Is ADHD Real or is it a Myth?
By Stuart Passmore
It is completely understandable that people are totally confused about ADHD or even doubt the existence of ADHD as a real behavioural disorder. There appears to be a number of solid arguments against the existence of ADHD including the contention it is simply a term used to describe normal childhood behaviour that has now been labelled as deviant and non-conformative behaviour. Others maintain that ADHD is nothing more than an elaborate scheme devised by powerful drug companies to make bigger profits through the sale of their medication. With all the different opinions we constantly hear through various media outlets many people question the reality of ADHD. So lets take a look at some of the more popular myths.
Myth: ADHD is not a real disorder
Proponents of this myth are either ignoring the accumulating and overwhelming evidence pointing to the fact that ADHD is a real disorder, or they are ignorant of the evidence. In my own private practice I have encountered many critics of ADHD, and when you get right down to it such individuals tend to base their arguments on what the media has recently reported. There are some sceptical individuals that do present reasonable arguments against the existence of ADHD. However, a closer look at the evidence they use tends to reveal their arguments are ‘paper thin’. The fact is evidence from the medical, psychiatric and psychological fields show without doubt that ADHD is a real disorder. In fact, ADHD is a neurological disorder and MRI, FMRI and SPECT all show there are five parts of the ADHD brain that are undersized and underactive.
Myth: ADHD is only a Western phenomenon
It is a fact that ADHD is a disorder causing a lot of concern in western societies, but is it limited to western cultures only or do other countries have the same or similar rates of ADHD? It appears some proponents of this myth like to argue that the United States for instance has the greatest number of children diagnosed with ADHD as compared to the rest of the world and that this number is growing every year. On the surface this is one of the better arguments as it sounds quite convincing. After all, when we watch media reports covering the prevalence of ADHD and the ever growing rate, we never seem to hear about any other culture other than our own or some other western country.
Nevertheless, it is well documented that ADHD is not just an American problem; in fact it doesn’t even appear to be restricted to just western countries either.
However, the question of whether or not ADHD is a western phenomenon has been raised and has prompted numerous investigations to answer this question. As a result of this research, there have been a number of factors identified that would explain the apparent differences in ADHD rates across the different cultures. Quite a number of investigators set out to test whether or not ADHD was truly an American epidemic and whether or not ADHD was prevalent in both western and non-western countries across the world. They also wanted to know whether the prevalence rates of ADHD in US children were similar to children in other countries around the world. Some of the key questions they set out to answer were;
- Is this behavioural disorder common to children worldwide
- Is ADHD common to a large number of races and societies?
- Are the apparent differences in prevalence rates between countries due to confusion regarding its diagnosis?
This last question is really quite important as differences in prevalence rates across countries may partly lie in the fact that different cultures have different diagnostic criteria and or different names that all appear to be essentially describing the common symptoms of ADHD. It seems there are cross cultural differences in the way in which ADHD is assessed as well as the name it is referred to.
The investigators reminded us of the history of ADHD and the different names it has been known under (e.g., minimal brain dysfunction and organic brain dysfunction). Other terms such as Hyperkinetic Disorder (HKD) and ‘deficits in attention, motor control and perception’ (DAMP) are still used today. For instance, the UK and a number of other European countries use the term HKD, while Scandinavia refers to ADHD as DAMP. Equally while some countries use the Diagnostic and Statistical Manual of Mental Disorders, other countries use the International Classification of Diseases. As we know while there are some minor differences in the diagnostic criteria between the two manuals, it is recognised they are describing the same disorder.
The investigators reviewed 50 studies of ADHD that only used the criteria as set out in the DSM-IV to diagnose the disorder. Of the 50 studies, only 20 were conducted in the United States, while the remaining 30 were conducted in other countries. The results of these studies revealed that the prevalence of ADHD in other countries was the same as or similar to that in the United States. A further 9 studies were excluded from the review as they had been conducted in countries that included Hong Kong, Germany, France, India, USA, UK, Sweden, Canada, and China because they used the ICD-10 criteria in their diagnostic procedure. Remember though the ICD is still measuring ADHD, just under a different name.
Other investigators have also suggested that the prevalence rate for ADHD is the same in many other countries as it is in the United States. That the apparent disparity in rates between various countries has been primarily attributed to the way in which ADHD is diagnosed across the globe. It has also been found that studies on ADHD conducted outside of the United States were almost predictably similar with those of the United States studies. Furthermore it has been found that the patterns of adaptive impairments, neuropsychological deficits, ADHD prevalence within family members, genetic influence, and functional and molecular imaging findings along with response to medication were all strikingly similar to the US. It has also been pointed out that there is a lack of studies coming out of developing countries and suggested that ADHD might in fact have higher rates in certain countries due to some of the severe social risk factors found in those countries.
Myth: Drug companies made up the term ADHD just so they could increase their profits.
There are a number of variations of this myth. One such variation implicates doctors (and therefore paediatricians and child psychiatrists) as being a part of a worldwide conspiracy to only prescribe certain pharmaceutical companies medications because they get ‘kick-backs’ from that company. Unfortunately there have been isolated cases where a trusted individual has sold out ethically, professionally and morally in favour of the almighty dollar. But when you take into account the prevalence rates of ADHD across the world there are tens, if not hundreds of thousands of doctors, paediatricians and child psychiatrists combined that are being accused of accepting bribes. This is just a ridiculous argument.
Join us next week for ‘Is ADHD Real or is it a Myth? Part Two,’ in which psychologist Stuart Passmore will go into more detail about the medications used to treat children with ADHD, and the question of ADHD in adulthood.