize what you’re saying? That you would have told Edison’s mom to drug him out of his mind?? We’d all still be sitting in the dark!” Even accepting their list of famous people at face value, it’s one of the world’s best arguments *against* stimulant use, not for it…
You are to be commended Roger in presenting your views with such clarity. I would agree with you on much in this article, particularly on "Medicalisation for profit" and on the need to understand human diversification. What then ae your views, please, on the realities behind diagnoses om PTSD and Autism ? Best wishes, Maurice.