Friday, March 08, 2024

The truth about ADHD

The Times has an article about ADHD but does not make clear that that there is no evidence that ADHD is a neurodevelopmental condition affecting the prefrontal cortex of the brain, which is what the article says is the case. Nor does it really make sense to say that ADHD is executive brain dysfunction (see previous post). These types of misunderstanding that ADHD is a brain disorder pervade public consciousness, even though they are wrong. 

The Times article quotes the consultant psychiatrist apparently behind the website Parenting Matters as saying there is no increase in actual instances of ADHD, which is misleading at least, if not wrong. He apparently thinks the real problem is just worry about ADHD. The difficulty with that explanation is that it denies that there is any overdiagnosis of ADHD. If there is no overdiagnosis why do numbers of cases continue to rise? At least the article correctly states that there is no blood test for neurodiversity.

Nor does an ADHD diagnosis necessarily mean treatment with Ritalin is required. Anyway, Ritalin does not always work (see previous post). If it ‘works’ it could just be because of the placebo effect. There is no evidence that amphetamine (Ritalin) particularly affects the brain chemical noradrenaline in those with ADHD to produce a paradoxical calming and focusing effect, rather than hyperactivity. Again, these common misunderstandings are widespread.

Last year a Panorama investigation uncovered rogue psychiatrists misdiagnosing ADHD, shining a light on the very real market for a diagnosis (see previous post). This exploitation of people occurs maybe particularly obviously online (see another previous post). Society does need to adapt to individual differences between people, but that doesn’t necessarily mean that increasing the diagnosis of ADHD and other neurodevelopmental diagnoses is the answer to understanding and managing our differences from each other (see yet another previous post).

My BMJ article described how the identifying of behaviour of children when stressed as ADHD can avoid having to deal with the difficult task of improving family and school life. For example, is ADHD an excuse for misbehaviour in schools? Looked at in this way, it is indeed likely that recourse to drug treatment discourages self responsibility and thereby exacerbates the underlying difficulties that it is supposed to remedy. As far as the diagnosis of ADHD in adults is concerned, many psychiatrists think this is an example of the over-medicalisation of everyday life (see previous post).

There needs to be a much more open debate about the societal diagnosis of ADHD. The cultural process of seeking to create panaceas for emotional and other mental health problems doesn’t always work and may create more problems than it is worth (see previous post).

No comments: