ADHD Is Not a Disorder
ADHD Is Not a Disorder
by Chuck Ruby, Ph.D.
“ADHD” is not a condition or disorder. It is a descriptive label given to people who are not interested enough in a particular topic that an authority figure says they should be. It is a moral judgement about what one ought to be interested in, how much, and when should that person be interested in it.
Yet, a recent article in the Washington Post entitled "ADHD in kids: What many parents and teachers don’t understand but need to know", like many others, continues to claim it is a “brain-based medical disorder”, a “neuro-behavioral disorder”, and “a type of mind, genetically transmitted”. These phrases are misleading and give the impression that ADHD is truly a neurological ailment, when in fact, there is no evidence of such an ailment. There is no research that shows the brains of people labeled ADHD are defective or in any other way pathological. Any “deficits” asserted by researchers are actually differences, not deficits. One would expect a child who has a history of paying attention very well to have a different looking brain than one who doesn’t. That’s what the brain does. It changes in structure and activity depending on how it is used over time. Those changes are not deficits. Further, the great majority of research fails to address the effect that the ADHD treatment of choice, stimulant drugs, have on the brain, making it difficult to determine what brain differences are true deficits created by long-term use of stimulant drugs.
It has been increasingly difficult over the years for psychiatry to explain why a child diagnosed with ADHD can sit for hours in rapt attention to a video game, when he is supposed to have a neurological deficit of attention. Instead of concluding from this that ADHD is actually a matter of the child’s willingness (not ability) to pay attention, this article demonstrates the typical response to that quandary. Linguistic gymnastics are used to re-describe ADHD, not as a neurological deficit per se, but as “wandering attention”, “inconsistency of attention”, or some other phrase that suggests a deficit of brain functioning, but without saying so directly. The concept of “self-regulation” has also been invoked as another linguistic fence-sitting tactic. Self-regulation merely means a person’s desire to bring behavior in line with societal expectations. But again, the idea is that there is a deficit of self-regulation, a contention which the evidence doesn’t support. So while no neurological deficit can be found, the believers in ADHD continue to suggest there is a deficit of attentional, disinhibition, or self-regulation capacity.
The announcement of the Mayo Clinic’s study, which found that girls diagnosed with ADHD have a “two-fold risk” of becoming obese, is also grossly misleading. Not only does it gives the impression that ADHD causes obesity, it also implies ADHD is a real and alarming disorder. In truth, the study simply shows a correlation between the behaviors that get one diagnosed with ADHD and weight control problems. This is something my grandmother would have known. The ADHD behaviors include a general failure to abide by societal expectations regarding self-regulation. It is logical to then assume those people who do not self-regulate according to societal expectations are likely to have similar failures of self-regulation in other areas of life, including eating behaviors. I cringe at the possibility of another study that compares ADHD kids who are prescribed stimulant drugs to “treat” the ADHD with those who are not. It would not be surprising in such a study to see that those not treated with stimulants were more obese than those treated. The conclusion? Treating ADHD reduces obesity. In fact, such a result would be what is expected for someone taking stimulant drugs - they lower appetite and induce weight loss.
The irony in this article is that although it markets ADHD as a real brain disorder, it inadvertently pulls back the psychiatric curtain a little so we can see what is really going on behind it. That is, it points out that ADHD is a label given to people who are not willing to fall in line with the status quo and who are interested elsewhere. Their creativity, vision, and inquisitiveness can lead to wonderful ideas and inventions. Perhaps there is a cost to such independence of thought, but that independence of thought is not a sign of brain deficit.
Now as a 17 year old who was professionally diagnosed with ADHD, I came to see this article that caught my interest now I am not here to diss your work and I know I am late to the band wagon but I truly felt the need to answer one of your questions. By giving my own personal experience. As you stated "It has been increasingly difficult over the years for psychiatry to explain why a child diagnosed with ADHD can sit for hours in rapt attention to a video game, when he is supposed to have a neurological deficit of attention. Instead of concluding from this that ADHD is actually a matter of the child’s willingness (not ability) to pay attention, this article demonstrates the typical response to that quandary." I have had multiple problems with this and mostly with my parents were I could watch an entire season (if it was short enough) within the day until my parents would tell me turn off the tv or come down for dinner. In fact I had a huge phase with this one show Transformers, I was practically obsessed to the point where I would watch as many episodes as I could and would stay up late into the night basically to the point where I would fall asleep on the couch a lot. Now I could watch Transformers for hours in end, but if you had made me read an short article that had not caught my interest than it either A) take me forever to read it. B) I would skim it. C) If could not read it at all And I do believe you make a good point on willingness to pay attention. But I think there's more to it. I'm gonna get little personal. I love my parents dearly and I aim to do well because they are reason I strive to good in school. The reason I try to keep good grades so I can get into a good college and have a job so when the time comes for me to take care of them, I can as to payback for all the years they cared for me. Now if here's were my point comes from willingness to pay attention so please bear with me. There are days where even in my favorite classes where I ask the most questions and pay the best of attention, I can't focus at all because I will keep zoning out or rereading the same line over and over again and trying to force myself to get back on track and these are classes that currently interested in learning about, classes I swant to know about as much as possible. But sometimes those days can turn into a week. I know opinions can change and I hope didn't come off as rude as that was never my intention. I hope this sheds some sort of light. I apologize for any spelling/punctuation errors.
