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The truth about ADHD

  • Published
  • By Capt. Colin Burchfield
  • 14th Medical Operations Squadron
COLUMBUS AIR FORCE BASE, Miss. --  Attention Deficit Hyperactivity Disorder is one of the most popular psychological diagnoses today. It has been estimated that between four percent and 13 percent of our child population in the U.S. has been diagnosed with ADHD. The number of office-based visits documenting a diagnosis of ADHD ballooned from 947,208 in 1990 to 2,357,833 in 1995. Most of the research on ADHD focuses on discovering the causes of ADHD or the effects of medical treatments of ADHD. Most findings that are reported to the public indicate that ADHD is biological in nature and therefore should be treated with medications. Unfortunately, there are a number of conflicting issues associated with these research findings.
We hear a great deal about biological/genetic causes being responsible for ADHD. However, we don't often hear about the conflicting issues during the data gathering phase of research that can make research finding rather difficult to understand. For example, there are difficulties related to the use of twins in studying the genetic link in ADHD. In such studies, the method used to gather data often leads to reporting higher percentage rates of ADHD among twins than is actually occurring. One problem with the data gathering method is that often times one twin in a pair is counted twice for the same research versus once. Such problems in these methods could signify that there could be other contributors to ADHD besides genetics but these other contributors are ignored due to the high percentage rates that mislead interpretation of the results. Furthermore, results of data involving identical twins fail to show that in all cases where one twin has ADHD, the other twin does as well. This is meaningful in that something other than genetics may account for the presentation of ADHD symptoms in identical twins.
Likewise, studies involving brain imaging to determine the characteristics of ADHD in the brain have similar problems during the data gathering phase of research - leading to possible inaccurate conclusions. One example of a conflict during the data gathering process on brain imaging is that individuals diagnosed with ADHD who have previously taken medication for ADHD do not report the medication use. Therefore, any neurological findings may be inaccurate purely due to previous medication use. The medications may alter the brain characteristics reported in the brain imaging. Other brain imaging studies using non-medicated ADHD individuals do not compare the brain images to those of non-ADHD sufferers. This lack of comparison between normal and ADHD brain images makes it almost impossible to determine much that is meaningful from them.
Other sorts of problems exist with medication research related to ADHD. The theories that present the belief that there are "chemical abnormalities" in children diagnosed with ADHD are based on the effects of certain medications that are given to children with ADHD. Medicating children diagnosed with ADHD certainly has some positive effects - in fact, medicating any child with such medications, even ones without ADHD, has some positive effects. However, 20 percent to 30 percent of children diagnosed with ADHD may not respond at all or may even show a worsening of behaviors while taking medication. Surprisingly, as many as 39 percent of children with ADHD will respond to "treatment" when given a placebo and not the actual medication. When the medication is discontinued, the positive effects of treatment disappear. Children diagnosed with ADHD continue to have significant academic, social, and psychiatric impairment during adolescence, even when still being maintained on medications.
The conclusion with regard to diagnosing and treating ADHD is that there are quite likely a variety of factors that lead to this diagnosis in children. As suggested in the first of this series of five articles, given the huge number of conflicts existing in the present research data, the only reasonable conclusion is that current research methods are incapable of indicating the sufficiency of any factor, biological or otherwise, in ADHD. This indicates that there is no data available to sufficiently support a purely biological explanation of ADHD. It is highly likely that ADHD is the result of a variety of factors to include biological, environmental, contextual, relational and personal factors.