Does ADHD exist?

I often receive emails questioning with my point that ADHD is a 'made up' disorder. Here's my response in case you have the same question...


I'm not sure how exactly we're in disagreement here. Is it to do with the use of the term 'ADHD' in itself?

Well, I have had people write to me and say, "What does it matter what we call it?" And I understand what they mean. I think. But it seems to me that the crucial point is that it's NOT an 'it'! And, while there may be many cases where a nominalisation maquerading as a concrete entity can be thought of as a matter of 'semantics' and it doesn't really matter, 'ADHD' isn't one of them. Too many dangerous consequences.

Anyway, how could I try to explain this?

Supposing we look at all the people who have sleep problems. There seem to be many more of such people around in these fast-paced times than there were in the slower days of yesteryear - so, it could be said that, as is alleged with so-called 'ADHD', it was a 'hidden problem' that's now grown into an epidemic over the past decade or two because people have been made more aware of it. That would make sense to a cursory glance at least. Even if it's not true.

Sleep problems could perhaps include lack of sleep, difficulty getting
to sleep, or poor quality of sleep. So the problem has several different forms.

The actual reasons why an individual person would have one or more of those forms of sleep problem could, however, run into dozens, if not hundreds - anxiety about a relationship, pressure at work, too much late night carousing, and so on. Any one or a combination of several.

Somewhere in amongst all the possibilities, there would probably be
some medical reasons.

If these sleep problems were to become long term, it would follow
naturally that many of the people with these problems would ultimately find it difficult to function in the world, and some would become a genuine danger to themselves and others. Thus we have a whole bunch of people who need help.

Now, supposing a private club of medical practitioners decided that it would suit them if all the individual reasons for people having a sleep problem were brought together into one single reason. It would be so much easier (not necessarily better, just easier) if, rather than trying to solve each individual's specific sleep problem it could be solved with the application of something general. Like, for example, a potion that will put *anyone* to sleep, whatever form of sleep problem they have, whatever the reason is for that sleep problem or, indeed, whether they have a sleep problem or not.

So we need a single identifier for all these people we want to help. We can't really call them "People who have a problem with sleep, whether it's not being able to get to sleep, not getting enough sleep, or their sleep is of poor quality, whichever one of possibly several dozen if not hundreds of reasons might be the reason why any one of these people has that particular sleep problem."
That may be what we're actually talking about, but it's far too much of a mouthful.

Well, we already perceive that these people are not only having
difficulties themselves but are also causing difficulties for others,
and society at large (whatever that means), so we're already thinking in terms of a 'disorder'. That's not necessarily the situation. That's just our description of the situation and it comes from the way we think.

Okay, so what would be a good generic word or phrase that would
describe the disorder that all these individual people share? They're
all sleep impaired in some way. Thus, they all have what we'll term a 'sleep impairment disorder'. Note the indefinite article and the small 's', small 'i', small 'd'. And the assumed appropriateness of the term 'disorder'.

Now we've created our category of people, we'll write this all down in our notebook. What the category is called and how we'll recognise the people who belong in this category. Note the word 'belong'. That's only our opinion, but we're starting to believe in our creation already.

So, if somebody has problems with sleep - they don't get enough sleep, or they can't get to sleep, or their sleep is of poor quality - what signs would we look for? Yawning, bags under the eyes, blank stare, easily disoriented, and so on. Now, since all these people with sleep problems have their personal reasons for having that problem and they each have their own idiosyncratic expressions of it, they will probably exhibit some of the behaviours we list and not others, or only at some times and not others. So we'd better make sure we include everybody who needs our help. Let's say we've listed ten things that will enable us to recognise people who have a sleep impairment disorder. (Or, to be more accurate, what we've decided to call a sleep impairment disorder.)

So, we'll say that a person will fit into the category we've
manufactured for them if they exhibit at least five of those things
we've listed at least twice a day. That seems reasonable. In fact, just to be sure we include *everybody* who needs our help we'll make our category as expansive as we possibly can. Let's call it three out of ten every other day. All those in favour, say "aye". Carried.

Okay, let's get this all down in writing and make it official. Sleep
Impairment Disorder. Note the loss of the indefinite article and the
capitalisation of the initial letters. Since we're medical people and
this is how we think, we now write down "The symptoms of Sleep
Impairment Disorder (SID) are ...."

