The Innovative Learner

Effective teaching and learning.

ADHD: Not Just Biology or Environment

ADHD is a biopsychosocial issue

Last week there was a brief flaring of the public furore that surrounds ADHD from time to time. Researchers at Cardiff University were reported by BBC on line (and many other news outlets) to have found that "ADHD 'has a genetic link'" ( http://www.bbc.co.uk/news/health-11437079.). My first thought on seeing this was to be severely underwhelmed. There is longstanding evidence of likely genetic variations being associated with ADHD. For an early review see the Rosemary Tannock's 1998 paper (ADHD: advances in cognitive, neurobiological and genetic research, Journal of Child Psychology and Psaychiatry, 39, 1, 65-99) which highlights a number of 'candidate genes' on the basis of compelling evidence from twin and family studies which show that ADHD is highly heritable.

It seems that the Cardiff researchers can take the credit for establishing a specific link that was not known before, but this is hardly earth shattering in the worlds of people who work with and study ADHD. However, some of the claims attributed to at least one of the autghors of the study are highly contentious. For example:
"Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children".

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And then:

"There's a lot of public misunderstanding about ADHD. Some people say it's not a real disorder, or that it's the result of bad parenting.

"Finding this direct link should address the issue of stigma."

It is alarming that a senior medical researcher could make such a fundamental error in attributing complex human behaviour, such as that associated with ADHD, to a genetic cause only. It is even more bizarre that the same researcher should go on to suggest that the identification of such a link will help free individuals with ADHD from becoming stigmatized. If things were as simple as that we would have the recipe for curing the world of racial and sexual discrimination - we just have to explain to every one that gender and skin colour are genetically determined. Does anybody really think that that would work?

The sad thing is that this massive and inappropriate exaggeration of the findings from this study detract attention from its true value. It is important that we understand the genetic pathways associated with ADHD, and this study contributes to this understanding. But this contribution is over-shadowed by the inference that genetic factors hold primacy in the range of biological, psychological and social factors that all contribute to the development of the diverse ways in which attentional and activity disorders are manifested. Such misrepresentation opens the flood gates to those at the opposite extreme who refuse to tolerate any discussion of biological influences on behaviour as reductive and deterministic, and who hysterically invoke the disgraceful history of eugenics in support of their position. In this camp are also those who claim that ADHD is an invention of drug companies whose sole motive is profit th is gained through the mass subjugation of justifiably angry and defiant children.

Sadly for extremists at both ends of the spectrum the informed position is both less dramatic and more complex. ADHD is best understood as a biopsychosocial phenomenon. One of the implications of this is that some people are at greater risk than others of developing ADHD because of their genetic inheritance. This does not mean that all people who have ADHD have the same genetic feature. It is highly likely that there are various, different genetic influences. Neither does it nmean that all cases of ADHD have a genetic basis. It has been known for a long time that the cognitive deficits associated with ADHD can be associated with pre- and post natal influences on brain develoment. Furthermore, it by no measn certain that the biolgical and/or cognitive characteristics associated with ADHD will always result in ADHD. The term disorder refers to a state of maladjustment which, in the case of behaviour is necessarily socially defined. For example, it is has been convincingly argued that the very real cognitive features of ADHD are rendered particulalrly dysfunctional by certain ubiquitous features of schools. The construct of ADHD helps us to understabnd why it is that a minority of young people find these features intolerable whilst the majority manage to cope with them. This is in spit eof the fact that arbitrary restrictions ofn physical movement, blind compliance with petty rules and the suppression fo self expression (which still feature in many schools) are antitheticvval to effective educational engagement.

This is an important argument, because it reminds us that the identification of disorders is useful because it helps to direct us towards the causes and, therefore, the solutions to problems that have a debilitating effect on the individuals who suffer from them. By understanding ADHD as a biopsychosocial problem we can learn something about the cognitive mechanisms that lie behind the difficulties that people with ADHD experience and present. This helps us (particularly parents and teachers) to make decisons about how we can best help the individula with ADHD by adjusting our behaviour towards him or her, and making changes to the environment they experience. Sometimes it is deamed appropriate to use medication to assist with this process, but medication can never seen be a sufficent treatment in itself.

It would seem that ADHD is often, in part at least a biolgical phenomenon, but even where this the case it is always much more than just a biological issue. Those who refuse to recognise this (whether they be bar-room bores or research scientists), far from being part of the solution, are part of the problem that is ADHD.

 

Paul Cooper is a Chartered Psychologist and Professor of Education at University of Leicester.

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