In a philosophically rigorous article published in Frontiers in Psychology, Spanish researcher Marino Pérez-Álvarez examines the logic of attention-deficit hyperactivity disorder (ADHD). The two-part analysis first deconstructs the rhetoric composing the diagnosis—including the symptoms and presumed causes of the “disorder.” Pérez-Álvarez then goes on to examine the philosophical bases of the diagnosis as it exists in society.
The researcher, from the University of Oviedo, Spain, has a background in logical theory, and provides specific examples of how the ADHD diagnosis violates the requirements for logically sound argument. His main point is that the reasoning is circular. As an example: If a child exhibits the behaviors that are agreed to constitute ADHD, then the child can be said to “have” ADHD, and by circular reasoning, therefore, the ADHD “causes” those behaviors. Pérez-Álvarez calls out this type of reasoning as illogical rhetoric.
However, he also asks: even if the reasoning is flawed, is there scientific evidence that the neurodevelopmental model is accurate?
His research finds that there is not. In fact, he writes that the general assumptions of genetic research on psychological health are flawed. The assumption that genetics can “cause” behaviors is not consistent with genetic theory. He writes, “The genome mediates adaptation and response to the environment; it does not cause response and adaptive action.” That is, behaviors are not “caused” by genetics. Behaviors are responses to the environment.
Pérez-Álvarez writes that this may help explain why psychiatric researchers include such caveats in their “conclusive” ADHD literature as:
- “ADHD-associated genomic variants are non-specific”
- “Genomic-wide searches have yet to identify a single candidate gene”
- “Specific genes or sets of genes causally linked to the disorder have yet to be discovered”
- “Genome-wide associations between ADHD and individual genetic variants have yet to be found”
- “The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history”
- “Findings from neurobiological research do not have a direct application in daily clinical practice”
Nonetheless, the same researchers who wrote these statements advocate the neurobiological model of ADHD, stating, for example, that there is “substantial evidence for a genetic origin of ADHD”—which Pérez-Álvarez argues is an illogical way of interpreting the conclusions above. In fact, that article is even titled “Moving toward causality in attention-deficit hyperactivity disorder” which is particularly misleading since the article reviews correlational evidence, not causal conclusions.
According to Pérez-Álvarez, the current direction in ADHD research—and in psychiatric research in general—is to use larger and larger samples in order to find smaller and smaller correlations. But he remarks that a tiny correlation that only shows up when you sample hundreds of thousands of people is not of any value to individual diagnosis.
He writes that researchers in psychiatry often work around the lack of evidence for their standpoint by arguing that “ADHD is a ‘heterogeneous,’ ‘multifactorial,’ or ‘complex’ disorder”—which may be true, but does not excuse researchers from the burden of showing data that can back up their claims.
Pérez-Álvarez also takes aim at the rhetoric of referring to brain-based findings as “bases” and “causes” rather than simple correlates. After all, “As studies show, the brains of taxi drivers and musicians show alterations in specific areas and connections associated with their activities compared to those who are not…” but those neural correlates are certainly not presumed to be the cause of driving taxis or playing the violin. Quite the opposite, in fact—those brain changes are understood to be results of those professions. So why do researchers assume that any brain differences detected when studying people that have been diagnosed are “causing” ADHD?
A key point made by Pérez-Álvarez is that although psychiatric diagnoses may be reliable—psychiatrists may agree on the criteria—there is no evidence that they are valid. Pérez-Álvarez quotes Thomas Insel (then Director of the National Institute of Mental Health) to make this point:
“The strength of each of the editions of DSM has been ‘reliability’—each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”
To further clarify the difference between reliability and validity, Pérez-Álvarez cites A. Marcia Angell, ex-director of the New England Journal of Medicine, who writes:
“If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be ‘reliable,’ but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers.”
It is important to note that Pérez-Álvarez also argues that ADHD is “real” inasmuch as “the diagnosis already functions as a “cultural idiom.” The construct of ADHD serves to explain a way of being in relation to others that is culturally unacceptable—namely, being more active, more distractible, and more impulsive than other children.
He writes that the diagnosis of ADHD fits perfectly in a long tradition of psychiatry selecting ways of being that are considered culturally invalid, selecting and exaggerating behaviors as “symptoms,” and creating a category or label that can serve as a self-reinforcing a priori concept.
