Would Finding A Biomarker For ADHD Actually Help Anyone?

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In The Lancet Psychiatry, psychiatrists Ilina Singh and Simon Wessely discuss the current, controversial state of understanding of ADHD, and ask whether finding a biomarker for ADHD would actually be a good thing if it happened.

“One way of answering this question is to see psychiatry as an essentially vulnerable science, poised as it is on the boundaries of medicine, mind, and society,” the authors write. “On this contested ground, psychiatry has only imprecise methods to provide proof that its medical description of what is going on with a child is the right description. In this sense, psychiatry is continuously battling diagnostic uncertainty. In many other disease categories, but in by no means all, validated biological markers — biomarkers — can inform diagnosis and authorise the medical account of disease. These biomarkers can also be problematic — there are false positives in cancer and shifting thresholds in heart disease. But ideally, biomarkers in these specialties provide some account of what is going on under the skin, enabling better predictive algorithms and treatment strategies. Psychiatry has yet to discover, let alone use, well established biomarkers in diagnosis and treatment—or when it does, as for example in the case of neurosyphilis, the problem suddenly ceases to be psychiatric.”

Yet would biomarkers indicating the definitive presence of an actual “ADHD” disorder truly help anyone? Perhaps not, suggest the authors. “It is also worth considering that biomarkers do not resolve the ethical concern about the diagnosis of ADHD as a violation of childhood: should this particular set of childhood behaviours or capacities be labelled a medical disorder requiring observation or intervention? This aspect of the problem of diagnostic uncertainty in ADHD is not about whether or not the diagnosis is correct; it is more fundamentally about whether or not medical diagnosis is the right thing to do. From this perspective, biomarker evidence might contribute to better (that is, more accurate) diagnosis of ADHD, but clinicians might also get better at doing the wrong thing.”

Singh, Ilina, and Simon Wessely. “Childhood: A Suitable Case for Treatment?” The Lancet Psychiatry, June 2015. doi:10.1016/S2215-0366(15)00106-6. (Full text with registration)

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3 COMMENTS

  1. I personally believe it is morally repugnant to claim the typical behaviors of a healthy, intelligent and active little boy are a mental illness. And it’s even more morally repugnant to force medicate such children with stimulants. Since every person with a brain in their head knows, and has known long prior to ADHD even being voted into the DSM as a disorder, that long term use of stimulents is bad for a person’s health. I am truly amazed and disgusted that today’s medical community claims largely to be unaware of this slice of, what I had thought was, common sense.

  2. Wow, another little dose of sanity from the world of psychiatry. I think that’s twice in less than a week! It is rare that anyone in the profession appears to pose the correct question, which in this case can be formulated as: “Does the fact that you are inconvenient for your teachers and other adults in your life mean there is something wrong with you?”

  3. Unbelievable! The question posed by these two ADHD researchers is troubling, given that their ultimate goal should be to discover the underpinnings of the ADHD problem. It has been 113 years since Dr. George F. Still pointed out that there was a behavior problem in a small group of normal children. He called it a problem of ‘ moral control’. as research continued through the years, the moral control notion gave way to the “minimal brain damage” (MBD) idea. When MBD could not be found, attention deficit was thought to be the cause (ADD). After stimulant medication was found to give temporary relief to the inattention problem, it was noticed that a certain amount hyperactivity had entered the condition. Not to worry, just add an H to the definition and you have it(ADHD). But wait; not all kids fit this description….. that’s easy, just add a few sub-types. Anyone who deals with children with ‘so called’ ADHD knows that they have too much attention, not a deficit of attention. Sometimes they try to attend to everything in their environment (distracted) and sometimes they zero in on something of interest and pour all of their attention on that one thing (fixated). Sometimes they appear to be attending to something unconsciously (inattentive).

    So, do we need a bio marker for ADHD? That would be great, but first and foremost, we need to know WHAT IS CAUSING THE PROBLEM IN 10% OF OUR CHILDREN. A bio marker for something we do not yet understand, would not be very helpful.