4.13.2014

The craziness around Attention Deficit and Hyperactivity Disorder



There is no worse answer to a complex problem than to construe a simplified version of its reality and apply social constructions that create another reality that attempts to solve it. Expand this to an extreme and you have instruments that are very effective to dehumanise the person, in this case, our children.

This article in the New York Times raises attention to the not-so-new tendency for the medical world to construct horrible nosological categories to identify behaviours that fit its own criteria, creating an illusion of a perfect instrument that finally captured the objective reality had been running way from science. However, we all know that reality is far more complex than we sometimes are lead to think.

This is not a question of theories of conspiracy or evil doing to children but simply a clarification of how a paradigm gains its power through a very powerful minority and how that same minority is lead to believe that they are indeed paving the way of science. It is painful to see.

Papers have proposed that a recognition of sluggish cognitive tempo could help resolve some longstanding confusion about A.D.H.D., which despite having hyperactivity in its name includes about two million children who are not hyperactive, merely inattentive. Some researchers propose that about half of those children would be better classified as having sluggish cognitive tempo, with perhaps one million additional children, who do not meet A.D.H.D.’s criteria now, having the new disorder, too.

This is just one of the examples that shows how the nosological categories established criteria that failed to truly grasp the problems faced by children. Although there are descriptors that attempt to address this issue, they do it to obliviate the problem, not to solve it. 

So anything we can do to understand what’s going on with these kids is a good thing.

This is what should be at the core of the interventions with children and everyone else in the worlds of psychology, medicine, psychiatry, social services. The issue here seems to be that when you lose sight of the existence of the individual and his ontological uniqueness, the traps of objectivity lead you to believe that the map is the territory. It isn't, at all. 

Steve S. Lee, an associate professor of psychology at the University of California, Los Angeles, who serves on the editorial board of The Journal of Abnormal Child Psychology, said in an interview that he was conflicted over the journal’s emphasis on sluggish cognitive tempo. He expressed concern that A.D.H.D. had already grown to encompass too many children with common youthful behavior, or whose problems are derived not from a neurological disorder but from inadequate sleep, a different learning disability or other sources.

Many problems identified as part of ADHD symptomatology should be first made intelligible in the context of the person and not on extrapolations to reifications of the self. This means that simple things like the lack of sleep, vinculation patterns that are anxiogenic or ambivalent, or a dysfunctional family, should be put at the forefront of the analysis, instead of jumping straight to the nosological categories that fail to take the most complex elements of life into account.

About two-thirds of children with an A.D.H.D. diagnosis take daily medication such as Adderall or Concerta, which often quells severe impulsiveness and inattention but also carries risks for insomnia, appetite suppression and, among teenagers and adults, abuse or addiction.

There is now a very solid understanding of the implications of medications in children. Now, imagine that those children have repercussions in their lives that causes intermediary effects that validate the condition that it is trying to address, e.g., how insomnia may lead to low energy and inattention and then to frustration, disenchantment concerning school and, consequently, to aggressiveness, as part of the signs of depressivity that sometimes plague adolescents. This is a cycle that I have watched myself happen in several interventions with students that were taking ADHD medications.   

An Eli Lilly spokeswoman said in an email, “Sluggish cognitive tempo is one of many conditions that Lilly scientists continue to study to help satisfy unmet medical needs around the world.

The unmet medical needs of the world are, more often than not, signs of the major problem of creating alternative grids to read the world that have a vague link to the the world that it is trying to study. The unmet is also strangely related to the pharmacology of the problems and not so much to interventions in the context of holistic social services.

“I have no doubt there are kids who meet the criteria for this thing, but nothing is more irrelevant,” Dr. Frances said. “The enthusiasts here are thinking of missed patients. What about the mislabeled kids who are called patients when there’s nothing wrong with them? They are not considering what is happening in the real world.”

The real world is a powerful evidence that doesn't tolerate oversimplification. The reductionism to the medical constructions of disease are not the answer, although very important to many cases. The case here is, however, to call attention to the efforts of dehumanisation of children and families and, consequently, to the wrong-doing of using medications to address problems that don't require them at all. 
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