"The ADHD Myth"

Jonathan Edwards

Jonathan Edwards

Senior Member (Voting Rights)
UK Channel 4 programme on ADHD claims it is all a myth, it seems (I have only read a review in the Grauniad.)

My old college friend Iona Heath says it is certainly not a medical condition in her view. Anyone can have the symptoms.

The main argument against seems to be that MRI scans are normal - familiar?

But the reality is perhaps suggested by a recent meta-analysis of GWAS studies. For ADHD based on a doctor's diagnosis there are clear peaks on the Manhattan plots and heritability is estimated at 74%. For ADHD symptoms alone there are still some peaks but they do not reach significance - suggesting dilution.

So it looks as if ADHD is a real biomedical phenomenon but may require careful diagnosis - familiar?
 
I suspect this is true for many conditions affecting the brain.

There's are symptoms that are believed to be characteristic of the condition, but the exist on a continuum of severity, and there is no clear border between normal and pathological. The symptoms are subjective which causes difficulty in communication. A diagnosis based on symptoms is also susceptible to a double distortion: first by the biases of the patient, then by the biases of the listener. If a person is very mentally occupied with some symptoms their description of them can make them seem more intense and important than they actually are. And a professional will form a habit of looking for certain symptoms and interpreting them in a certain way, based on their specialization.

Presumably many of the symptoms believed to be characteristic of a condition can be experienced by a normal, healthy person who is merely subject to an environment and lifestyle that induces these symptoms, at least to a sufficient degree that misinterpretation is possible.

A profit-oriented healthcare system will tend towards overdiagnosis rather than underdiagnosis.
 
The idea that every person who struggles with ADHD just needs to do some yoga and spend time outdoors is so offensive. And very familiar, of course.

It's not just being a bit hyperactive or naughty or lazy or whatever. It's sort of like saying everyone gets a bit tired so anyone could have MECFS.

I know people with it who are very smart but struggle immensely with basic stuff because of the executive functioning issues. It really shapes their lives in a fundamental way.

I've recently been exploring the idea that might have it myself with a therapist. I have really struggled with concentrating, planning tasks and sticking to goals long term since I was a little kid. I struggled to do the things I wanted to (here I mean the ones that would have been pretty accessible even with my health issues) in my life because of these issues.

I don't know whether or not amphetamines are the best way to medicate ADHD, especially for children. But attacking the idea that anyone with ADHD has any kind of real condition is just following the current fashion for dismissing the struggles of neurodivergent people and trying to take their support systems away.

Shame on Channel 4 for by hopping on the O'Sullivan-Wessely overdiagnosis bandwagon. It seems to me that that is the real trendy myth.
 
Last edited:
The problem with ME diagnosis is that criteria are used not just to describe the cohort but to create cohorts. the former practice is imo clinically and the latter scientifically motivated. Thus the new "PEM must be delayed" dictum may be fair enough for clear blue water between ME and other fatiguing conditions for study but it is not fair imo to deny the term to those whose PEM is more immediate - nor deprive them of a CFS/ME diagnosis. A careful diagnosis for research purposes may not be the same as a careful clinical diagnosis.
 
The diagnostic criteria for ADHD require the difficulties to be consistently present and to a degree that significantly interferes with normal functioning. It is simply untrue to say that that could apply to anyone.

One of my children has ADHD. It affects her significantly and in specific ways, some of which I have more personal insight into now that I have the cognitive difficulties of Long Covid (they are not the same but there are similarities in the way a train of thought gets lost, or how one task or stimulus inhibits another). For years of her childhood the impact of the problem was made worse by her feeling that she was a bad person for not being able to do things that were simple for others, or being called lazy or uncaring because she hadn't managed to do something that she really did care about. The huge benefit of going through the long and demanding diagnosis process was not to have a "label" or an "excuse" for the problem, as some people ignorantly suggest, but to have a better understanding of the problem and find appropriate strategies to counteract it. The difference has been enormous not only in her ability to do the things she needs to do but also in her mental health.

I didn't watch the programme but I'll guess it was the usual mix of some people who understand the issue alternated for "balance" with people who don't understand it but are keen to sound off about their own pet theories.
 
Eleanor said:
For years of her childhood the impact of the problem was made worse by her feeling that she was a bad person for not being able to do things that were simple for others, or being called lazy or uncaring because she hadn't managed to do something that she really did care about
Click to expand...
This is very familiar. I'm glad your daughter has gotten the support and strategies she needs.
 
At one point in my life I was struggling with returning to a social life and was wondering if I might have a mild form of autism.

