How ADHD became the diagnosis that ate the world.
Most of us fail to accept the simple notion that if a medical condition is so common that almost all of us have it, it is no longer an illness, it is the norm. Our mouths and guts are populated with friendly bacteria that help us digest food. No sensible physician would ever propose that we should kill all these off with antibiotics. Having these organisms in our gut is not simply an incidental finding, it is what characterizes us as human beings.
When the parent of a child speaks to me about his or her problems with learning in the classroom, as a matter of course, the suggestion is raised that he or she must have ADHD (Attention Deficit Disorder with Hyperactivity) or Aspergers Syndrome or Anxiety or Autism in some form, mental health disorders, mental diagnoses that are somehow meant to explain variations in behaviour and poor academic performance.
If I take the position that the speaker has no expertise to proffer a clinical opinion, the reaction is hostile. It was not always the case.
There was a time when the average person had no problem acknowledging that their medical knowledge was limited. Now, however, and we can probably attribute this to the internet, everyone can make a diagnosis.
When you talk to the non-medically trained about these “diagnoses”, confusion is evident. They confuse diagnoses, tending to mix up symptoms of Autism with those of Attention Deficit, Anxiety, and even obsessive-compulsive disorder. This confused mixture of symptoms that they hold in their heads actually has a technical academic origin and they may not be aware of this. It originates from a compendium of diagnoses in the printed text, the Diagnostical and Statistical Manual of the American Psychiatric Association 5th Edition also usually designated as DSM5.
The DSM5 is questionable text in its own right and much criticized by academics but when used by lay educators and psychologists who may be desperate to solve what they perceive as a problem in child behaviour or learning, it is dangerous.
On the 1st of August 2023 Professor Allen Francis of Duke University, regarded as the father of the 4th Edition of the American Diagnostic and Statistical Manual, the predecessor to the DSM5, stated in interview on ABC radio that the DSM5 was a serious mistake and that conditions such as ADHD were so over diagnosed and so over treated with dangerous medication in Australia and America that it was becoming a serious problem not only for the high number of misdiagnosed children but society as a whole.
It is pointless to question this confusion because there is no point in arguing with the ignorant. The ground keeps changing. What educators, psychologists, and parents really want is a diagnosis so that children can be put in a medical box where testing is done, and medication is given.
Cochrane Reviews, the most highly respected medical authority for assessing research, have repeatedly shown that there is no significant benefit in prescribing dexamphetamine and related drugs (those used most often in these “diagnoses” ) when comparing treated and untreated populations.
It is a different matter when I talk to my colleagues. They know that these conditions are greatly overdiagnosed and that there is far too much pointless testing by psychologists and too much medication being prescribed. They are shirking their responsibility, the obligation to stand up to this nonsense. They shrug their shoulders as if to say that questioning this dangerous paradigm will lead to cancelation, complaint, and censure by their medical boards.
Then again why have a psychological or medical assessment when lay people, even children, can simply diagnose themselves?
Children and their mothers have come to me and told me that they have started taking the medication prescribed to their child's relatives because it makes them feel better and then expect me to provide a script
Discussions about this subject are less torrid when talking to teachers about a third party, a child they are teaching but unrelated to. It tends to go like this. “Robby is a difficult child in class at times. I am convinced that he has ADHD”.
“Everyone can’t have ADHD, surely,” I observe.
“You know, somehow I think we are all on the spectrum,” comes the reply.
But are we really all on this ‘” spectrum”? What is the “spectrum”, in any case, and if we are on this “spectrum” doesn’t that mean that this is just another characteristic of what it is to be human not part of a mental disorder at all?
The problems of a disorder being everywhere and everyone having it are obvious. It is beginning to bankrupt the health system. In this country, the diagnosis of Autism and Attention Deficit are costing our National Disability Insurance Scheme 8 billion dollars yearly and growing rapidly each year. Schools cannot teach all the children being diagnosed because teachers do not have time to give each separate child with the diagnosis specialized assistance and they are threatened with the Disability Act if they deny a child has the diagnosis. Parents insist that their children with the diagnosis receive special treatment and are too often hostile and demanding about it.
Now adults are diagnosing themselves, demanding treatment, and worse, claiming incapacity. Those who fail and those who refuse to work now have the perfect excuse.
Worse than this, the medications being used more and more to treat these conditions, especially ADHD if that is the diagnosis, are dangerous and addictive. The most serious of these is Dexamphetamine and related drugs, highly addictive and dangerous in withdrawal.
Attention Deficit Disorder and Autism as well as Autistic Spectrum disorder cannot be medically diagnosed. There is no x-ray or test to confirm their presence which relies on highly dubious psychological tests administered by psychologists. These tests are dubious because there is no objective scientific way to validate them and because in the real-world Autism and Attention Deficit, whose true incidence is about one in every six hundred children, can only be diagnosed by medical specialists, not general practitioners. These diagnoses require physical examination, neurological assessment, and IQ tests to confirm.
Sometimes these children are said to have “high functioning” autism which is supposed to mean they function so well they don’t appear to have it at all. It means no one can question the diagnosis because it is present but still somehow invisible and incapacitating without causing incapacity. If you are confused by this do not be surprised because the whole process is inherently self-contradictory. The words “spectrum” and “high functioning” are “weasel” words that don’t mean anything. You can’t be a little bit pregnant.
It is at this point that we realize the dangers of this movement to diagnose everyone, to test and medicate children and overwhelm the health system for there is nothing we can do about this because “everyone is in on it” except the taxpayer. The diagnosis eats the world because while it is impossible to prove definitively that it exists, it is not possible to prove that it doesn’t.