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ADHD Philosophy – The Background

ADHD (Attention Deficit Hyperactivity Disorder) is an emotional and highly controversial subject. On this subject there is a continuing dispute, where both sides of the debate have criticized the other side with emotive terms. When such a situation arises within the scientific community it is usually pointless to resort to science as the referee, since the opposing groups base their positions on different philosophical assumptions.

Both extreme sides accuse the other of being less than truthful. They use the same words, but have different meanings and connotations for these words. This article will try to bring a little clarity into the debate and help clean up the mess and confusion made by this academic pie fight.

There are many researchers in the middle ground between the extremes and are changing the paradigm of what ADHD is and developing treatments for lasting results. We do not hear much about these people through the noise of those on the extreme ends of the ADHD debates. But it is from these scientists the effective long-lasting cure for ADHD will come.

The word that causes most confusion is “disorder.” This word is considered either a disorder as in sick and disease, or that the use of “disorder” is a fraud, used as an attempt to control active children in the classroom. Other ideas, such as the “ADHD disorder” is an invention of the pharmaceutical companies to boost drug sales are also floating around. Both of the first two views are wrong, and both sides of the debate agree the ADHD behaviors are real. No wonder this confuses people on the sidelines.

Most of the confusion would be removed if there were a distinction between a set of behaviors and a disorder. The DSM-IV diagnosis for ADHD lists a series of behaviors. If there is a disorder, then the disorder is the cause, or the reason, for the behavior. The behavior itself is a symptom. If the child has an over- or underproductive thyroid, then the disorder is the thyroid gland and not a so-called “inherited neurobiological mental illness.”

Genes causing this “inherited neurobiological mental illness” do play a role in ADHD behavior, but the connection is far more complicated than researchers’ statements quoted in the media suggest. Certain genes predispose a person to ADHD, but not everyone with these sets of genes will have ADHD. On the other hand, there are people without these combinations of genes who have ADHD.

This emotionally driven fuzzy science has led to ADHD being the most over diagnosed, the most under diagnosed and the most misdiagnosed children’s condition, all at the same time. The official diagnosis is 15 to 20 years out-of-date. There have been great advances in our understanding of the brain and of what ADHD is over the last 5 to 8 years. This research has not been incorporated into the current diagnosis, which are still assessments based on subjective attitudes and not on objective tests. The DSM-IV manual (the official diagnostic tool) makes this clear:

"There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder."

(DSM-IV, page 88)

This statement is still valid today. The next DSM, the DSM-V is due for publication in 2012, and hopefully that will clarify some of today’s misunderstandings.

The idea of what ADHD is has changed over the last century. A review of ADHD history shows clearly that we who have ADHD, or have a family member or friend with this condition, need to be aware of in which direction the current ADHD research is heading. We need to move forward and not be bogged down with outdated two-decade-old science.

The use of DSM-IV

There are four logical explanations for the use of the term “disorder”:

  1. It is an historical artifact of the terminology used for a hundred years.
  2. The term is used for health insurance purposes, so that children with these behavior patterns can be legally protected during their education, receiving special help and not be discriminated against.
  3. A specific technical definition understood by consensus among professionals using the DSM-IV. This definition is based on deviance, distress and dysfunction. Unfortunately most researchers use the common dictionary definition of the word “disorder” which not only confuses them, but us outside the academics’ ivory towers.
  4. A common standard for research purposes, so that research results can be compared, nationally and internationally. DSM-IV is the research standard.

The DSM-IV committee had difficulty with the term and decided this term was a compromise:

“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)

The philosophical difficulties in the ADHD diagnosis, which the DSM-IV diagnosis does not tell us about, are covered in the article: DSM-IV ADHD misdiagnosis.

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