Textbooks Provide Misleading Information on the Neurobiology of ADHD

Peter Simons
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People expect textbooks to provide trainees in medicine and psychiatry with up-to-date information about biological illnesses. However, when it comes to ADHD, some researchers suggest that textbooks provide inaccurate and misleading information.

Researchers in the Netherlands, led by Sanne te Meerman at Hanze University of Applied Sciences, wanted to discover how textbooks portrayed the neurobiology of ADHD. According to the authors:

“This study has clarified that one of the premises of the worldwide prescription of psychostimulants and medical treatment of ADHD — abnormally developing brains — is far too simplistic, yet it is often presented in this fashion in academic textbooks.”

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They examined 43 textbooks that were currently in use by universities in the Netherlands. The researchers analyzed the language used to describe the neurobiology of ADHD, and whether this comported with the current state of scientific evidence.

The Current Scientific Consensus

The current scientific consensus regarding the neurobiology of ADHD is exemplified by the response in the research community to the publication of a 2017 study in the top-tier medical journal Lancet Psychiatry, which overstated its conclusion that ADHD is a brain disorder.

That study, by Martine Hoogman and other researchers, included statistical errors as well as misleading statements about the results. This led to intense scrutiny by expert researchers such as Allen Frances (chair of the DSM-IV task force) and Keith Conners (who performed pioneering research on methylphenidate, and after whom the Conners scale for ADHD diagnosis is named).

Ultimately, after researchers circulated a petition to retract the article, Lancet Psychiatry decided to devote an entire issue of their journal to researchers rebutting the claims made in the original article.

The researchers in the original article claimed to find brain volume differences between children with ADHD and “healthy controls.” However, the articles written in the follow-up issue illuminated the errors in that research.

For instance, Allen Frances wrote a response in Lancet Psychiatry with Sanne te Meerman and Laura Batstra, as well as Keith Conners. They state that the conclusion reached by Hoogman was “wildly speculative and dangerously misleading at a time when ADHD is already overdiagnosed and overtreated with medication in high-income and middle-income countries.”

Firstly, the brain differences were only found during certain developmental periods—once the children reached adulthood, any brain differences disappeared. Secondly, when researchers controlled for IQ, the brain differences disappeared, meaning that they were not associated with ADHD independently of intelligence. Thirdly, there was a 95% overlap in brain volume between the two groups. Only a few outliers in each group were responsible for the statistically significant difference.

Researchers, after re-analyzing the data, wrote in Lancet Psychiatry, “We found no significant difference between individuals with ADHD and those in the control group in any of the investigated areas of the brain when IQ difference is controlled for.”

What’s in the Textbooks?

In the current study, te Meerman and the other researchers found that 58% of the textbooks had only fully overgeneralized claims and unsupported statements about the neurobiology of ADHD. Some further textbooks included disclaimers or nuanced statements but still relied on overgeneralized statements that were not fully supported by scientific evidence.

Only one textbook chapter admitted that identifying brain volume differences was diagnostically meaningless. None of the textbooks mentioned the methodological limitations in the neurobiological research they discussed.

te Meerman suggests that “journalists and researchers may have mutual benefits for simplifying and overstating findings. These benefits include standing out amidst the fierce competition for publications and readership among authors, scientific journals and newspapers. However, such dissemination has important implications for influencing how audiences, such as parents, teachers and (health care) professionals, perceive and respond to children’s behavior.”

After all, studies (including this one in Lancet Psychiatry) have found that the youngest children in a classroom are much more likely to be given a diagnosis of ADHD—and to receive psychiatric drugs—most likely due to the age-related stage of development. Children who are almost a year younger than their peers are often compared to other children in their classroom without regard to a 10- or 11-month difference in maturity. te Meerman writes:

“These studies illustrate how educational structures, such as combining children who differ in age up to a year into groups, can contribute to interpreting age‐related variation of behaviors as indicative of a disorder, which often results in them receiving potentially dangerous psychotropic drugs.”

 

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te Meerman, S., Batstra, L., Freedman, J. E., Hoekstra, R., & Grietens, H. (2019). ADHD and brain anatomy: What do academic textbooks used in the Netherlands tell students? Children & Society. doi:10.1111/chso.12362 (Link)

4 COMMENTS

  1. Teachers are getting more demanding about children’s behaviour. I believe it is a complex situation. Teachers today have been reared on and by technology, many want to go home and text their friends, many kids want to go home and play video games. Perhaps both teachers and kids brains are somewhat wired in a unique manner by technology. Teachers and parents have been taught that unruly children have ADHD, and that there are pills for that. Because after all, EACH child is meant to ‘learn’, each child is meant to sit there and be obedient to the boring stuff that is not quite as interesting as recess and games. Long ago, unruly kids existed, antsy kids existed, the method to control was a smack, or tell the parents who then smacked. The kid learned that in order not to get smacked or disciplined, he sits there and listens or pretends to listen. It’s too easy now, you give them a pill, because of their antsy ‘disorder’. Nothing ever changes, we are all supposed to follow in line and if we don’t, we are disordered. It was a system that stunk then and reeks now. If someone believes that a child should be interested in exactly what is presented to him, that belief is ludicrous. We developed an institutional system for kids and adults alike, and we all dislike it, but there is always a pill for it. I used to give my son a ‘mental health’ day here and there, many parents disliked me, since their kids asked for one also. My kids fell in line perfectly with the system, fine model citizens.

  2. Anyone who thinks force feeding children, drugs which are chemically identical to cocaine, is stupid or evil. Let’s be real. The psychiatric defamation and drugging of children needs to end.

    Thank God, I already knew about the fraud of psychiatry, when an insane school social worker came after my child. Because he’d healed from child abuse, and gone from remedial reading, after the abuse, to getting 100% on his state standardized tests.

    Kill the intelligent American Christian children, is the goal of our insane “mental health” and social workers. Eliminate the potential competition, prior to them even growing up. How disgusting can psychiatry, psychology, and their many DSM deluded “mental health” and social worker minion, get?

    Stop all the psychiatric drugging of children!

  3. What is endlessly frustrating is that Pharma gets to promote bogus pseudoscience and we are expected to disprove it with real science. All that was ever known about ADHD is that some incorrigible elementary school kids were calmer in the classroom when given amphetamine. How did this spin into the “inattentive” but well behaved child, and then to the whole family?