A new article, just published online in the journal Emotional and Behavioural Difficulties, presents research suggesting that the diagnosis of ADHD is philosophically inadequate, fails to explain the complexity of children’s experiences, and may actually increase the distress experienced by children in the long run.
“ADHD, however adequate it may seem, is founded on inadequate knowledge,” the researchers write, “and the legitimacy of the individual diagnosis should, therefore, be questioned on the grounds that on a long term scale it is passivizing and stigmatizing rather than liberating.”
The researchers, Mattias Nilsson Sjöberg and Johan Dahlbeck, note that “Despite enormous amounts of medical research on ADHD it remains a fact that ‘[n]o biological marker is diagnostic for ADHD’. Accordingly, it is somewhat paradoxical that the same diagnostic manual deﬁnes ADHD as a neurodevelopmental disorder.”
However, they argue that “Diagnosis—however inadequate—may oﬀer a kind of defense against mental distress (pain/sadness).” From this standpoint, they suggest that the most important question pertaining to ADHD is “Whose pain is primarily addressed?”
The evidence, according to the researchers, is that it is the distress of others—teachers and parents—that is being soothed via the diagnosis, rather than the distress of children themselves.
To make their point, the researchers cite a statement concerning ‘ADHD’ by the Swedish National Board of Health and Welfare:
“Parents who experience that their children are difficult to manage, without understanding why, are relieved when given a diagnosis and information about what it means. The diagnosis provides a name for the difficulties of the child and makes it easier for parents to acquire knowledge and to come in contact with others with similar experiences.”
Sjöberg and Dahlbeck summarize this: Children are considered to have the disorder if others (primarily teachers and parents) complain that the child does not focus attentively enough, sit still enough, or even play quietly enough. According to this guideline, diagnosis is effective because it provides an explanation, to others, regarding why the child does not meet the demands of the parent. For instance, if a child is playing loudly and running around, perhaps even at times the parent considers inappropriate, this can now be explained as a “disorder.”
Thus, as Sjöberg and Dahlbeck explain, the diagnosis of ADHD does not help the child so much as it provides an explanation to those who find the child’s behavior intolerable. Indeed, the authors state that “The labeling tends to target and beneﬁt parents and other people in the child’s immediate environment rather than the child.”
The researchers cite studies that demonstrate the ways diagnosis helps parents and teachers make sense of the child’s behavior, while children themselves tend to try to distance themselves from the diagnosis. According to research on children’s experiences of ADHD diagnosis, they tend to feel that the diagnosis does not adequately explain or label their experience. Additionally, each individual child with the ADHD diagnosis may have a very different way of interacting with the world and may exhibit different symptoms. In this way, the diagnosis is inadequate for explaining the difficulties children experience.
Research has shown that the diagnosis of ADHD is most commonly given to the youngest children in the classroom. Despite the fact that these children are at a developmentally different stage, they are pathologized as having a mental illness. Children given the diagnosis are often given a diagnosis and medicated although they might be more energetic or simply younger than others.
It is also important to note that outcome research shows that stimulant medications do not result in better long-term outcomes for children. In some cases, medicated children had worse outcomes and far more adverse effects than children who did not receive treatment.
In terms of stigmatization and disempowerment, the psychiatric argument holds that biomedical explanations reduce blame by indicating that the child is not responsible for their behavior if they have the “disorder.” However, research has found that these explanations actually increase stigma and self-blame because they localize the problem within a damaged brain—essentially telling children that they are fundamentally broken individuals.
The diagnosis of ADHD has been increasingly criticized for many years. This year, in particular, has included calls for the retraction of misleading research falsely purporting to show a biological cause. Indeed, Keith Conners, the very researcher who performed the initial research into ADHD medications was a leader at criticizing the diagnosis. In addition, Allen Frances, who played a role in codifying ADHD as a mental health illness, has also been a powerful voice critiquing the diagnosis, especially the rampant overdiagnosis and overmedication of children that has accompanied it. Researchers have even argued that the diagnosis does not meet the DSM’s own criteria for a “disorder.”
The current researchers assert that rather than reducing the distress of children, the ADHD diagnosis soothes parents and teachers, but leaves children stigmatized and disempowered.
Sjöberg, M. N., & Dahlbeck, J. (2017). The inadequacy of ADHD: a philosophical contribution. Emotional and Behavioural Difficulties, doi: 10.1080/13632752.2017.1361709 (Link)