In 2013, pharmaceutical cartels, Kafkaesque schooling systems, pesticides in our food, bad nutrition, gut problems, and overall breakdown of the middle class family were once again blamed for the condition known to create inattention and hyperactive-impulsive behaviour in children.
Faced with a 22% increase in the diagnosis of ADHD in children in the Western World, it is natural to look for reasons.
As 2013 draws to a close, several worrying themes have cropped up in the field of ADHD. These need to be dealt with and put to rest. Among the most controversial counts the so-called “confession” by psychiatrist Leon Eisenberg, “that ADHD is not a real disease.” Contending culprits included the increased prevalence of the pervasive weed killer, glyphosate, in the food supply, changes to the educational system, sugar (again), poor nutrition, vaccine additives, and parental dysfunction.
So let’s unpack the 2013 ADHD Xmas-cracker… starting with the good doctor Eisenberg.
In an article on the rise of mental illness among children (6 February 2012), the German weekly Der Spiegel described psychiatrist Leon Eisenberg (87) as the “scientific father” of ADHD. Journalist, Jörg von Blech, claimed that Eisenberg made a ‘deathbed confession’ during an interview seven months prior to his death (in 2009), that “ADHD was a prime example of a fictitious disease.” At the time Eisenberg was neither on his deathbed (cancer was only diagnosed later) nor did he “confess” to anything.
However, reading the original German article, it seems that Eisenberg was not, in fact, denying the existence of ADHD, but raising concerns about possible over-diagnosis and the role played by environmental and social factors. The emotive language used in the article aside, this is a clear case of advocacy journalism, which brushes over contradictions in the core of the argument made.
But, let’s stick to the facts.
Dr Eisenberg, nor any other human being for that matter, “invented” ADHD. It was scientifically documented for the first time in 1775 by Melchoir Adam Weikard, a prominent German physician, in his textbook Der Philosophische Arzt. Weikard’s text contained a description of ADHD-like behaviours, possibly the first ever such description in medical literature. Weikard described many of the symptoms now associated with the inattentive dimension of ADHD in the Diagnostic and Statistical Manual of Mental Disorders.
A couple of years later, Scottish-born physician and Sir Alexander Crichton described a mental state much like the inattentive subtype of ADHD, in his book An Inquiry into the Nature and Origin of Mental Derangement. Both Weikard and Crichton wrote about the occupationally disabling features of this disorder, including attentional problems, restlessness, early onset, and how it can affect schooling.
In March 1902, the father of British paediatrics Sir George Frederick Still (1868–1941) gave a series of lectures to the Royal College of Physicians in London under the name “Goulstonian lectures” on “some abnormal psychical conditions in children,” which were published in the Lancet later the same year.
He described 43 children who had serious problems with sustained attention and self-regulation, who were often aggressive, defiant and resistant to discipline, and excessively emotional or passionate. They showed little inhibitory volition, had serious problems with sustained attention, and could not learn from the consequences of their actions, though their intellect was normal. He wrote “I would point out that a notable feature in many of these cases of moral defect without general impairment of intellect is a quite abnormal incapacity for sustained attention.
The rational and logical conclusion, then, would be that ADHD has been described in the literature for several centuries prior to Eisenberg’s contributions to the field. Its name has changed over the years, but the essential features of the condition have not.
On analysing the original interview with Eisenberg, child psychiatrist Dr Brendan Belsham wrote that “It becomes apparent that the doctor’s concern was around the alarming increase in both the diagnosis of ADHD and the use of stimulant medications. In short, the over-diagnosis of ADHD. Many childhood conditions and environmental stressors can masquerade as ADHD, and when these other factors are conveniently ignored in favour of the simpler ‘ADHD’ diagnosis, then ADHD is indeed a fabricated diagnosis in that child.”
But whatever the good doctor may have said, the facts about ADHD speak for themselves. To claim that it is not a genuine medical condition is simply nonsense. On what grounds do we claim that diabetes, asthma or hypertension are authentic medical disorders?
Firstly, these disorders all have a recognisable, discrete cluster of symptoms and signs which occur with relative consistency from case to case. In diabetes, for example, excessive thirst and passing lots of urine are characteristic symptoms. Similarly, the symptoms of distractibility, short concentration span, procrastination, absentmindedness and poor impulse control are hallmark features of ADHD.
Secondly, the symptoms of medical conditions cause impairment to the individual concerned. In asthma, shortness of breath can affect exercise tolerance and sleep quality, and can even be life-threatening in severe cases. In ADHD, academic underachievement, social difficulties and low self-esteem are typical consequences.
Thirdly, medical disorders have biological underpinnings which can be consistently observed from case to case. In hypertension we find raised blood pressure readings, and under the microscope there are characteristic changes in blood vessels and other organs. In ADHD, there are specific genes which have been implicated in the transmission of the disorder from parent to child. Brain changes have also been reliably demonstrated. Not only are brain volumes smaller in those with the condition, but there seems to be a direct correlation between the number of ADHD symptoms and the thinness of the brain’s cortex (the outer layer of brain cells).
If you throw out ADHD, then you must throw out asthma, hypertension, diabetes and a slew of other accepted medical conditions…which is fine if you want to live on that planet. But for everyone else, let’s concentrate our energies on something really worth debating… How about the over-diagnosis of ADHD?
Yes, it is true that some 20% of children are incorrectly diagnosed with ADHD; conversely researchers believe that ADHD is severely under-diagnosed in some locations, while many children and adults with ADHD are wrongly treated for other conditions, including depression, anxiety and bi-polar disorder.
Should we analyse psycho-social conditions and other clinical conditions before diagnosing ADHD? Absolutely. It would be irresponsible not to do so. However, it is equally irresponsible and downright dangerous to ignore the existence of this serious and debilitating condition.
Gut feel and nutrition
Should we analyse what we feed our children and should we be concerned about pesticides? Yes. Healthy, toxin-free food for all, not just children with ADHD, is of vital importance for general and mental health. But would a gluten-free, probiotic, organic, iron-enriched, preservative, and colorant-free diet, prevent ADHD? No. It did not do so in the eighteenth century and it will not do so now.
Should we re-examine middle-class parenting and an overcrowded, stress-inducing schooling system? Yes. Should we improve our teachers’ understanding and handling of children with ADHD? Without a doubt. But will the perfect parent and the perfect school prevent ADHD? Absolutely not.
That is why researchers are currently focussing on gene research and the development of an electronic diagnostic tool to help prevent incorrect diagnosis.
Lastly, myths, deliberate “alternative” advocacy, disinformation, and vitamins do nothing to help families and children with ADHD that have to deal with the disorder 24/7.
As my grandmother always said, “Half-truths are evil. And if you don’t know enough about something – rather hold your tongue.”