The Logic of the ADHD Diagnosis

Craig B. Wiener, EdD
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Welcome! This blog presents a psychological understanding of the diagnostic category “Attention Deficit Hyperactivity Disorder” (ADHD). Over the past decades, professionals have been informing the public about the neurobiological causes of the behaviors, and the necessity to medicate and stringently manage those who have been afflicted. This blog analyzes those claims.

While biological determinist assertions may continue to prosper there is increasing concern that we are positing the existence of a medical problem when there are no biological markers or dysfunctions that reliably correspond with the behavioral criteria.

Over the coming weeks, I will also present an alternative intervention that develops self-management in individuals who receive the ADHD diagnosis. This intervention is designed to replace traditional treatments that have been yielding very poor longer-term benefits.

The Logic of the ADHD Diagnosis 

When constructing the ADHD diagnosis, progenitors essentially say, “Let’s study a group of people who do particular hyperactive, impulsive, and distracted behaviors that are associated with chronic and pervasive problems in school, social life, and work. If the person is an adult, the problems must be present in childhood and show consistency throughout development. We will call this group “ADHD” and study correlated biological characteristics and other associated difficulties. We will continue to tweak the criteria so that the diagnostic net falls on the people with the correlated dysfunctions and patterns of biology that we find in our research.

While not everyone in the designated group has every correlated problem (i.e. no correlated problem is useful for diagnostic purposes), researchers might find that people assigned to the ADHD diagnostic category have other problems in common. For example, (as a group) they might show driving problems, higher levels of anxiety, executive functioning difficulties, fine motor impairments, learning problems, failures to complete schooling, frequent divorce, “hotheaded” outbursts at work, problems doing homework, and atypical patterns of brain biology and molecular biology, etc.

Having ADHD vs. Doing ADHD

What goes unnoticed, however, is that “doing” the behaviors that qualify the individual for the ADHD diagnosis transforms into the individual “having ADHD.” Qualifying for the criteria, magically converts into “having” something even though nothing in that regard is identified other than meeting the behavioral requirements and showing (or not showing) correlated problems.

An Alternative Understanding

So when people say that ADHD is a chronic and pervasive developmental problem, of course it is. The criteria require it to be. And when we find that people qualifying for the criteria have other problems and traits in common, why are we surprised.

Quite often people behaving in similar ways develop a variety of shared “living in the world difficulties.”  And quite often people behaving in similar ways share certain traits, talents and shortcomings.

For example, cab drivers in London are more likely to have a larger visual-spatial cortex because navigating the streets throughout the day develops that aspect of biology. They might also show impressive skill in learning navigation (or they would not be hired or be able to maintain employment), and they might share a variety of psychosocial problems as a function of dealing with city traffic and stringent time constraints throughout the day.

While we are willing to say that people “have ADHD”, it seems peculiar to say that people “have cab driving.” Yet similar to ADHD, cab drivers have a correlated biology that separates them from the masses and a unique array of psycho/social problems. The two groups differ in the social acceptability of their actions, but for both groups, we rely solely on behavioral criteria to determine category designation.

Conclusions

  • People don’t do ADHD behavior because they have ADHD. More precisely, when people do ADHD behavior, we classify them as ADHD.
  • ADHD is a category name, not an explanation even though people use it in that fashion.
  • It is still a matter of debate as to why some people do ADHD behavior more often than others.

15 COMMENTS

    • True.
      Btw, a question to the audience ;):
      does anyone know the article which supposedly shows that “ADHD” rodents have different responses to stimulants than normal rodents? I’ve heard numerous stories about that but nobody so far was able to point me to a specific paper…

  1. ADHD was part of my “diagnosis” but the treatment , getting high on stimulants, is not sustainable long term.

    I am going to attract haters from the ADHD world but the truth is stimulants get you way high at the dose that ‘works’ (makes things stick in working memory). I told the lie too “I don’t get high from it, the medication only calms me so I can focus on stuff” Ya right. People with ADHD don’t get a high, NOT !

    I am not the biggest fan of the war on drugs , if people want to get high let them if they don’t harm others but I can’t believe the same system that built a police state to fight a war on drugs pushes Ritalin and amphetamines on children. It’s really mind altering shit and it really dose feel similar and I think better than Cocaine. Cocaine you have to keep hitting up every 20 minutes and even less if you smoke it, down some ADHD pills your set for several hours.