Freeze frame. What's a 'symptom'? Well, I'm a simple minded person, so, to me, a symptom is an indication that something is wrong. Are bags under the eyes an indication that something is wrong in the context of sleep? Could be. But there might be other explanations. Is yawning an indication that something is wrong? Hardly. It's a perfectly normal function. Nearly everyone will yawn at some time or another - maybe a lot more than twice a day - without having a sleep problem. Oh dear, SID is a perceptual mess already and we haven't even got it out to the public yet. To start with, we're making observations and calling them symptoms. Not because they are, but because that's the way we think.

And we're making arbitrary decisions about those observations and
calling what we end up with the diagnostic criteria. Even though they're not.

Well, as they say in the newspaper business, never let the facts get in the way of a good story. We're medical people, so we talk in medicalese. That's our thing.

Different thread. It's the Decade of the Brain and everybody's going
bonkers trying to win a Nobel Prize. Gotta discover something new about the brain. Don't care what it is.

Here you are - I've discovered that people whose sleep is disrupted for long periods of time have distinctive neural patterns in certain areas of their brain and the patterns are quasi-permanent. Could that be the cause of the sleep problems, I wonder? I know. I know. Since 99.99% of the brain's workings are still a total mystery, it only amounts to my opinion, and it could just as easily be an effect as a cause, in fact that's more likely, but, what the heck, I'm a scientist, aren't I? That makes me smarter than you.
And this is MY claim to fame, so there.

Back with our private club of medical professionals, we're very excited about this. We've forgotten that humans are creatures of habit. We've forgotten about conditioned responses. Psychologists are into all that stuff. We're medical people, so we Think Medical. That's our motto. And the technology hasn't arrived yet that will tell us that certain areas of airline pilots' brains, for example, have distinctive neural patterns not found in other people's brains, purely as a byproduct of their professional activities, so our claim that such patterns are intrinsically abnormal will look a bit suspect, to say the least. Don't worry, we'll find a way around that when we get to it.

We have our Sleep Impairment Disorder and we now know that all the people who have this disorder (see how the thinking has moved on?) have abnormal neural patterns. Whatever anybody else says. Abnormal? You mean different. No, no. Abnormal. This is a disorder we're talking about, right?

We have our sleep potion that will put ANYONE to sleep - which will, of course, INCLUDE people who have a sleep problem, so it'll be easy peasy when it comes to demonstrating our potion's effectiveness. But naturally we don't call it a potion. We call it a medical treatment. Even though, strictly speaking, it isn't. Well, so what? Do you have to split hairs over everything?

And what happened to all the individual reasons these people have for their sleep problems? Well, they're all in there somewhere, for
goodness sake, are't they? As long as these people take our potion and get a good night's sleep, what does it matter?

There is one more thing, though, about the potion. It doesn't change your behaviour. It just puts you to sleep. Consequently, whatever it was that produced the sleep problem in the first place will keep reproducing it - thus, as it happens, maintaining the distinctive neural patterns characteristic of someone who, for whatever reason, can't get enough sleep, or can't get to sleep, or whose sleep is of poor quality. Never mind, we can stonewall on that point for ever if we have to. And, in any case, what does it matter if people have to keep taking our potion all their lives because we never actually solve their problem? Whatever it is. That's more money for us, isn't it? That's good. And these people sleep, don't they? So, we are helping them. Whatever anyone else says.

Fast forward, and here's Mr and Mrs Parent, who are worried about
little Freddy who tosses and turns in bed every night because he thinks the Bogey Man is going to come through his window and eat him up and he hasn't had a good night's sleep for weeks.

But, what's this Mr and Mrs Parent read in a glossy parenting magazine?

"Does Your Child Have SID?" SID? What's that? So they read on,
fascinated. "Sleep Impairment Disorder is a neurological dysfunction caused by abnormal neural patterns in certain areas of the brain. It may develop in early childhood and has been found in infants as young as six months.

The condition especially affects adults, many of whom have had the
disorder since they were children. There is no known cure. However, SID can be managed with a daily dose of Potilin (tm) a medical treatment developed by PhoneySmartPotions Inc."

