Hello, friends. Russ Barkley back again with another commentary on ADHD. This time, I want to talk about two articles that appeared on October 30th in the website and the magazine The Economist.
Now, both of these articles had a very similar slant to them, and that is that ADHD, as you see here, should not be treated as a disorder. Instead, adapting schools and workplaces would be far more helpful. The second article, appearing on the same day, states that researchers are questioning if ADHD should be seen as a disorder at all; it should instead be seen as a different way of being normal.
So, I want to talk about the points that are raised in both of these articles because there is much that is wrong in what is being claimed here. So, let me bring up my PowerPoint presentation so we can have a look at just what the problem is in these articles. So, is ADHD just a neurodiversity rather than a disorder?
Let me tell you where I think The Economist gets it all wrong. First of all, The Economist claims that ADHD is no longer viewed as binary or as a category, but is now seen as a spectrum of neurodiversity—just a different way of being normal. Well, hold on just a second, this is not a recent change in our view of ADHD as binary.
We have been talking about ADHD as representing a spectrum of symptoms within the population for more than 30 years. So, the idea that this is something new, some great discovery by researchers, and therefore ADHD is not a disorder, to me, is just grossly illogical. How you get from one to the other is almost like stating that if something isn't binary and it falls along a spectrum, that means it can't be a disorder or a dysfunction—those don't go together.
Right? There are many instances in life where things fall along a spectrum, like your eyesight. But when it gets to a point where it is extremely dysfunctional, it's not effective; we can draw a line and call it a disorder, right?
And then get some treatment for it. And we can also do that with developmental problems like language, and we can certainly do it with psychiatric disorders like autism spectrum and ADHD, all of which fall along a spectrum. But, as I've said in other lectures on this channel, just because something falls along a spectrum doesn't mean that as you get out toward the extreme degrees of those spectrums, you can't call it a disorder.
Yes, you can! The reason why is at some point along that spectrum, your functioning begins to fail. The particular adaptation or trait that we're talking about, in this case, ADHD and self-regulation, reaches a point of being so deficient that it can't do what it's supposed to do to help the individual adapt and function effectively.
And at that point, when it begins to cause harm to the individual—significantly ineffective functioning for a particular major life activity—we can, in fact, draw a line right there and call it a disorder—whether it be blindness in the case of vision, whether it be a language disorder in the case of language, or whether it be ADHD in the case of the spectrum of executive functioning and self-regulation. So, there was so much illogical reasoning across the first part of both of these articles that it's hard to really get a grasp of them because they're implying that, as I said, if something isn't binary anymore, it can't be a disorder. Well, that's just not true—it's uninformed.
Moreover, at no place in the article do the researchers raise any definition of what a disorder should be. If they're concluding that ADHD isn't a disorder, what's their definition of a disorder? Then we can look to see whether ADHD meets that definition or not.
But at no point do they talk about some general definition of disorders that they have reviewed and have decided that ADHD simply doesn't meet that. They're just saying that because it isn't binary, it can't be a disorder, and that is uninformed. They also go on to say that researchers are questioning if it should be seen as a disorder at all.
What researchers? Nowhere in the article do they quote researchers or even give references to other researchers who are saying that. Yes, they do talk about the results of two researchers who are acquaintances of mine: Ed Sonuga-Barke being one and Steve Hinshaw being the other.
But when they talk about what those people said, none of that has any bearing on whether ADHD is a disorder or not. So, you can't use those researchers' names to support that conclusion or that statement, and then they don't cite any other researchers; they just put that statement out there. Well, it's not true.
Most researchers that I know of are not questioning whether ADHD should be a disorder or not. The authors of this article are, but not the researchers. The articles go on to claim that ADHD is not easy to define, that the diagnoses are subjective and therefore imperfect, and that the criteria used for the diagnosis are arbitrary.
None of this is true. It's as if they never even looked at the history of how we developed the diagnostic criteria for ADHD over the last 50 years of research. So, claims that ADHD is not easy to define are simply not true.
ADHD can be defined. We've defined it; we've even created a list of 18 symptoms to help recognize it. And while yes, these symptoms have to be used in an interview and on rating scales with people, so to some extent they're a little subjective, that doesn't mean that they're not valid.
The fact that something is subjective doesn't immediately dismiss it. It dismisses it that it is somehow being out of bounds for our consideration or makes it imperfect. Most of the judgments we make in life are, to a large extent, subjective, but they work, and we make them because we have to.