    The reason they are still giving this stuff to kids is because most lawmakers have never downed a dose themselves and have no clue at all what it’s about.

    I did watch the movie limitless on Ritalin , that was fun.

    Preview http://www.youtube.com/watch?v=jOLqNOfzus4

    Watch full “Limitless (2011)” movie produced in 2011. Genres are Mystery, Thriller, Sci-Fi.

    http://www.solarmovie.is/watch-limitless-2011.html

    • Actually, I didn’t get high on speed. I really did look like I was on speed when I wasn’t and looked like I wasn’t when I was. It didn’t give me more energy, it helped me do very linear things like make a checklist every night and go through it methodically the next day— every night and day. And it made it possible for me to keep myself and two others on schedule and on time. It helped me with mail and paperwork.

      But it caused chronic sleep problems that led to benzos, etc. You know the drill.

      Now I take guanfacine and it really helps, it calms me down and makes my thoughts a little slower and more orderly.

      My “ADHD” is the result of a head injury I had when I was eight, the result of which is probably a hundred absence seizures a day, and difficulty with executive functioning and decision making. Whether my lack of judgment is due to the head injury or temperament is anyone’s guess. I can’t drive because I don’t want to kill anyone, and I’m a royal klutz, but “ADHD” (my fist-full of daisies) doesn’t interfere with my work or schooling as long as math isn’t involved.

      It’s a physiological condition for me, and learning to understand that has helped me immensely in the ‘get off my back’ department.

    • I have a friend who take them and tells me “I finally feel like I am supposed to feel, like myself”. I can’t imagine how can you know how you’re “supposed to feel like yourself”. I mean you are yourself – the drugs may make you feel different, maybe better but that in no way says that the way you’ve felt all your life was pathological. Many people have problems to socialise and they feel “more like themselves” on alcohol but nobody would claim that alcohol is therapeutic for them.
      And the constant mantra: “ADHD drugs work differently on ADHD patients than on other people”. Not by any evidence I’ve seen (that’s why people abuse them – e.g. students and military personnel).

  2. The reason I do the ADHD behavior of interrupting and speaking out of turn is that if I politely wait for my turn to speak I know I am going to forget what I was going to say and therefor loose the chance to say it, so sorry for the rudeness but I must interrupt and add my thoughts now. Sorry about that. The behavior is not impulsive, it’s adaptive.

    I have practiced holding the thought and waiting for the next person to finish yapping before speaking and have gotten better at it.

    • Darling, some people are boring and repetitive and deserve to be interrupted.

      Since when was interrupting people a disorder?

      Or even universally rude? You should hear the politicians on the radio debating each other in the UK. Rhetoric interrupts is the rule, not the exception.

      Drugging for some imagined standard of politeness? What happened there?

      What ever next? Drugging because you’re dressed in last years fashions?

    • “I have practiced holding the thought and waiting for the next person to finish yapping before speaking and have gotten better at it.”
      A lot of people have this “problem” and it’s completely normal. It’s by no way “hyperactive”.

  3. Logic ?? Check this out.

    Ritalin (and Adderall) logic: An imaginary conversation
    1. What do psychoactive drugs do?
    A: They change brain chemistry.

    2. Why do you want to change the brain chemistry of small children?
    A: Their brain chemistry is flawed.

    3. What biologically based test do you use to determine that this is so?
    A: We do not use such tests.

    4. Why not?
    A: There are no valid tests available.

    5. How then do you diagnose and prescribe?
    A: We use behavioral tests.

    6. Are you saying that merely by observing a child’s behavior you can tell exactly what problems he has with his or her brain chemistry and then prescribe the correct substance in the precise dose needed to correct it?

    Read more http://www.brasscheck.com/druggingkids/

  4. I hope one day the “mentally ill will realize the system that is keeping them down, perpetuating and reinforcing illness and stigma. What we really need is strength. We need to realize that trauma is the source of our differences. Our dissociation from ourself and our suppressed memories keep us afraid. Society keeps us afraid and ashamed of our trauma, of our anxiety. This fear of being different can escalate symptoms of mental illness. “Mental illness”

    It is designed to oppress us, take away out power, our voice. There is a cure. It is realizing there are suppressed memories. We have hidden these memories to protect ourselves, but once we realize how past traumas have influenced “symptoms” we can become whole.
    My mission is to find the cure to the Illness that does not exist.

    -Tru Harlow

    http://Www.curementalillness.wordpress.com