According to Pérez-Álvarez, “Any problems related to “attention,” “activity,” and “impulsivity” are not outside learning as aspects of the development of self-control. Some children may require additional “training” (not treatment).” That is, diagnosing these traits as a “brain disorder” and medicating children only serves to prevent children from learning skills of self-regulation and maintaining attention. Pérez-Álvarez advocates methods of teaching children these skills as part of the developmental process, rather than pathologizing children for acting impulsively and inattentively.
Pérez-Álvarez writes, “Attention-Deficit/Hyperactivity Disorder harmonizes a variety of scientific, medical, educational and family interests besides pharmaceutical industry profits (the most openly shameless and rightly denounced). The only party harmed seems to be the children.”
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Pérez-Álvarez, M. (2017). The four causes of ADHD: Aristotle in the classroom. Front. Psychol. 8(928). doi: 10.3389/fpsyg.2017.00928 (Link)
thank you for sharing, peter. clear and to the point. perfect to share with the next friend to insist that her child has a biological disorder called adhd and requires mind-damaging drugs to treat it!
especially love maricia angell’s quote re freckles/cancer. shows clearly how ridiculous the dsm is!
great stuff, ty.
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Great summary. This guy has it all laid out in one article, but of course, logic is not part of psychiatric research, so the truth will have little to no impact on psychiatric practice or research.
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Exactly. The only logical thing left to do is to abolish psychiatry.
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Excellent blog, thank you. I loved this point, “‘The genome mediates adaptation and response to the environment; it does not cause response and adaptive action.’ That is, behaviors are not ’caused’ by genetics. Behaviors are responses to the environment.”
This points out the flaw in the logic of all the DSM disorders, as well. None of them are of “genetic” etiology. They are all caused by the environment. For example, the ADHD drugs and antidepressants can cause the “bipolar” behaviors. And the “bipolar” and “schizophrenia” drugs can cause the “schizophrenia” behaviors (via both neuroleptic induced deficit syndrome and anticholinergic toxidrome).
Today’s entire psychiatric system is about greed, and utilizing medical knowledge against any and all of those in our society who did not choose to study medicine, disguised as science. It truly is proof of betrayal by today’s medical community, against the rest of the population. How sad, especially in a country which is brainwashed, 24/7 on the boob tube, to trust in, and “ask your doctor.”
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If you look at ADHD as a syndrome with one or more of a number of causes, it won’t matter what psychiatric practice is, as long as GP’s with enough energy and investigative skill to study their cases in detail are available. Actually, I suspect GP’s are preferable to shrinks, being trained to deal with physical ailments (e.g., subclinical lead poisoning, nutrient deficiencies and dependencies, sugar addiction, etc.), that shrinks usually aren’t.
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“The researcher, from the University of Oviedo, Spain, has a background in logical theory, and provides specific examples of how the ADHD diagnosis violates the requirements for logically sound argument. His main point is that the reasoning is circular. As an example: If a child exhibits the behaviors that are agreed to constitute ADHD, then the child can be said to “have” ADHD, and by circular reasoning, therefore, the ADHD “causes” those behaviors. Pérez-Álvarez calls out this type of reasoning as illogical rhetoric.”
Or, to put it another way, if an academic researcher exhibits behaviours that are agreed to constitute Academic Research, then the academic researcher can be said to “have” [the quality of] academic research, and by “circular reasoning”, therefore, the Academic Research “causes” those behaviours. Pérez-Álvarez calls out this type of reasoning as illogical rhetoric.
The problem here is the style of analysis, which is in itself circular.
Almost all nouns can be processed under that style of analysis and the conclusion can then be reached that the noun is an example of illogical logic.
Whereas again, it isn’t so much “illogical logic” — an illogical, rhetorical coinage — but a kind of “autistic” failure to approach language itself as very different to algebra.
For me this is the first example of an academic attempt to codify a cultural meme. The one in which someone offers up a noun for ritual sacrifice, slaying it on the alter of “circular reasoning”.
But I do go along with the general gist. In that ADHD is a construct, in much the same way that Academic Researcher is a construct. In both cases the noun performs its incantational magic, bringing into being that which it calls into being.
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Great article Pete.
