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Is ADHD real? Only if you believe in unicorns

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I fully expected my recent column on ADHD — in which I expanded upon noted Harvard psychologist (emeritus) Jerome Kagan’s contention that it is an “invention” — to stir the pot. Kagan said what I’ve been saying in this column and at every opportunity for more than 25 years. During that time, psychologists and psychiatrists have responded with vitriol and even threat, but when I have invited them to debate me, on their turf, at my expense, they have — to a person — become silent.

My column drew opposing responses from mental health professionals, parents of children diagnosed with ADHD, and a few folks diagnosed with adult ADHD. I’ve heard all the talking points before. The ADHD establishment has been beating the same drums for as long as there’s been the diagnosis.

One person, for example, claimed that ADHD is a “real thing” because it is “documented in the nonfiction book ‘Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.’” That argument presumes that the psychiatric diagnoses contained in the DSM-5 are valid in some objective sense of the term — as in the common explanation that many are caused by “biochemical imbalances.”

And yet (a) no biological anomaly has been found to be reliably associated with any psychiatric diagnosis, (b) no one has ever quantified the fictional “biochemical imbalance,” and (c) no psychiatric drug has ever consistently outperformed a placebo in clinical trials. Concerning the latter, it can therefore be reasonably argued that those drugs rely to one degree or another on the placebo effect. Indeed, in study after study, placebos have often reduced the symptoms of conditions contained in the DSM-5. Placebos do not, however, ameliorate the symptoms of valid diseases such as pneumonia and cancer. It appears that whether the DSM is fiction or nonfiction has yet to be determined.

Several respondents informed me that saying ADHD doesn’t exist is as absurd and untenable as denying the reality of cancer. Ah, but a, b, and c above do not pertain to cancer. Cancer’s symptoms are objective and quantifiable. The diagnostic symptoms for ADHD, on the other hand, are entirely subjective and unquantifiable. A physician can prove that someone has a malignant tumor, but no one has ever offered proof that someone “has” ADHD. As such, ADHD is not, as things stand, a reality. It is, rather, a construct and will remain so until proof of its biological reality is confirmed by peer-reviewed research. Until then, claims to that effect are spurious at worst, well-intentioned speculation at best.

It is telling to note that whereas billions have been spent trying to find a cure for cancer, no one is trying to find a cure for ADHD. But then, to cure a malady, one must be able to locate it. ADHD cannot be located.

In short, to equate cancer and ADHD is to equate horses and unicorns.

Caveat: The diagnosis might be bogus, but no observant person would deny that significant numbers of school-age children have pronounced difficulties with paying attention, impulsivity, completing tasks, and the other diagnostic signs of ADHD. Interestingly, according to every single person to whom I’ve ever spoken who taught elementary school in the 1950s (well into the hundreds of such former teachers), this behavior pattern was not a significant issue in their classrooms. Most report that it was nonexistent. The consistency of such reports effectively discredits the idea that ADHD is genetically transmitted, another common claim made by diagnosing professionals.

In our book “The Diseasing of America’s Children,” published in 2009, my co-author (behavioral pediatrician Bose Ravenel) and I point out that the behaviors diagnostic of ADHD are typical to toddlers. In other words, since the 1960s, significant numbers of children have brought toddler behavioral characteristics with them to school (including behaviors diagnostic of oppositional defiant disorder and bipolar disorder of childhood. Our explanation is that 50 years of bogus professional parenting advice based on bogus psychological theory (in combination with early exposure to screen-based media and increasingly non-nutritional diets) has created a slew of behavior and development problems that weren’t significant problems in the classroom of the 1950s and before.

Mental health professionals are fond of claiming that I blame parents for the behavior pattern known as ADHD. Wrong. The professionals are passing the buck, and for understandable reason: I blame them.

Family psychologist John Rosemond answers parents’ questions on his website, Rosemond.com.

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