In this concluding video in my 12-part video series ”The Myth of the ADHD Child,” I examine the question ”Does ADHD even exist?” I approach this question from several angles, including the questions: ”Do ADHD symptoms exist?” (yes, they do), ”Does ADHD exist as a de facto disorder?” (yes, it does, it’s in the DSM), ”Does ADHD exist as an absolute truth? (no, it has changed names and definitions too many times over the past 120 years), and ”Does ADHD exist as a paradigm?” (yes, but that is bound to change).
I define the word ”paradigm” as a world view with its own terminology, experts, technologies, tools, and methodologies. To explain how they develop, I turn to Dr. Thomas Kuhn’s ideas about how scientific revolutions occur, and how science doesn’t proceed slowly over time toward closer and closer approximations to ”the truth” but rather that they are relatively stable but then as anomalies begin to pile up that don’t agree with them, the tension grows and suddenly a scientific revolution occurs and a new paradigm takes the place of the old one. I suggest that this is what the ADHD paradigm will face eventually.
I explain some of the anomalies that don’t fit into the ADHD paradigm , including many of the issues raised in this video series, such as the research finding that children diagnosed with ADHD have normally developing brains but that they develop 2-3 years later than neurotypical kids. I also talk about Dr. Richard Saul’s book ”ADHD Does Not Exist,” and describe his thesis that what seems to be ADHD can be accounted for by other existing health disorders such as vision or hearing problems, a mood or anxiety disorder, learning disabilities, or a sleep disorder, among others.
I reflect on how interesting it is that both Dr. Saul and myself have critiqued the ADHD paradigm, but from totally different points of view and that together our raising of anomalies provides a strong critique of the powerful forces that sustain belief in ADHD as a discrete medical disorder, and provide hope that eventually a more holistic paradigm will emerge to explain the behaviors of hyperactivity, distractability, and impulsivity.
Transcript of Video
Hi, I’m Dr. Thomas Armstrong. This is part 12 of my 12-part video series on The Myth of the ADHD Child. This video is entitled ‘’Does ADHD Even Exist?’’
I believe after 50 years of studying this issue, that the hypothesis that there is a specific medical disorder called ADHD causing the symptoms of hyperactivity, distractibility, and impulsivity is wrong and there are many other situations and conditions that can account for these symptoms. The videos in this series describe some of these perspectives. In this concluding video, I look at the somewhat heretical question of whether ADHD even exists in the first place.
I’d like to look at this question in terms of several propositions. First, does ADHD exist as a set of symptoms?
Clearly the symptoms are real. I worked with these kids for several years in the U.S. and Canada in special education programs, and I encountered these behaviors – hyperactivity, impulsivity, distractibility, forgetfulness, and other symptoms firsthand. As one ADHD expert, Edward Hallowell puts it, ‘’the evidence is as plain as the nose on your face.’’
So, yes, as a set of symptoms ADHD does exist. This is important to point out because sometimes people think that because I wrote a book called The Myth of the ADHD Child, that I believe there are only focused, relaxed, obedient, organized, reflective children out there. I’d have to be a real bozo to believe that.
Second, does ADHD exist as a de facto disorder? De facto means ‘’ in fact, or in effect, whether by right or not.’’
Here’s a shot of the Diagnostic and Statistical Manual [slide 7] – the bible of psychiatry– comparing passages from the DSM IV with those from the DSM V. Clearly, as a matter of fact (whether you agree with it or not) ADHD does exist in this medical institutional context.
So, yes, ADHD does exist as a de facto disorder. Now how about the question: does ADHD exist as an ultimate truth. In other words, does it really exist, has it existed in the past and will it continue to exist in the future?
Here I think we’re on shaky ground. ADHD as a term is only about forty years old. Before that, there were all sorts of labels and ideas, and the numbers of kids folded into each definition was quite small compared with the millions of kids we have now. Even today, the World Health Organization has its own version of the DSM called the ICD (International Classification of Diseases), which doesn’t even used the term ADHD and has different criteria for a diagnosis. So, I’m not sure we can say that ADHD exists as an absolute truth. That’s one of the senses in which I believe ADHD is a myth.
