Chapter Two

A Minority Opinion

Do most doctors agree that Attention Deficit Hyperactivity Disorder is a proper diagnosis? Only in America. There the general view is that it is only mavericks who disagree. However, outside of Canada and the United States, very few doctors make the diagnosis at all. On the European continent they won’t touch it with a ten foot stethoscope.

Furthermore, in America, there are many senior clinicians who question the validity of the ADD/ADHD category. Some, like myself, have been doing so for over a decade now. Though this questioning has appeared in the medical literature, it is only lately that this concern has begun to reach the public.

As far back as 1976 Shrag and Divorky, in their book The Myth of the Hyperactive Child, trace the origin of the diagnosis to advertising campaigns run by drug companies which manufacture cures for such behavioral disorders. They say that with ADD the cure preceded the ailment. As we shall see later, this approach is a most unusual way for a new medical diagnosis to emerge. (See Shrag and Divorky, The Myth of the Hyperactive Child, New York: Pantheon, 1976.)

Weinberg and Bromberg, contributing to a consensus article entitled “The Professor’s Opinion,” state unequivocally that “the diagnostic category ADHD is a myth.” Offering another opinion in the same article, Golden says: “Even if the condition exists, it is probably much less common than is diagnosed in practice.” (See Weinberg and Bromberg, “An Analysis of the Legal Issues Surrounding the Forced Use of Ritalin: Protecting the Child’s Right to ‘Just Say No’,” New England Law Review, 27, 1173+.)

In yet a third “Professor’s Opinion” in the same issue, Levine comments that “at a time when professionals contend with a perceived epidemic of ADHD it is indeed ironic that such a low level of agreement regarding the conditions identity as a discrete entity, its precise manifestations, its mechanisms, and its diagnostic criteria exists.”

Despite these grave dissents, ADHD has grown like topsy. The diagnosis has become a waste basket into which any misbehaving child can be tossed.

Some children proved not to fit too well into that basket. How did the American Psychiatric Association deal with this? Since the children wouldn't fit the category, they refitted the category to accommodate the children.

In each new version of the Diagnostic and Statistical Manual they modified to criteria by which the diagnosis was made. So it is the DSM III criteria are not the same as those in DSM IIIR. Nor are these the same as DSM IV. With check list diagnoses it’s easy to alter the criteria. You just change the questions on the check list.

As the Attention Deficit waste basket became the repository of all these variegated fruits and vegetables, the American Psychiatric Association decided to divide their big basket into a lot of little baskets. Never at a loss for nomenclature, the committee gave each of these little baskets its own name. Here’s the current roll call of those baskets:

o        Plain vanilla ADHD

o        ADHD Combined Type

o        ADHD Predominantly Hyperactive-Impulsive Type

o        ADHD Predominantly Inattentive Type

o        ADHD Not Otherwise Specified Type.

You know what will be probably be coming in DSM V, don't you?

ADHD Normal Child Type

If, despite this wide choice of baskets to choose from, some children still show bits and pieces of other disorders, these are explained away by calling them Co-morbid conditions. It is clear that Attention Deficit Hyperactivity Disorder has become a one size fits all diagnosis -- which makes it a win-win situation for lazy doctors and a lose-lose situation for lively kids.

The committee members at the American Psychiatric Association, the group responsible for these categories, should realize that all this patching up is losing its capacity to obfuscate. As it becomes less politically incorrect to do so, more and more doctors are emerging from their storm cellars to express some doubts about the situation. All these doctors dare do so far is to agree that Ritalin is being over-prescribed. However, sooner or later it’s bound to occur to them that faulty prescribing is a result of faulty diagnosing, and they may be ready for the next step in their understanding.

To understand this situation properly we need now to take a short look at the history that led to the creation of this label and ultimately to its explosion, like a super-nova, upon the innocent heads of North American parents and children.