ADHD (Attention Deficit Hyperactivity Disorder) has been a topic of question since its discovery. It is widely known and commonly diagnosed as a childhood disorder. Since this is the case, many people are questioning if this disorder even exists due to the prevalence and growth in our society. The controversy over the existence of ADHD has been argued for years since the emergence of the disorder. In the article, “Taking Sides: Issue 11” explains both sides from two psychologists and their colleagues to either persuade or debunk ADHD as a real mental disorder. In this essay, I will summarize both sides of the argument and give my take on whether ADHD exists or does not exist.
The two psychologists in this issue are Russell A. Barkley is for the existence of ADHD to be false whereas Sami Tamimi is against the presence of ADHD to be true. Both sides state their arguments and contribute their evidence. Barkley argues that the current scientific evidence such as genetic predisposition and neuro-imaging studies points toward ADHD as a valid disorder. Tamimi’s argument stems from the belief that many people hold when it comes to the existence of ADHD, that it is an outcome of the childishness society we are so desperately trying to eschew from and as a result are using pharmaceutical companies to try and “fix” deviant children by administering medications to them, resulting in an over-prescription of psychotropic drugs.
Russell A. Barkley, a professor of psychiatry and neurology, and his colleagues have dedicated their lives and careers to argue that ADHD does exist. He believes ADHD stems precisely from the biological standpoint like many psychologists think mental illness of any kind causes physiological irregularity. Psychologists focus on biology more than the environment to explain the development of ADHD because of this focus on “nature” versus “nurture” meaning that this disorder is out of their control and children to have to be taught and medicated for their condition. At the International Consensus Statement on ADHD in 2002, Barkley states that ADHD has been associated in a negative connotation by many people, specifically due to how it is portrayed in the media. He believes there is no disagreement at all insofar as “smoking causes cancer” or “a virus causes HIV/AIDS.” (p. 206). To back up his claim, he cites “all of the major medical associations and government health agencies recognize ADHD as a genuine disorder” (p. 207).
Barkley establishes two pieces of evidence to explain the disorder: harm and impairment. “There must be equally incontrovertible scientific evidence that this serious deficiency leads to harm to the individual” (p. 207). The harm being debilitating and attributing to the mortality and morbidity in one’s life. Impairment is a lack of functioning normally in domains such as school, social interaction, independence and self-care. If any of the above areas are lacking in any form, this may be explained with the diagnosis of ADHD because there is no doubt that those who acquire this disorder inflict harm to themselves such as, severe physical injury and accidental poisonings.
Another major point to Barkley’s claim is the evidence of the countless amount of studies done to specific brain regions to explain the relationship of ADHD. These studies are using neuro-imaging techniques to learn what the brain of an individual with ADHD looks like. The studies conducted found that individuals with ADHD have less electrical activity in the brain and less reactivity to stimulation. More studies show smaller brain matter and less metabolic activity in the brain.
Barkley also argues that the existence of ADHD is valid due to the studies done with identical and fraternal twins. The traits inhibition and lack of attention and detail are prevalent across twins, making these results “the highest of any psychiatric disorder 70 to 95% of the time” (p. 208). However, family environment plays no role into attaining these traits among twins, but the environment the child is set in does play a major role in the lives of those who have the disorder, which is often caused by being comorbid with another associated disorder such as conduct disorder. With this being said, ADHD is not the only explanation for the result of the environmental factors of the child. ADHD affects more than just home life; it also affects every other aspect of the individual’s life. Those who have ADHD are often high school dropouts, have little to no social life, are unemployed, antisocial, and abuse drugs. This disorder carries significant risks and potential impairment, yet many do not seek treatment. In fact, “less than half of those with the disorder are receiving treatment” (p. 208), which can be due to media portrayal or social stigma. Barkley suggests the media can instead use their power to divert the negative
connotations of ADHD by accurately depicting ADHD as it indeed is. We should recognize ADHD as an actual disorder with significant risks and dangers and impairment that can debilitate one’s life.