I went through the diagnostic process and was diagnosed, but had doubts. In the end I think the diagnosis is incorrect and an example of how patients and professionals can collude to arrive at a diagnosis that doesn't really make sense. I considered the diagnosis because I was hoping for support. The professional has a conflict of interest: a diagnosis meant further visits and a long term customer.

According to the clinical psychologist, I had questionnaire scores consistent with autism. But I've neve been able to replicate these high scores on various questionnaires when I'm the person filling them out. I get at most scores in the grey zones. The diagnosis also requires a history of autistic behaviours but it's easy for a psychologist to convince herself that ordinary negative events were in some way a manifestation of autism.

The psychologist was also ignorant about ME/CFS. The cognitive issues overlap. The parts that overlap cannot be used to support a diagnosis of autism in someone who probably has ME/CFS (a decades long history of delayed PEM). It can lead to social isolation and abandonment by society which is very detrimental to one's social skills and confidence.

The diagnosis in the end doesn't seem to make sense. While it's interesting to explore ideas from this space, it doesn't benefit me and is associated with additional stigma. The diagnosis seems like a simple and wrong answer to a complex and difficult problem. The system doesn't have the capacity to deal with complex and difficult problems so it tends to reduce them to something simple.

Diagnoses like autism are convenient for the system because they locate the source of the problem in the brain, which in practice is difficult to falsify. It saves them from having to understand the whole person - their other diagnoses, life history, family situation, lifestyle and contribution to symptoms, etc. It also places the responsibility entirely on the patient.
 
Last edited:
V.R.T. said:
This is very familiar. I'm glad your daughter has gotten the support and strategies she needs.
Click to expand...

Thank you!

Just in case it rings a bell for anyone else reading this: the first little indication that she wasn't just "scatterbrained" came during the early phase of the Covid pandemic, when people started wearing masks and she suddenly couldn't understand people speaking in a group. It turned out she'd been lip-reading for years. She can hear a single voice with no problem, but finds it very hard to pick out and follow one voice among several or against background noise. (This also explained why she'd always wanted subtitles on the TV at home.) So we took her to the GP and then an audiologist, and that was the start of discovering.
 
I hear the programme includes a man (GP?) who was diagnosed and the medication made him feel odd, and he doesn’t think he has ADHD?

But there is a saying in the community - you’ll know if you have it because the meds totally change your life.
So maybe the inverse is true and this guy just found out the hard way. I’d hate to accuse a patient, and one who is a GP of being caught up and swept along in the latest social media trend but maybe he just convinced himself and then was able to convince others. Perhaps he could have started with some brain training or CBT to challenge his negative thoughts?
 
Eleanor said:
The huge benefit of going through the long and demanding diagnosis process was not to have a "label" or an "excuse" for the problem, as some people ignorantly suggest, but to have a better understanding of the problem and find appropriate strategies to counteract it. The difference has been enormous not only in her ability to do the things she needs to do but also in her mental health.
Click to expand...

Interesting contrast to my experience with autism (which some say is the same condition as ADHD). I felt like they had nothing to offer me that was useful. No treatments, no ways to manage specific issues (like pacing helps managing PEM), no practical help. They offered therapy which over time became harmful. I did get a recognition of a certain percentage of disability but it ended up being useless because the only benefit is tied to work contracts that require at least 20 hours per week. It's too much for me. According to the system ME/CFS causes no impairment in work ability so I can't get a higher percentage. The system felt out of touch and of benefit mostly to the people that work in it.

What strategies were given in your case that made an enormous difference?
 
You can watch the programme here: https://www.channel4.com/programmes/the-great-adhd-myth

I found it interesting. Psychiatrist Max Pemberton got himself diagnosed, but was sceptical. He tried the medication, and found that it made him better at concentrating but made him less 'himself'.

He followed a family with a child who was rather over-active and was prescribed the drug, and it improved his behaviour so that he could sit still and concentrate, but he didn't like taking it so came off it. He seemed to blossom again, but on return to school his behaviour got bad again, so he's back on the drug.

I wonder whether the drug could be prescribed on and off?

It was suggested that the requirement for children to sit still and concentrate, and the reduction in outdoor activity, and maybe the increased use of mobile phones, was the/a reason for the problem.
 
Hoopoe said:
Interesting contrast to my experience with autism (which some say is the same condition as ADHD). I felt like they had nothing to offer me that was useful. No treatments, no ways to manage specific issues (like pacing helps managing PEM), no practical help. They offered therapy which over time became harmful. I did get a recognition of a certain percentage of disability but it ended up being useless because the only benefit is tied to work contracts that require at least 20 hours per week. It's too much for me. According to the system ME/CFS causes no impairment in work ability so I can't get a higher percentage. The system felt out of touch and of benefit mostly to the people that work in it.

