ADHD - Urban Legends

Your long-awaited appointment with the pediatric neurologist had finally arrived. After a 20-minute interview he states his diagnosis.

Doc #1: Your child has a disorder called #ADHD. This means that his brain has structural and chemical differences from a normative brain, resulting in his attention deficit. The best treatment is a combination of #pharmaceuticaldrugs and behavior therapy.

Doc #2: Your child is exhibiting symptoms of ADHD. There are no tests to determine a brain dysfunction, and very sparse and unreliable studies demonstrating an imbalance. Therefore, we can assume that your child is perfectly healthy. We must explore different possible causes of these symptoms to know what ADHD is actually like and build a program to help him flourish.

Which doctor would attract more patients to his practice?

Who would you prefer meeting?

Which diagnosis seems more scientifically based?

I’ve been lecturing parent and teacher groups about ADHD for many years. In the past, my series began with an explanation of the science that proves that ADHD is a neurological disorder, and discussed the value of medication. My message was clear; although there is not much a parent can do to fix her child’s broken brain, she could discipline more compassionately and help him develop better habits.

My delivery was so convincing that about 80% of the parents in the audience registered for the entire series each time.

A few astute parents asked some fantastic questions, creating a crack in my presentation…. Why don't we have a child take an MRI to determine if there is indeed a problem? Why are doctors concluding that my child has a broken brain based on images taken from a study of someone else’s brain? There is no other discipline of medicine where a patient is prescribed a drug without proof of pathology, why here? When the parameters for diagnoses were dramatically loosened from the DSM3 to the DSM5, was it due to a new scientific understanding, or a vote at the APA (American Psychiatric Association)? Where are the studies?

Things got more troubling when I started reading what leading psychiatrists were quietly saying.

“#MentalIllness is terribly misleading because the ‘mental disorders’ we diagnose are no more than descriptions of what clinicians observe people to do or say, not at all well established diseases” #DrAllenFrances, psychiatrist, DSM Task Force Chairman, 2013

“We do not have an independent, valid test for ADHD, and there is not data to indicate ADHD is due to a brain malfunction” final statement of the panel for the NIH consensus conference on ADHD.

“For mental/psychiatric disorders in general, including depression, anxiety, Schizophrenia, and ADHD, there are no confirmatory gross, microscopic or other chemical abnormalities that have been validated for objective physical diagnosis”. Quote from Dr. Supriya Sharma, Director General of Health Canada (Canadian FDA)

Here is the most shocking: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend-never a theory seriously propounded by well-informed psychiatrists”. #DrRonaldPies, Editor-in-chief of the Psychiatric Times, July 11, 2011

Really???? It’s an urban legend? So, most psychiatrists and neurologists are just not serious? Very influential doctors tell us lay people with a straight face that our children are struggling with a brain chemical imbalance, but amongst themselves they are chuckling about the urban legend? Is there an exclusive club that only permits the well-informed entry?

It’s a little dizzying trying to absorb these honest, behind the scenes statements. Vertigo may set in when being presented with the following hot off the press study:

“We confirm, with high-powered analysis, that patients with ADHD have altered brains; therefore, ADHD is a disorder of the brain. This message is clear for clinicians to convey to parents and patients, which can help to reduce the stigma of ADHD and improve understanding of the disorder”.

This is the concluding statement made by Martine Hoogman and collogues upon publishing their mega-analysis of brain volume conducted at 23 sites, including 1,713 participants, in Lancet Psychiatry 01, April, 2017.

Here is a breathless review from the New York Times bringing the results of this very same study to their readers.

"The facts are in, ADHD is indeed a