ADHD: Maybe–But Maybe Not
Guest post by parenting columnist and psychologist John Rosemond
A mother asks why I don’t believe in ADHD. Her son has ADHD. After administering a battery of tests, a psychologist said so. According to the mother, the psychologist also said the boy probably inherited the disorder—a biochemical imbalance—from his father, who admitted to having been bored, inattentive, and fidgety in school. ADHD must have something to do with biochemistry, she said, because her son is now taking medication and it has helped a lot. (Note: I am not able to speak directly with the psychologist in question; therefore, I am assuming that the mother has represented him accurately. Regardless, I have heard very similar stories pertaining to psychologists from lots and lots of parents.)
I asked if the psychologist had ordered a brain scan, blood test, or genetic testing. After a moment’s reflection, and with a puzzled look, she told me that he had not.
“Psychologists are not medical doctors,” I said. “They are not qualified to make statements concerning a person’s physical condition without consultation with a physician or physicians who have made the determinations in question.”
“Then why did he tell me that?” she asked.
That’s what he believes, I told her, and I do not question his sincerity. She asked what I believed, so I told her that no physiological anomaly has been reliably found in children diagnosed with ADHD. Said differently, there is no compelling evidence that ADHD is caused by faulty biology. Furthermore, the idea that brain chemistry is “out of balance” supposes that one can determine the proper state of balance. Brain chemistry is in a state of constant flux. According to experts with whom I have spoken, it varies according to mood, situation, prior history, and other factors too numerous to mention. Brain chemistry in “balance” is whimsy.
As for ADHD being genetic, that too has not been proven. Furthermore, it fascinates me that whenever I have heard a story of this sort—and I have heard hundreds—the parent who supposedly passed the gene to the child in question is almost always the father (I estimate the preponderance to be above 90 percent). Yet girls are diagnosed with ADHD, so one is prompted to ask, “If girls possess the gene, how is it that they seem to pass it on so rarely?”
The criteria that define ADHD are found in the Diagnostic and Statistical Manual.* Those criteria are subjective, which means the diagnosis rests on no objective standards. Furthermore, they are replete with such unscientific words as “usually” and “often,” as in, the child “often has problems finishing tasks.” In other words, children diagnosed with ADHD sometimes act like they have it and sometimes act like they do not have it. The only rational conclusion to draw is that they do not “have” anything at all.
It is worth noting that none of the criteria are test-based; therefore, a psychologist who administers an battery of tests under the pretense that tests are a diagnostic essential or claims to have made the diagnosis based on test results is misrepresenting the nature of the tests. If one believes a diagnosis of ADHD is appropriate, there is value to knowing the IQ of the child in question, but an IQ test is not a valid diagnostic tool.
Last but not least, the medications in question are stimulants that have the predictable effect of lengthening attention span and increasing ability to focus…in everyone. It is not true that certain people (those “with” ADHD) have one reaction to these drugs and certain other people (those “without”) have an opposite reaction. This canard is put forth to support the unproven claim that the ADHD nervous system is substantially different from the non-ADHD nervous system. As for the oft-observed fact that when highly active children take these drugs they become less active: an increase in attention span results in a decrease in activity level.
“So,” I asked the boy’s mother. “What are your thoughts now?”
She told me she was going back to the diagnosing psychologist prepared to ask some tough questions and insist upon clear answers. More parents should do the same.
(Author’s note: “Before I published this column, it was reviewed and approved by two psychologists, one of whom has published extensively on the subject of ADHD, the other of whom is skilled in the diagnosis and treatment of ADHD, and two pediatricians, one of whom specializes in treating children who exhibit ADHD symptoms.”)
|* The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatic Association.|
|Family psychologist John Rosemond answers parents’ questions on his website at www.rosemond.com.|
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