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Is ADHD a Disorder?

Although the ADHD (Attention Deficit Hyperactivity Disorder) diagnosis is defined in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as a disorder, making it appear scientific, this was based on arbitrary decisions.

To put the issue of DSM-IV (the current version) and ADHD in perspective, according to the earlier version, the DSM-III, homosexuality was a diagnosable mental disorder until 1974.

Similar reasoning to that justifying today’s ADHD diagnosis as a disorder, was applied to homosexuality until 34 years ago. Homosexuality can be called a sexual orientation, a lifestyle or a sin, depending on one's preference, but not a mental disorder.

ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) were separate conditions in the earlier DSM version. They are now two of the three subtypes of one condition called AD/HD. When the next version is released, in 2012, this will hopefully be revised. Obviously the DSM definitions should not be considered as absolute fact.

Often forgotten in the jumble of disorders, is the purpose for the diagnostic manual in the first place. Firstly, there was a need to categorize behavior patterns, in order that psychologists and psychiatrists could communicate easier and clearer with each other. Secondly there was a need to systematize conditions for the health insurance industry. This is the reason for giving numbers to the “disorders,” e.g. 293.84 for Anxiety Disorder. The Diagnostic and Statistical manual serves these purposes very well. However, from a purely medical and scientific standpoint, the manual tends to cause confusion, rather than help.

There are three major errors in the current ADHD debate:

  1. Three concepts are misused: norm, normal and average.
  2. There is a preconceived assumption that it is a disorder.
  3. There is a universal cause e.g. genetic, and therefore a universal solution.

Normal and Average

What is seen as excessive, but still in the “normal” range in one culture can be considered as “abnormal” in another culture. There might be a genetic cause, the ADHD gene, in many cases, but that still should fall within what is considered the normal range of the human genome. Did Leonardo da Vinci, Galileo, Isaac Newton, Einstein, The Wright Brothers, Thomas Edison, Beethoven, Mozart and Abraham Lincoln, all of whom showed signs of Attention Deficit, suffer from a “mental disorder”?

The term "normal" is used as if it were a synonym for "average" without the "consensus" scientists apparently being aware of it.

There are many people in society who are far from average, yet we do not think of them as suffering a disorder. A person with fair and sensitive skin living in Alaska does not have a problem, but moving to Florida could be problematic. Does that person develop a skin “disorder” in Florida? This is genetic, but is within what is considered the normal variations of the human genome.  This person is not average, but is still normal.

No two people are the same. An artist who is bad at maths can become successful in some artistic field, but would never consider becoming an engineer.  The mathematically challenged artist does not have a disorder problem as society does not regard a lack of maths skills as a disorder.

What makes ADHD a Disorder?

This may sound like a crazy question to a stressed out parent of a hyperactive child, but changing cultural contexts and it becomes a valid question. A study comparing Kenyan Masai tribesmen leading their traditional lifestyle, with tribesmen settled in town, puts this in perspective. The nomadic tribesmen had no ADHD problems, but some of their town dwelling cousins did.

We are after all not biologically designed to sit still at a desk for many hours in our childhood. The hyperactivity condition was first noted 150 years ago in a children’s book. A century ago it was written about scientifically as a “Morbid Defect of Moral Control.”

Something drastic happened in western society in that period. It may not be the ADHD children who have a “disorder,” but the disorder may be in our modern western lifestyle.

The DSM-IV criteria are not derived in a scientific manner. The committee of the DSM meet in a committee room and by a show of hands, vote into existence the disorder of the day, and give it a code number in the DSM. This is called opinion, not science or fact.

Yet that same committee has difficulties with the term “disorder” as they explain in the DSM-IV manual:

The problem raised by the term mental disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute. . . Mental disorders have also been defined by a variety of concepts (e.g., distress, dysfunction, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndromal pattern, etiology and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, and different situations call for different definitions.”

(Introduction page xxxi)

When we start a discussion assuming we are talking about a disorder, we are on a different track than if we assume we are discussing variations within the human race.

Where did the criteria that ADHD has to show up before the age of 7 come from? This is an irrational arbitrary criteria to make this a children's disorder. The hyperactive children are after all a problem in the classroom. Other ADHD criteria in the DSM-IV are formulated in a way to suggest that this is only for children, with words such as schoolwork, homework, play, toys and school assignments.

Young children with ADHD Inattentive Type are not so easily spotted before the age of seven and are more likely than the ADHD Hyperactive Impulsive Type to remain undiagnosed through their school years. This error is expected to be corrected in the next DSM, the DSM-V due out in spring 2012.

Is ADHD One Disorder with One Cause?

The idea that Attention Deficit is one disorder inhibits research. There is a large variation within the ADD ADHD population. There are many distinctly different medical and emotional conditions that result in hyperactive behavior, but which are not ADHD. There are over 100 causes of ADHD behavior. Much of Attention Deficit Disorder research is funded directly or indirectly by the pharmaceutical industry, and their model is accepted as standard.

A symptom is not a disorder, but can easily lead to a misdiagnosis.

In fact many disorders, considered occurring together with ADHD, or comorbid, have similar symptoms. This problem of ADHD and comorbidity can be confusing as the hyperactive or inattentive behavior can be the comorbid condition and not ADHD at all.

Science advances through open discussion, and the ADHD debate has got bogged down in the pharmaceutical industry's model for ADHD searching for one magic pill cure.

There should be special schools for ADHD children; they are special children. Society should invest more in children. This is a political decision. If there was an ADH lobby (without that last “D” for disorder) there would be funding, but politicians aren't to keen to fund “disorders”. The case with Gulf War veterans with Gulf War Syndrome illustrates this point.

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