In contrast, Sami Tamimi and her colleagues believe that ADHD does not exist. She critiqued Barkley’s statement at the International Consensus and stated that “if the evidence is already that good then no statement is needed” (p. 210). Tamimi feels personally and ethically responsible for bringing to the public’s attention that ADHD and the practice of psychiatry can be open to abuse, especially if targeted to a demographic that is as easily susceptible as youth. She debunks Barkley’s statements one by one, starting with the how there are no such tests that can diagnose ADHD. She cites the differing prevalence rates (0.5-26%) because ADHD has no set definition, which may have been overdiagnosed for decades. Cross-cultural studies have also found that children from different countries and backgrounds vary in their diagnosis as well. As previously stated, ADHD has a high comorbidity rate with conduct disorder and other disorders such as depression and anxiety, “about three-quarters of children diagnosed with ADHD also fulfilling criteria for another psychiatric disorder” (p. 211). Tamimi claims that ADHD’s comorbidity rate is the reason for misdiagnosis and that ADHD is not enough of a disorder to satisfy a diagnosis on its own.
Tamimi then debunks Barkley’s point regarding the neuro-imaging research for those with ADHD. She says that no one has yet to make a simple comparison between those with ADHD and have not been medicated and a control group. Her point is that there have only been studies showing inconsistencies between the children who are diagnosed with ADHD. Tamimi also believes that ADHD does not have a genetic predisposition since the discrepancies with the neuro-imaging research and ADHD’s high comorbidity rate with conduct disorder; she suggests that conduct disorder is heritable, which may be skewing the results of the twin studies.
One of Tamimi’s major points is that the pharmaceutical companies want to increase their sales and do so by overprescribing medication to children who may or may not have a disorder. With the statistics she gave, those taking psychostimulants doubled. Tamimi then argues the efficacy of stimulants in treating ADHD, claiming that they do not help and do more harm than good by producing addiction from the drugs. If a child grows up to believe they have a disability, that will invoke a self-fulfilling prophecy, making them more addicted to their medication because they think they are not capable of controlling their behavior.
The last major point Tamimi argues is that the way our society is surrounded by adult media can influence a child in certain ways. Our society accepts childishness as a trait innate in children, however, believe they cannot sustain or make reasonable decisions for themselves, which is why they need protection, especially if the parents are not deemed fit. In our world, the innocence has entirely dissipated, making it almost impossible for children to be children anymore. There are greater sexualization and advertisements depicting adult images that influence children. Tamimi believes because of this world we have built, the fear that children are above authority has made us change our opinions of youth from less innocent to more dangerous. Tamimi suggests we stop blaming parents and teachers and instead educate and counsel children to pave their way through life.
After reading this article, in my opinion, ADHD does exist. Regardless of either side, both of whom had irrefutable evidence to back their claim, as an inspiring psychologist, I believe it is a good quality to keep an open mind about all mental illness. I have personally been around friends in my community who have dealt with ADHD for their entire lives, and it has been no easy feat. With that being said, it is unfair and invalidating to deem their disability nonexistent. ADHD is a disability, one that carries significant risks and impairment, and to say that it does not is undeniably ignoring the truth.
Regarding my opinion of the article, I have to say Barkley had the most compelling evidence than Tamimi. Barkley gave concrete reasons for the existence of ADHD, whereas, Tamimi only gave abstract reasons. I believe environment plays a significant role in any psychological disorder and the adult world is sadly the real world. To say that “innocence has left our children” and that is the reason for their misconduct is absurd. There have been many biological studies showing the existence of ADHD in children, and that is a more concrete example than blaming society for not raising their children right. We cannot change what the media portrays, but we can certainly protect our kids from the stressors that may exacerbate their underlying condition because there have been studies that show a genetic predisposition in relatives. The over-prescription of stimulants could be a result of the strict demand from the pharmaceutical companies towards psychiatrists, to meet a certain quota. This may explain the misdiagnoses or eagerness to use medication as a primary or initial treatment. I believe stimulants should not be given to young children unless the severity of their ADHD is impairing and debilitating their daily functions. I am not sure if this disorder is still a controversy now because the article was written in 2006. Nonetheless, ADHD is a valid and real disorder that affects millions of people to this day.