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ADHD and Scientific Philosophy

ADHD and Scientific Advancement

The leading scientific philosophers of the 20th Century, Thomas Kuhn and Karl Popper, have described the processes by which science advances.

Kuhn said that science advances through scientific revolutions, where a new paradigm, or model, replaces the accepted one at the time. A few individuals, usually independently, see the problems or paradoxes within their current scientific explanations.

The individuals who are able to make this transition have two characteristics in common. Firstly they are focused on solving the paradoxes and secondly they are young researchers seeing the problems with fresh eyes. They have not yet made a career within the old paradigm. They have less to lose, including egos.

Their seniors learned the old paradigms and have made their careers within these paradigms. To change one’s paradigm when one is a decade or more into one’s career is difficult to do. Many other researchers are working on hypotheses and theories within the then current paradigm and resist any change.

It usually takes several generations to change paradigms. When Copernicus received the first copy of his published treatise on the Earth orbiting the Sun, it was at his deathbed, as he did not relish the thought of the troubles to come. It took a century to turn science from thinking the Sun orbits the Earth in 24 hours to the Earth orbiting the Sun in a year.

The story of the Church resisting Galileo’s ideas is not completely true. It was the scientists of his day who used the Church to silence Galileo and his uncomfortable paradigm shift. The Church was the judiciary in those days and is similar to arguing in a secular court today about Creation vs. Evolution.

Kuhn called the transition to a new paradigm “revolutionary science” and called working within a paradigm for “normal science.” When we sit in a classroom or lecture hall, with a textbook in front of us, it is not facts we are studying, but the current theories and hypotheses of normal science.

It is in this context we should think about the so-called facts of Attention Deficit Hyperactivity Disorder. There are a few problems or paradoxes with the present paradigm, based on the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision):

• Attention Deficit kids have an incredible attention focus when not bored. Maybe it should be called Boredom Intolerance Disorder.
• The diagnosis is based on subjective assessments of behaviour; there is no objective clinical test of anything biological causing ADHD. Many different disorders have similar symptoms, like flu and hay fever, and it is the same wih the attention deficit and hyperactivity issues. A DSM-IV diagnosis is a guide, not the definition of a disease and since there are no objective criteria (as there is with flu and hay fever) other serious disorders blended in with ADHD confusing the diagnosis.
• It is estimated that 3% to 8% of the population have ADHD. This is a wide margin. Such a wide margin suggests there is something fundamentally wrong with diagnosing the disorder. Maybe it is not a disorder, but a normal part of the population, as are those who are not good at maths or art are still considered normal.
• Too much is made of brain imaging without understanding what we see. If the ADHD person’s brain does not light up where the average person’s brain has synapses flashing like the 4th of July or Guy Fawkes Night, then this could means the brain is doing the work using different channels. For some tasks this might be an inefficient use of the brain, but for other tasks, these alternative thinking pathways are turbo charging the brain. In other words, the ADHD person has talents. These talents are suppressed by forcing the talented child to become “normal.”
• No matter how much clinical researchers try to make lying in a tube in a big machine natural (while the brain imaging is done) it still does not test the child on the child's terms. Science still cannot do a battery of brain imaging experiments to test the child while s/he is playing basketball, football or climbing a tree. This may be where the ADHD child's brain is functioning at best. Where are the ADHD brain imaging studies testing the ADHD person while s/he is hyperfocussed. Hyperfocussing is the other side of the genuine ADHD coin.

Scientists use the DSM-IV as their diagnostic tool of choice. This is in order that they have a unified standard for comparing research studies. In that context it serves a purpose.

As a diagnostic tool for assessing patients in doctors’ consulting rooms and in clinics, it leaves a lot to be desired. Using the DSM-IV there is a classic case of “normal science.” Scientists outside the consensus mainstream have conducted the “revolutionary science.” But there are now signs that a paradigm shift is developing among scientists stuck in the consensus quagmire. Sooner or later reality has to be faced.

The direction of ADHD research is now moving is from the narrow vision of studying behavioural symptoms, to studying the cause of these symptoms. It will be interesting to read what the next version of the DSM, the DSM-V, has to say about ADHD. We who are personally affected by ADHD, whether we have it ourselves, our children are hyperactive or inattentive, or if we have family or friends with ADHD, it is important to be aware of the direction ADHD research is heading.

Having to wait until 2012, when the next DSM will be published can be OK in some clinical scientific research, but we who live with ADD or ADHD daily need to know where science is standing today.

We should not rely on outdated diagnostic criteria. The DSM-IV was published in 1994. It was based on consensus opinion, which means the research underlying this version was accepted some years earlier. This dates the DSM-IV research as 17 to 20 years out of date for us today. The developments in brain research during the last 5 to 8 years were then unknown. The DSM-IV is still a good guide, but not infallible scientific truth.

The cure for ADHD is individual, and depends on what causes the attention deficit, or the hyperactivity. The latest trend is giving us keys to unlocking the ADHD potential, while managing the negative sides of our ADHD personalities.

We must npw wait for the DSM-5 (in 2012) to see if it will radically change doctors' attitudes and knowledge of ADHD.

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