ADHD kids are perfectly normal in every way. Here is my hypothesis:
Hypothesis: Attention Deficit Hyperactive Disorder (ADHD)
Rev.4, 10-22-2016
ADHD is a behavioral anomaly, initiated by the Autonomic Nervous System (ANS), to facilitate the survival of the individual. The behavior is a Limbic System (unconscious) response, ordered by Primordial/Autonomic Emotion, to restore Dopamine (DA) homeostasis in the sensory areas of the brain.
Abnormally low dopamine levels in the sensory areas of the brain, degrades the most primitive human survival capability; the Fight or Flight Response. The ANS, sensing this threat to survival, initiates, supports and remembers unconsciously learned misbehaviors that increase systemic dopamine levels (a homeostasis restoration process).
Emotions that cause an increase of DA or DA derivatives in the sensory areas are fear,
stress, anxiety and depression. These unconscious behaviors, initiated by the ANS, cause the individual child/adult, to present behavior that is risky, obnoxious and socially un-acceptable. These behaviors present an outward appearance that could be mistaken as a disorder, but they are DA producing behaviors and are a form of self-medication.
The basic problem is unbalanced attention, which leads to a low dopamine level in the sensory area of the brain. When Involuntary attention (attending to external stimuli) exceeds Voluntary attention (memory retrieval), it leaves a DA deficit in the sensory areas. This condition causes the homeostasis restoration process to begin.
Processing external stimuli into long term memory decreases DA in the sensory areas, while memory retrieval replenishes DA into the system. Since all behavior initiates in the subconscious mind, appropriate psychotherapy techniques and life style changes, can be used to bring the sensory system into balance (homeostasis). Co-morbid low DA problems would also respond positively from a sensory system in homeostasis.
Several of the universal environmental changes affecting children and young adults are:
Increased use of electronic devices that demand their Involuntary attention and a increase in memory requirements (TV, Video games, Tablets etc.). Decreasing requirement for physical exercise (School Buses and fewer exercise opportunities) while in or out of school. The combined effect is impaired signaling within the brain (low DA levels).
Chester Germain Bush, MS.
Counseling and Human Development
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Hunter farmer…
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Trump
“We must embrace new and effective job-training approaches, including online courses, high school curriculums, and private-sector investment that prepare people for trade, manufacturing, technology, and other really well-paying jobs and careers. These kinds of options can be a positive alternative to a four-year degree. So many people go to college, four years, they don’t like it, they’re not necessarily good at it, but they’re good at other things, like fixing engines and building things. I see it all the time, and I’ve seen it — when I went to school, I saw it. I sat next to people that weren’t necessarily good students but they could take an engine apart blindfolded.” https://www.whitehouse.gov/the-press-office/2017/03/17/remarks-president-trump-roundtable-discussion-vocational-training-us-and
I am watching the news and next thing they might talk about is our “broken education system”.
Meanwhile I can learn about anything in the world right now by typing it into search on the upper right side of my screen.
What would I like to learn today ? How about how to build a rocket and land on the moon.
http://www.google.com/search?q=How+to+build+a+rocket+and+land+on+the+moon
About 9,230,000 results (0.80 seconds)
Education system is not broken, the internet is the most amazing education system ever built. And ADHD is a huge crock they WANT the population stupid. Its functioning just as they designed it too.
I am accused of so called ADHD and I was always smarter then most of my teachers. Lucky I am old enough to got out of school before the mass drugging began.
Amphetamines work, get high study and ace the test but you don’t retain all that detail you “mastered” studying high. Short term memory retainment boost. Its fake.
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Musing over whether ADHD is a bona-fide DSM condition, genetic or environmental in origin, misses the point. There are people whose distractibility, impulsivity, and inattention, interfere with the ability to learn. (Hyperactivity is less of a concern, being more a problem for the teacher than the child.) The truth is these people don’t fit into our current hyper-productivity culture, which can’t/won’t adapt to the learner. It is a real condition impacting current and future success in their world. We should put our energies into helping the child, and adult, to understand their behaviors and learning styles rather than insisting the condition doesn’t exist. Cognitive Behavioral (Developmental) Therapy, with or without assistance of medication for more difficult cases, is needed. If we don’t “call it what it is,” we won’t do what’s needed to help the child become a successful adult understanding what makes them unique, with special skills they can call on to succeed in the future.
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Wow! thanks for sharing this information, what you said is absolutely true. You really made widen our knowledge about ADHD. People like me who don’t really have an idea about this feels like we are able to reach those people who have ADHD. So, THANKS and more POWER.
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