So, I’m going to say, no on this one, ADHD doesn’t represent some ultimate truth that is out there in the ozone somewhere. Rather it seems to be a product of its times and changes its definitions and terminology over the course of time. In that sense, it’s a somewhat unstable concept.
Now this last one is the most intriguing question of all. Does ADHD exist as a paradigm? You might be thinking, what’s a paradigm? I’ll spend a little time on this so you can see where I’m going with it.
To help explain the idea of a paradigm, I turn to the ideas of Thomas S. Kuhn, a philosopher of science, and author of The Structure of Scientific Revolutions, one of the most important books of the twentieth century, who took the word ‘’paradigm’’ and pretty much put it on the map so to speak both in his own discipline – the history of science– and in many other disciplines as diverse as business, education, physics, and mental health.
A paradigm by definition is ‘’a framework containing the basic assumptions, ways of thinking, and methodology that are commonly accepted by members of a scientific community.’’ It’s the whole ‘’world view’’ that a group of thinkers has about a topic. It might be about the law of gravity, the theory of macro-economics, or the existence of ADHD.
As far as ADHD being a paradigmatic issue, in 2021, over sixty ADHD experts signed a consensus statement on the state-of-the-art with respect to ADHD. This document seems to provide a good illustration of an ADHD paradigm if we could put it like that. ADHD has its own assumptions, its own ways of thinking, and its own methodologies that differ from, for example, other paradigmatic models such as Copernicus’ heliocentric idea of the earth revolving around the sun. These may seem like two totally different paradigms, and they are, but each has its own set of terms or nomenclature, its own experts, its own body of work, its own ways of doing research and so on. And we’ll come back to Copernicus a little later in this video.
Thomas Kuhn’s most important contribution to culture is probably his view of how scientific revolutions occur. For most people, a scientific revolution (like Newton’s law of gravity) occurs when scientists come up with a brand-new truth that matches the way the world really works. This is the sense I had in mind when I asked the question ‘’does ADHD exist as an actual truth?’’ But Kuhn, as a philosopher of the history of science, did not believe that science follows a pathway that gradually leads over time to greater and greater approximations of the truth. In this respect, he was quite a radical for his time, because, as I said, most people think of science in that way. According to Kuhn, science operates in terms of a sequence of ‘’paradigms.’’
Scientists work within the auspices of one particular paradigm – they share common methods of research, ask the same kinds of questions, work on the same kinds of experiments, and so forth. And this process of working inside a paradigm Kuhn calls ‘’normal science.’’ So, here’s this paradigm with all these normal scientists working within it [see slide 15] and accepting a basic understanding of a world view with respect to it. But not everyone goes along with the existing paradigm. Some scientists come up with data that doesn’t square with the existing paradigm – they find anomalies that don’t fit in. And the reaction of the normal scientists are to deny, defy, ignore, isolate, and in other ways discredit these so-called heretics, so that the normal scientists can keep the paradigm just the way it is.
Over time, however, the anomalies begin to start accumulating from different laboratories or individual scientists.
And still more anomalies come up challenging the basic assumptions of the existing paradigm.
And eventually, there are so many shards of data, or points of view, or ideas that conflict with the assumptions of the existing paradigm, that something remarkably unexpected happens.
A scientific revolution occurs. And the existing paradigm is destabilized and there is a brief period of much consternation, confusion, and instability. But fairly quickly, as the dust begins to settle, something new and stable comes out of all of that confusion . . .
. . . a new paradigm is born, with a new set of assumptions, a new set of beliefs, a new set of terminologies, a new collection of assessments, and other tools and theories that support the new paradigm. New groups of scientists take on the role of servicing the new paradigm through their ‘’normal science’’ and many of these are in fact the old scientists who’ve converted their beliefs during or after the revolution either because they wanted to save their careers, or because they genuinely began to see and think in a new way.
So, does ADHD exist as a paradigm? Yes, but with a proviso. ADHD seems to be the reigning paradigm for explaining why some kids are hyperactive, distractible, and/or impulsive. But it’s existence can be predicted to be temporary. Because, according to Kuhn’s model, other paradigms will come along to supplant it, and a new paradigm will be born to explain the same behaviors.