So, off go Mr and Mrs Parent with little Freddy to the doctor. "Hmm..." goes the doctor, noting that Freddy is yawning his head off, has bags under his eyes and seems to be altogether a bit hazy, "You were right to bring your son to me. He has got SID. I'll prescribe him some Potilin straight away."

Off go Mr and Mrs Parent, happy that they've done the right thing for their child. Oops. They forgot to say, "Excuse me, doctor, but if this is a dangerous brain disease, as I've been reading, why did you only give my son some medicine (note how they've been suckered into thinking 'medicine' already) instead of referring him to a neurologist?" And, oops again, the doctor completely forgot to ask little Freddy why he couldn't sleep.

Well, he knows SID when he sees it, so what do you expect? Houston, we have a diagnosis. Chalk it up and let's get on with our lives. We're busy people, you know.

And so - other things you might read in a magazine, or in a newspaper or hear or see on TV (or get from your hairdresser or some bloke you met down the pub, for that matter):

"SID: the mystery disease that now affects 1 in 20 Americans". No
mention that Norwegians, for example, are strangely immune to it. What is it about the Norwegian brain that's different to the American brain?

There's a Nobel Prize awaiting somebody, if ever there was one. Where's the research on that, eh? Unfortunately, all available research efforts are by now going into defending our private club of medical practitioners' particular view of reality.

"SID may be linked to excessive TV watching". Or nutrition, or bad
parenting, or poor air quality, or stress, or industrial noise, yada,
yada, yada, whichever of the many hundreds of options is flavour of the month. Of course, it's the thing that 'SID' is 'linked to' that's the
real reason for the sleep problem. We both know how this supposed
'neurological dysfunction' was created, right?

And, of course, there's "SID may be linked to fear of the Bogey Man."
One for Freddy's mum and dad to worry about. If Freddy ever tells them about his fear of the Bogey Man, that is.

"SID is genetic, say scientists." That's a good one. Very scientific.
Yes, most people can remember one or other of their parents having
trouble sleeping at one time or another. But, of course, that's
"genetic" as in "I support the same soccer team as my dad. It's
genetic."

"New book says SID sufferers are really just artisans in a mechanic's
world." Well, we're dealing with a fantasy anyway, so why not? How
about "New book says SID sufferers are really aliens accidentally
stranded on planet Earth when their space ship went home without them"?

"What happens when your SID child starts school? Twenty tips for
worried parents."

"Manage your SID child without potions. New book from MeToo Holistic Enterprises reveals secrets of little known herbal remedies."

"SID Sufferers Association launches campaign to raise SID awareness."
"We believe this disease is seriously underdiagnosed," says an
Association spokesperson. "There may be tens of thousands of people out there who have fallen through the safety net and we're anxious to find them. We're grateful that we have this opportunity to help so many people who may be suffering from SID but don't realise it yet."
Campaign sponsored by PhoneySmartPotions Inc. Except you're not told that.

"Concerns over long term effects of Potilin. May have dangerous side effects, says expert."

"New safe SID potion comes onto market." "Doctors welcome Pottera (tm), Bandwagon Laboratories' new SID potion. "This will enable us to brush aside parents' concerns and get on with treating SID sufferers in peace," says Dr. I. M. Gullible."

"World's leading SID expert publishes International Consensus Statement on SID."

"Brain scan expert discovers three different types of SID." "Latest
research into the brain disease SID reveals that there are different
kinds of abnormal neural patterns associated with this affliction. Dr.
B. S. Artist says there are subtle differences between the neural
patterns of those sufferers who can't get to sleep, those who can't get enough sleep and those whose sleep is of poor quality. Dr. Artist has identified these three types of SID as Classic SID, Diet SID and SID Spectrum Disorder." Note the tautology in the use of the word "Disorder". That's because Dr. Artist, like most of the population by now, has forgotten what the letters S I D stand for.

"SID overdiagnosed, claims expert." "Of course, there are genuine cases of SID, but a lot of people are being diagnosed with this disorder when they don't really have it. Just because you can't sleep for a few nights in a row, it doesn't mean you have SID."

"Expert claims SID doesn't exist." This one really has people jumping
up and down. "Doesn't exist? What does he mean it doesn't exist? I've got SID! Come and look at the bags under my eyes, you moron! Come and watch me yawn fifty times a day and stagger around in a daze. Doesn't exist? Bloody idiot."

So, what is SID? And who's got it?

Bob