According to Dr. Berezin, ADHD can’t be real because kids in France aren’t diagnosed with it.
Where do you start with something like this? Maybe, at first, with a compliment. Dr. Berezin certainly brings up some valid concerns regarding the perennial debate over ADHD and its treatment (see my previous post on the subject). The increase in the rate at which this diagnosis is being applied is quite startling and research has shown both that there are many children who don’t meet criteria who are being treated and that there are many children who do meet criteria who aren’t. People spend a lot of energy condemning one side of this equation, but for many of us who actually do this work and see these children and their families, our objective is to get this right on both sides.
It is also a legitimate criticism, in my view, to claim that psychiatric medications are being too heavily emphasized at the expense of non-pharmacological interventions. However, many of people now leading the charge to bring things back into balance are also psychiatrists, and Dr. Berezin’s blanket contempt for all of psychiatry is misguided and uninformed. Maybe he has given up on his own field, but the rest of us certainly have not.
So before you decide to move your family to France, it might be worth examining some of the fantastically misleading errors that are contained in this blog post.
Further, to ignore the genetic influence on ADHD means conveniently ignoring literally dozens of studies conducted with twins that are raised in the same household. It is true that there is no single gene mutation that leads to ADHD. It also appears true that ADHD behaviors exist on a general continuum that encompasses the full temperamental spectrum of traits like activity level and attention span. In this way, one could certainly conclude that ADHD is not a disease like pneumonia in which you have it or you don’t. At the same time, it is important to remember we have yet to find “the gene” for some of the most genetically influenced properties we know of, like height. In addition, some of the most common non-psychiatric conditions that exist, such as hypertension, diabetes, and high cholesterol, also exist in dimensional form.
As for the lack of a concrete test for ADHD, fair enough. But if you are prepared to disqualify as “not real” anything that you can’t point to on a lab test or scan, then be ready to write off everything from physical pain to autism.
To be sure, these challenges makes ADHD a difficult and more subjective diagnosis to make. However, denying decades of science to mount a parent-blaming argument for ADHD behaviors not only is factually wrong but a true disservice to the vast majority of hard-working parents.
Recorla L, et al. International epidemiology of child and adolescent psychopathology II: Integration and applications of dimensional findings from 44 societies. Journal of the American Academy of Child and Adolescent Psychiatry 2012; 51:1273-1283.
@copyright by David Rettew, MD
David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.
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