Right now, the ADHD paradigm is quite strong, but as you probably notice in the graphic, there are those who have detected anomalies in it, including yours truly.
In 1995 I wrote a book The Myth of the ADD Child and in 2017 I substantially updated and revised it with the new title The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels, or Coercion.
In the book I pointed out many anomalies with respect to the ADHD paradigm, several of which I’ve covered in this 12-part video series on The Myth of the ADHD Child. For example, in video #2, I noted research suggesting that the brains of kids diagnosed with ADHD develop normally, but 2 or 3 years later than neuro-typical kids. This helps explain why these kids show hyperactivity, distractible and impulsive. They’re acting like younger kids, and they’re doing it at a time in our culture where we’re expecting more mature behavior at earlier and earlier ages (kindergartners, for example, are doing worksheets instead of playing), making these kids with delayed brains caught between a rock and a hard place. So, this is an anomaly that doesn’t square with the ADHD paradigm which is based on the idea of disorder, dysfunction, and/or deficit in these kids’ brains. Similarly, as you see from this slide, I’ve offered several other anomalies that clash with the reigning ADHD paradigm, and these are all covered in my 12-part video series.
I should note, however, that I’m not the only ”heretic” in the field pointing out anomalies to the ADHD paradigm. There are many of us out there, but I want to point out one person in particular who has critiqued the ADHD paradigm in a way that’s amazingly totally different from the way I did it. He, thus, has not echoed my own criticisms, but added new ideas to the mix.
His name is Richard Saul. He’s an MD, a behavioral neurologist who has practiced medicine for over fifty years, and he wrote a book in 2014 called ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder. You couldn’t say it any plainer than that. But as I said, his reasons for believing this are entirely different from my own criticisms of the paradigm.
He believes that what looks like the symptoms of ADHD are in fact due to one or more of a long list of other health conditions that DO have validity in his estimation. What people call ADHD, according to Saul, could be vision or hearing problems, a sleep disorder, a mood disorder, learning disabilities, and/or several other conditions.
Now the normal scientists who support the ADHD paradigm have a rather clever way of dealing with this claim. They say that ADHD exists and so does, in some kids, a sleep disorder, or in another child, a mood disorder, or in other children, an anxiety disorder or Tourette’s syndrome. Following the disease-based medical model, they call the idea that you can have two or more disorders at the same time ‘’co-morbidities.’’
Now, of course, this is just common sense. A person can have the Covid virus and also the RSV virus. But Saul is suggesting that if you have a mood disorder, for example, you won’t be able to focus your attention for very long, are likely to be restless or hyperactive and display other symptoms associated with ADHD. So, to critique the idea of ‘’co-morbidity’’ for a moment, we can ask where does the mood disorder leave off and the ADHD begin? This Venn diagram suggests the interpenetration of different disorders with ADHD.
I said I’d come back to Copernicus. Copernicus, of course was famous for his own scientific revolution. Before his time, people thought that the sun, the planets, and the stars revolved around the earth – a geocentric model of the solar system. The trouble with this paradigm was that the planets’ motions did not fit in with the data supporting the idea of the earth being the center of the universe. The planets movements were erratic. Well, along comes Alexandrian mathematician and astronomer Claudius Ptolemy in the second century of the common era, and he creates these secondary revolutions, almost as if each planet was a ballerina or something executing a pirouette in what he called an ‘’epicycle’’ or tiny orbit on its wider orbit around the earth. In this way he was able to square the data and keep people believing in the Geocentric paradigm for another 1300 years.
I bring this up, because this diagram of Ptolemy’s epicycles [slide 28] looks a little like the co-morbid diagram that I just showed you [slide 30]. Of course. there’s absolutely no relation between these two graphic depictions, except in the sense that you have in both cases, an attempt to shore up an existing paradigm with a ‘’make do’’ intervention to keep the existing paradigm rolling. So, instead of rejecting the ADHD paradigm,and saying something like ‘’it’s actually depression that makes him inattentive,’’ people can just say, oh yah, there are these other co-morbid conditions that intersect with ADHD. That should keep this paradigm going along for another few years at least!