The idea that the criteria are arbitrary, as I've already said, simply doesn't withstand any scrutiny. It tells me that the people who wrote these articles are really ignorant of the history of developing diagnostic criteria for this disorder. So once again, the authors are laying out a lot of gross statements and generalities without providing much of any support, logic, or reasoning for their position.
They're just tossing it all out there in the article. They go on to assert that, therefore, there have been little advances in understanding the genetics and neurology of ADHD, and thus it's not a single condition or a disorder. Oh, here we go again, right?
First of all, that's not true. We have made tremendous advances in the genetics of ADHD beyond just establishing that it's heritable. We have huge studies, genome-wide scans, of individuals with ADHD numbering in the tens of thousands of participants.
These studies have helped us to narrow down the risk genes for ADHD, and while many of them remain to be identified, at least 20 to 30 of them already have been and are used in research to create polygenic risk scores to evaluate the contribution of those genes to risk for ADHD. To say that we don't understand the neurology of ADHD is simply ignorant. We have hundreds of neuroimaging studies and meta-analyses of those studies that point to the major regions and networks in the brain that are involved in ADHD.
So once again, the authors show just how uninformed they are about this condition. The authors then go on to state that most symptoms of ADHD are mild and can therefore be dealt with through alterations in the school and workplace environment; no need to call this a disorder. Nothing to see here, just move along, and we'll just change the environment.
Well, first of all, if most symptoms of ADHD were mild, you wouldn't get a diagnosis to begin with. We all have, to some extent, some mild symptoms occasionally of ADHD: some inattention, some distractibility, and occasional impulsivity, right? But to be diagnosed with ADHD, your symptoms must be persistent, frequent, and severe, leading to impairment in major life activities, and then it becomes a disorder.
Simply altering the environment around the individual, while healthful to some extent in some places, is not going to eliminate the symptoms, as is claimed in these articles. Indeed, I know of no evidence to show that that is the case, and all the authors do is give us two anecdotes of one school district in England that is trying to modify the environment to help children. Well, good for them; it's probably helping, but that doesn't mean it's getting rid of the disorder.
Then they go on to talk about an employer consultant who also helps employers do this in the workplace, but at no point do they provide any evidence from any research or elsewhere to show that by doing this you have gotten rid of the disorder or the dysfunction. They do state that ADHD medications should be used, but only in the most extreme circumstances. They admit that they're effective, but that most people don't need them.
What most people need is to, A, have the environment altered around them so that they can do better, and B, they should not be labeled as having a disorder. C, they go on to also say that the things people with ADHD can't do well should simply be delegated to others. Oh great, like the rest of us are supposed to pick up the slack.
I mean, that makes no sense whatsoever. So for these authors to be making these kinds of claims or assertions about ADHD without providing a lick of support for these assertions is misleading to anyone who would pick up these articles and conclude that, oh my God, the field is moving on, and ADHD isn't going to be called a disorder anymore. Well, that's simply not true.
I will also conclude this commentary with what I sensed in reading both articles: a strong whiff of the socialist approach to dealing with problems in society, and that certainly fits with the economists, as far as its views on political and other circumstances. This idea that by designing environments we can perfect mankind is a sort of throwback to Fabianism or even Karl Marx and communism: all we have to do to perfect mankind is to alter the social environment, alter the culture, and voila! No problem; everybody is perfect, everybody functions well.
So, as we all know, this view of life is simply not true. Altering environments can be helpful; there's no question about that, especially for ADHD. But by saying that we need to redesign all of society, all schools, all workplaces in order to perfect people with ADHD is simply not going to work.
It's not affordable, it's not rational, it's not reasonable, it's not even close to doable. The idea that we should then dump what people with disorders can't do very well onto others—don't you think those others should have a say in that? The article even talks about how we should allow people with ADHD to come and go at school whenever they like and to come and go at work whenever they like.
This makes no sense. You're assuming that people are going to be standing around in these places just waiting for the person with ADHD to show up. Well, we've got other things to do and better things to do, and they have to be done within a certain time period.
Not going to keep schools open 24 hours and workplaces open 24 hours so that people can come and go as they please. Do you see what I mean by this kind of utopian view of society? It clearly isn't very practical.
Well, that said, I think there's a lot wrong with these articles in The Economist. There are a few things that they get right; as I've said, they at least acknowledge that medication can be helpful. However, in most cases, their assertions are groundless, and their logic requires a lot of filling in to make any sense of the argument that they're making here.
All right, everybody, thanks for joining me for this commentary. As always, I'm going to conclude by saying, live well, be well, and take care. Thanks, and bye for now!