What strategies were given in your case that made an enormous difference?
Click to expand...

It is interesting - I'm sorry you've gone through that. I'm autistic myself (and happy with the diagnosis) and find it very distinct from both ADHD and ME/CFS (although of course people can have both or all three). One of the worst things about developing ME/CFS for me is that it's taken away some of the benefits of autism that made me happiest, the capacity for deep sustained focus and encyclopaedic fact-knowledge (and the kinds of work which that enabled me to do).

I think a lot of the help for my daughter has been about letting go of the ways you're expected to do things neurotypically (e.g. breaking up tasks in certain ways or rewarding yourself once you've finished something) and stop seeing the difficulties as "failure" and instead something you just have to manage and work around, then it frees you up to look at what actually works. And being aware in advance of the kinds of things that are likely to trip you up, so you can maybe put something in place to help beforehand - can I reschedule something I'm likely to be late for, can I get information in writing instead of relying on remembering what someone said, can I automate this thing instead of having to try and remember it every time - instead of always thinking "next time I really will try harder and do better"... But also not having so many strategies and reminders that they become overwhelming in themselves! It's something you have to evolve with trial and error in the same way pwME have to evolve pacing.
 
MeSci said:
He followed a family with a child who was rather over-active and was prescribed the drug, and it improved his behaviour so that he could sit still and concentrate, but he didn't like taking it so came off it. He seemed to blossom again, but on return to school his behaviour got bad again, so he's back on the drug.
Click to expand...

Children's behaviour is a huge confounder with ADHD because so much of it is influenced by the actions and reactions of the adults around them, and anything that changes the attitude and behaviour of the adults will have a further effect on the child. This is a factor even in big studies, let alone a single 'case study' of one child over a short time.

(edited to add) Something that's often seen in discussions around ADHD and autism is an assumption that the behaviour is the condition, and if an intervention changes behaviour then it has treated or cured the condition. But behaviour can be an expression of how the individual is feeling in particular circumstances in which the condition is only one factor.
 
MeSci said:
It was suggested that the requirement for children to sit still and concentrate, and the reduction in outdoor activity, and maybe the increased use of mobile phones, was the/a reason for the problem.
Click to expand...
I'm not really convinced. Sounds like a weak generic "modern life is to blame for everything" argument.

By everything I've heard from my parents and grandparents, I'd say teachers used to be stricter. My gut feeling is that older generations had to sit more still and be more focused in school. There's a lot of teaching through games and play and all sorts of interactive ways, which are more chilled than how it used to be in the past.

Wouldn't there be documented increased numbers of people with ADHD-like traits and behaviours in the generations that grew up during wars, if reduction in outdoor activity was a problem?

I'm not sure about mobile phones either. There are many people seeking ADHD diagnosis who've had problems their whole life but got their first mobile phone when they were adults. I got my first mobile phone when I was a teenager but I had my obsessions, i.e. activities I was really into, which kept me in the bedroom before the phones and remained obsessed despite having a phone (I don't have ADHD, just talking about my experiences and observations). I appreciate the mobile phone world is very different now as well as many other things but it's not that our childhoods were ideal before them. Trends and stupid ideas spread from person to person but they existed. Not everyone played super smart games in optimal amounts to facilitate their development and read books. I don't know... Somehow I don't find it convincing enough.
 
Felis Catus said:
I'm not really convinced. Sounds like a weak generic "modern life is to blame for everything" argument.

By everything I've heard from my parents and grandparents, I'd say teachers used to be stricter. My gut feeling is that older generations had to sit more still and be more focused in school. There's a lot of teaching through games and play and all sorts of interactive ways, which are more chilled than how it used to be in the past.

Wouldn't there be documented increased numbers of people with ADHD-like traits and behaviours in the generations that grew up during wars, if reduction in outdoor activity was a problem?
Click to expand...

I think outside factors are generally relevant when talking about the brain. Simply because the function of the brain is, in part, to process all the input coming from the outside. The output must depend on the input.

I'm pretty sure modern life is to blame for a lot of things. It solved many problems but it created new ones.

How does constant mental stimulation, zero autonomy and a demand constant performance affect the growth of child's brain? Does the brain literally grow used to operating in a certain mode, so much that when the stimulation is abset, no other person is there to set goals, and there's nothing to do the brain suddenly struggles?

Or maybe some brains don't need constant stimulation and can't bear it? Should we label them as wrong or label the environment that provides this constant stimulation as wrong?

Do people have a sleep disorder or are they sleeping in an environment that is too noisy and interferes with sleep? In some cases it's a matter of perspective.
 
Last edited:
You must log in or register to reply here.
Back
Top Bottom