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Is ADHD Real?

Why does everyone think it is?

This post is in response to
Different Temperaments Make Some Kids More Active

Why do most people (including doctors) think that it is a real disease and not simply a matter of temperament or the result of childhood trauma, as Dr. Berezin argues?

Here are some of the reasons:

1. Stimulant medications like Ritalin and Adderall work. My child is a different person after starting to take medication. He is calmer and more focused at home and at school.

2. Most pediatricians and child psychiatrists say that ADHD is a real disease. We have every reason to trust our doctors who have had years of training and experience.

3. Research studies (even by researchers from Harvard Medical School) have shown that ADHD is a real disease caused by genes. That is why ADHD tends to run in families.

4. Brain scans show that the brains of children with ADHD are not the same as other children's brains. ADHD is caused by a defect or chemical imbalance in the brain.

5. ADHD has been around for a long time. Playwrights like Moliere described children with ADHD hundreds of years ago.

If we take a closer look at each of these beliefs, we find that not a single one of them is based on truth. These beliefs are based on a 50-year-long PR campaign that has "sold" a disease called ADHD to parents, teachers, doctors, and the general public.

1. Stimulant medications work.

This is the belief that I hear most often by parents in my office. They have been told that if stimulants work for their child, then the child must have ADHD. Stimulants won't help a child focus if the child doesn't have ADHD. The truth is that stimulants work for everyone, both adults and children. Benzedrine, a stimulant that chemically resembles Adderall, was widely used in World War II to keep fighter pilots alert and focused. When the American military discovered that German bomber pilots used Benzedrine to keep their pilots alert during the blitzkriegs over Britain, they began to include the drug in the kits of American bomber pilots. Certainly, not all bomber pilots in World War II had ADHD!

A 1978 study, directed by an NIMH researcher and published in the respected journal Science found that stimulant drugs improved attention and focus in "normal" boys as well as in boys diagnosed with ADHD. This study challenges the view that if a child has a positive reaction to stimulants, the child must have ADHD.

Moreover, 35 percent of college students take stimulants to improve their focus. Few of them have been diagnosed with ADHD.

2. Doctors believe that ADHD is real.

For more than four decades, pharmaceutical companies that make stimulant drugs have "sold" doctors on the idea that ADHD is real. Articles in respected medical journals were ghostwritten by the marketing departments of drug companies. Drug companies sponsored medical conferences and hired speakers to convince doctors that ADHD was a real disease that could be helped by their products. Pediatricians and child psychiatrists were paid handsomely to become consultants for drug companies. The PR campaign by Pharma was more successful than they could have dreamed. Today, stimulants for children are a multi-billion-dollar industry.

3. Research studies show that ADHD has genetic causes.

A major study that promotes a genetic factor in ADHD was directed by Nigel Williams and published in the prestigious Lancet in 2010. The researchers found that rare chromosomal deletions and duplications were associated with ADHD. However, the study merely showed that 78 percent of the kids diagnosed with ADHD did not have the genetic anomaly. Compare this with a real genetic disease like Down syndrome where 100 percent of children diagnosed have the genetic anomaly. As of today, there is no consensus among scientists worldwide that there is a genetic biomarker for ADHD.

4. Brain scans show that kids with ADHD have brain defects.

Most of the activity in the brain is at the neuron level, not in the larger brain regions that we see with today's scans. Vast arrays of individual neurons interact in complex ways, but brain scans cannot show us how these neurons interact.

5. ADHD has been around for a long time.

Children, especially boys, with active temperaments have been around for a long time. Here is where Dr. Berzerin's description of the "active, externalizing, narcissistic, and participatory child" is particularly useful. This kind of child exists now and there is no reason to think that they didn't exist before. Childhood trauma like abuse or molestation, which can exacerbate these traits of temperament, has also been around for a long time and has been observed by authors, playwrights, and scientists. Parents who do not provide a calm, structured environment for their children have existed for a long time.

Having treated hundreds of children diagnosed with ADHD over the years, I have found that environmental stress on a child can produce symptoms that look like what is commonly believed to be ADHD. Temperament is, of course, a factor as well. Some kids are simply more active, fidgety, and challenging than others.

Children who have been abused, neglected, exposed to domestic violence or to ongoing parent bickering, not provided with appropriate limits and consequences, and a host of other environmental stressors, present with behaviors that look like what has been sold to the public as ADHD. Over-exposure to electronic screens—like TV, tablets, game devices, and smartphones—can also stress a child's brain. The solution to these children's problems is not stimulant medication, but removing the source of the stress.