There has been an awful lot of debate lately about the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) brought on by a thought-provoking article in the New York Times (NYT) by Alan Schwartz followed by a number of interesting and challenging blog posts here at Psychology Today by Allen Frances, Marilyn Wedge, Robert Berezin and others here as well as from many other sites.
In all the rhetoric, it is important to point out that there may be more common ground, at least between most commenters, than folks might think. Whether it is the NYT article or the blog entry by Dr. Frances, there is almost always at least some fine print acknowledging that ADHD exists and that at least some people deserve the diagnosis. On the other side, even the most ardent supporters of ADHD and its treatment acknowledge that overdiagnosis can be a problem, medications can be misused, and the long-term impact of our treatments are not studied as well as they could be. Thus, we are talking about those kids (and now adults) in the middle: the ones who struggle with focus and activity to the point that it causes problems but who aren’t the kids who anybody could easily recognize as literally bouncing off walls.
This observation brings us to the essence of the problem, which is that attention span and activity level are complex dimensional constructs with no clear boundary between normal and abnormal either on the surface level or even possibly when it comes to the underlying neurobiological processes in the brain. Diagnosing someone with ADHD is a little like diagnosing someone as being too tall, except that you don’t get to use a ruler.
A lack of clear cut-offs points or specific biological “thing” to point at on an MRI scan, however, in no way makes ADHD not real. Apply that logic, and everything from most types of pain to autism to hypertension should be called into question too. Remember, we are talking about the human brain here. Yet despite the brain’s astonishing complexity, progress is being made to understand the causes—yes, causes—of ADHD. The level of evidence that genetic factors play a huge role in ADHD and that the behaviors reflect significant and measurable changes in brain structure and function is simply overwhelming. To deny this fact requires someone to simply write-off and dismiss massive amounts of research data that comes from hundreds of publicly funded scientific studies, not from the pharmaceutical companies, as the New York Time article mistakenly implies.
One convenient way to dismiss these studies is to basically view researchers as corrupt mouthpieces of the drug companies. As the Schwartz article points out, the influence of the pharmaceutical industry is huge and we as psychiatrists would be quite naïve to think that their marketing effects everyone except us. As one of the only professions that actually receives training in the mechanisms through which our beliefs and ideas can be undermined by other forces, we of all people should know better.
At the same time, those pointing fingers also need to keep in mind that there are a lot more ways to introduce a bias or conflict of interest than a speakers’ bureau. Yes, receiving money to talk about ADHD from a drug company will introduce bias, but going on the talk circuit about how evil the pharmaceutical industry has become, or writing a book about why ADHD does not exist (or the fuzzy boundary between traits and illness for that matter), or being trained to do one type of treatment but not another, creates a conflict too. Perhaps the ultimate hypocrisy are those elected officials who preach to physicians about how brainwashed they have become from drug companies and then accept massive political donations.
All of us, I think, could do with a bit less stone throwing and bit more honest introspection.
In closing, I would respectfully suggest a few considerations from folks who come from either sides of the issue.
For those who are inclined to doubt ADHD as a valid entity…
- Keep in mind that because something is subtle or difficult to measure does not make it unreal.
- Consider the possibility that at least some of the hundreds of studies of ADHD are not biased from the pharmaceutical industry.
- Know that most parents of children with significant attention problems and hyperactivity are doing a pretty good job and that you may not look so good either if the same child was in your house.
For those people, especially my fellow physicians, inclined to dismiss all ADHD critics as the lunatic fringe….
- Understand that we are not immune to the influence of money, prestige, or even the embarrassment of not being right all the time.
- Stay aware of the possibility that someone who is not entirely correct in one area might be somewhat correct in another.
- Be humble in our acknowledgement of the immense amount of really important things that we still do not understand when it comes to the brain.
I hope this small effort may serve to bridge many concerned and well-meaning people together. Nobody wants to see kids suffering needlessly. Neither does anyone want to see children being plastered with medications they don’t need. It is time to get to work.
@copyright by David Rettew, MD
Image courtesy of David Castillo Dominici and Freedigitalphotos.net
David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illnessand a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.
Follow him at @PediPsych and like PediPsych on Facebook.
Research Papers On ADHD: Documenting Information
Attention deficit hyperactivity disorder, or ADHD, is becoming a more prevalent diagnosis through out the nation. There are so many children who are put on medication to battle the implications of having ADHD that it is becoming quite the controversial topic. If you have chosen to write your research paper on ADHD, then you are in luck. There is a lot of information that is available through printed texts, and online. The tricky part is trying to keep all of your information organized. There are a couple of tips that you can follow in order to make sure that all of the research that you collect on the topic of ADHD stays in order. Here are a couple of the best tips for you to follow:
- When you are collecting information on ADHD, you are going to have to keep track of all of your various sources.
- It helps to create the professional citation for the source on the same card as your notes.
- By having the citation with the information that you collect, you will not have to back track and spend hours trying to remember exactly what page your information was from.
- Furthermore, this will help you to be able to draft the completed text when it is time to get to writing.
- As you collect information and cite the source next to the information, you are going to want to fill the information in to your outline.
- By placing the information, with citations, in to the structure of an outline, you are going to be creating the basic format of your research paper while maintaining the ability to edit the organization of the information at a later date if needed.
- You want to avoid having to edit the organization of the information when the paper is already drafted as much as possible because this will prove to be extremely challenging.
By following these simple guidelines, you will drastically cut down on the time wasted during the writing process and collection of data for your research paper. Once you have all of your research completed and your outline information organized and completely filled out, you are going to be ready to get started with your first draft. Remember that it is okay to have mistakes in your first draft because you are going to be editing, revising, and rewriting your first draft again. You will be happy that you invested the time and energy in organizing your data early on in your outline and research stages.