Now I want to approach the theme of this video ‘’Does ADHD even exist’’ from a slightly different angle. I want you to imagine that the 100 boys and girls depicted on this graph [slide 31] are representative of all the children who have been diagnosed with ADHD in the country. Now, let’s say that I’m a doctor who’s had an extensive transdisciplinary background, and that I’m trained in developmental pediatrics, with additional training in gender studies, media studies, sociology, and a few other fields as well. Just as an aside, that’s the problem with doctors – they don’t have this transdisciplinary background and tend to see things in terms of just the medical model which is primarily based on disease and drugs. That’s another thing that keeps the ADHD paradigm rolling along. But let’s get back to our 100 boys and girls.
Now let’s say that of this group of 100 children diagnosed with ADHD, 10% of them look like they have ADHD, but it’s only because their brains tend to mature a little later than the average child. Since they don’t actually have ADHD (I suppose you could say they were ‘’misdiagnosed’’), we’ll take them out of the frame.
Now let’s say another 10% of the group show ADHD symptoms because they have to sit in classrooms for hours at a time listening to lectures, doing boring worksheets and the like. Now we’re down to 80 kids.
Now let’s say that of the original 100 boys and girls 10% of them show ADHD-like symptoms because they’ve had traumas in their past, which are now referred to as Adverse Childhood Experiences (I dedicated a whole video to ACEs in this series). Another 10 kids disappear from our group. I should mention here that I’m using very low percentages for each of these scenarios – it’s likely that there’s a much larger proportion of kids involved in each of these situations.
Now let’s say that 10% of the original group show ADHD-like symptoms because their brains’ dopaminergic systems have been dysregulated due to intense media exposure (the average for a teen today is seven hours of screen time not counting computer use in the schools). We’ve got 60 kids left.
Now let’s say 15% of the original group show ‘’all boy behavior’’ that simply looked like ADHD but was simply due to normal gender differences.
Another 10% of kids show ADHD-like behaviors and wouldn’t qualify if they only had a better diet, played more often, got out in nature more often, and got plenty of sunshine (with sun blocker, of course). You can see how small our group is getting.
Then let’s say that another 10% of these kids aren’t disordered at all, they’re better viewed in terms of being neurodivergent. They’re like the calla lily. You don’t say a calla lily has ‘’petal deficit disorder,’’ do you, but you just appreciate their uniqueness, their freshness, their originality. Now we’re down to 25 kids.
Then let’s say another 10% of kids show symptoms of hyperactivity, distractibility, and impulsivity because they’re highly creative and these symptoms are characteristic of highly creative individuals.
Finally, let’s say that 15% of the original group of 100 don’t have ADHD, but instead one or more of these other health conditions surveyed by Dr. Richard Saul, such as vision problems, mood disorders, learning disabilities, Tourette’s syndrome and ASD, whose symptoms mimic those of ADHD. What are we left with? No one!
It’s a little bit like Russian dolls. The largest one is the existing ADHD paradigm as it is today and the 6 million kids who’ve been diagnosed with ADHD in the United States. You open the doll and there’s a smaller one inside. Open that one, and an even smaller doll is revealed. Just like the Russian dolls, one begins to screen out individuals who look like they have ADHD but where other things are going on, and the group gets smaller and smaller, until finally there’s hardly anyone left if any. Maybe, just maybe, there are a couple of kids who do truly qualify for ADHD, but it would be at best a miniscule percentage of the total group of kids who are labeled as ADHD. This is why I ask the question, ‘’does ADHD even exist?’’ I leave you with that to think about.
For more information about the ideas in this video and other themes in this 12-part video series, see my book The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span without Drugs, Labels, or Coercion. It’s available through online stores like Amazon, national chains like Barnes and Noble, and independent bookstores worldwide. It’s also available as an audio recording on Audible. Also, get my book for teachers, ADD/ADHD Alternatives in the Classroom. And make sure to watch my other videos in this series on You Tube. Thanks so much for watching and listening!
This blog post was brought to you by Thomas Armstrong, Ph.D. and www.institute4learning.com.
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