Dr. Ruby, Thank you for your response. ADHD kids are the !!% of children ages 4-17 who have been diagnosed as having ADHD based on the DSM criteria for the disorder, according to the CDC in their 2011 report. The CDC estimates that this number increases by 3% each year. If this is true, the current rate for ADHD in the 4-17 category would be close to 25%. The non-ADHD kids are the 75% of the kids who do not have ADHD. You are correct in that the brain does not "consider" things people do ; the mind does. The mind and brain are two separate entities (dualism). All behavior is initiated in the unconscious mind and resides in the limbic system. I like to think of the brain as a computer and the mind as the operating system. Please note that there are only two things that separates ADHD kids from non-ADHD kids and one of those things is their BEHAVIOR.
Chet: I don't conceptualize the problem called ADHD as a matter of normality or abnormality. The label is given to kids (usually) who chose not to sit still, pay attention, and inhibit urges that conflict with social demands. Furthermore, the delineation between "the ADHD kids" and "the non-ADHD kids" is impossible to define. It is a judgment call and more a reflection of the person doing the judging than the kid. In essence, ADHD is a manifestation of human diversity and human choice. Hope I responded to your comment. PS. the brain does not "consider" things, people do.
Bill, A correction to my last post.....It was Dr. Charles Bradley not Barkley that made the Benzedrine discovery in 1937. Here is the Abstract: In 1937, psychiatrist Charles Bradley administered Benzedrine sulfate, an amphetamine, to “problem” children at the Emma Pendleton Bradley Home in Providence, Rhode Island, in an attempt to alleviate headaches; however, Bradley noticed an unexpected effect upon the behavior of the children: improved school performance, social interactions, and emotional responses. Drawing on Bradley’s published articles on his experiments, this paper explores the historical context of his experiments and the effect this background had on the emerging field of child psychiatry. Bradley’s studies went largely ignored in the field of child psychiatry for nearly 25 years. However, they proved to be an important precursor to studies of amphetamines like Ritalin and their use in conditions such as attention deficit hyperactivity disorder. Bradley’s Benzedrine trials were thus highly influential in shaping modern objective understandings of children with behavior disorders.
Bill, As a Youth Counselor, working with kids in a Psychiatric Hospital setting and with kids adjudicated into a State Incarceration Facility for Juveniles, I have always thought of myself as trying to get kids 'out of trouble'. When I see these kids , they have already gotten themselves into trouble. Bill, in 1937, Dr. Charles Barkley accidentally discovered that Benzedrine (a stimulant) had a beneficial effect on children presenting with what we now call ADHD. Unfortunately the Pharmaceutical Companies saw an opportunity to promote and profit from an ever increasing demand for stimulant medication. The temporary benefits received from stimulant medication are far outweighed by the harms they cause, and they do nothing for the underlying cause of ADHD.
Dr. Ruby, Sorry for not getting back to this site sooner. I used the term "anomaly", based on the following definition: 1. Deviation or departure from the normal or common order, form, or rule. ADHD behaviors do fall outside of social expectations. This is why Kids presenting ADHD behavior, often find themselves isolated from the non-ADHD kids. Perhaps I should have used the term ' unacceptable behavior' instead of 'bad behavior'. As I mentioned in my original post, ADHD is not a disease or disorder. ADHD is a ordered response, to overcome, what our brain considers, a more serious problem. Let me know if you are interested in my ADHD Hypothesis
Bill, looks like we agree about the bogus-ness of ADHD. Not sure about the exact effects of stimulants on kids vs. adults - I always assumed they work the same as stimulants are central nervous system "uppers" and increase brain activity, not sedate. But you may be referring to the so-called paradoxical effect of stimulant drugs on kids labeled "ADHD". It really isn't paradoxical; rather, the stimulant action on the brain artificially enhances the child's attention capacity (somewhat like how steroids and growth hormones can artificially enhance athletic capacity). What the observer sees, though, is the child settling down and attending, making it look like they are sedated.
Sorry, Chuck Ruby! I shoulda' paid more attention! It was only after I'd posted my comment, that I realized you're the AUTHOR of the above article. Thanks! I'd be glad to hear your views on what I've said here. ~Bill
I'd like to know why "Chet Bush" insists on always getting kids into trouble! And, one salient point is omitted. So-called "ADHD"/"ADD" is a bogus "diagnosis" that was fabricated as an excuse to sell methamphetamine-like drugs to school kids. It has NO other purpose. And, yes, the drugs DO have a sedative effect on kids, which is the opposite effect on adults. (c)2016, Tom Clancy, Jr., *NON-fiction
Chet - Thank you. I would not refer to these behaviors as an "anomaly", as this implies something abnormal. Calling them "BAD" behaviors shows they fall outside of social expectations. But the behavior is not necessarily the problem, the social expectations might be. One thing is clear: a diseased brain is not causing the problem/behavior.
I enjoyed your article Dr. Ruby. I agree that ADHD is not a disease or disorder nor is it caused by any abnormal brain physiology . ADHD is a behavioral Anomaly, pure and simple. The underpinnings of this, ALWAYS BAD BEHAVIOR, however, are anything but pure and simple . Since all behavior is unconscious behavior, our kids do not know why they do the behaviors that always get them in trouble. There is,however, a Behavioral, Neurological and Biological basis for this BAD BEHAVIOR.