ADHD and the Meaning of Evidence

By Barry Turner , 2003.

There are some people that are denying that Attention Deficit Hyperactivity Disorder exists. They are accused of being irresponsible, causing the condition to be underdiagnosed and even causing the sufferers of this disease to “unwittingly self medicate with illegal drugs or alcohol”. If it were not for the fact that the explosion in ADHD diagnosis and treatment with stimulants such as Ritalin (Methylphenidate) represents the greatest medical catastrophe since Thalidomide these statements would be laughable.

Do the makers of such statements really believe that the millions taking Ecstasy (MDMA), and other illegal substances that are closely related to Ritalin (methylphenidate), at thousands of night-clubs every weekend, are “self medicating” because they have not been “properly diagnosed”. How can a “medical scientist” say that a “disease” is underdiagnosed (based on what data?)

There is absolutely no reason why those opposed to the myth of ADHD as a disease need to justify that position. The matter is clear. It is for those who maintain the position that ADHD is a disease to adduce evidence of it. That evidence must be in the form of data collected in experimental conditions that can be validated by objective repeat studies.

Evidence is made up of three elements. The autoptic evidence which relates to material or physical evidence such as chemical residues or fingerprints. Direct evidence, which is that, proposed by a witness or an expert, and circumstantial evidence, the weakest form of all. What do the proponents of ADHD have in the way of evidence from these sources?

Autoptic evidence is perceived by the senses and is commonly called ‘real’ evidence. In disease this evidence is always present. In carcinomas biopsies will reveal evidence of cell mutation. In cardiovascular disease necrotic muscle tissue, arterial plaques or calcified arteries can be observed. In infectious diseases the pathogens causing the infections can be collected and identified. The evidence is there for all medical professionals to see. Not so with ADHD.

Direct evidence is that which an eyewitness or expert describes from their own first hand observations. What do the experts say?

ADHD may be (may be?) genetic? no one has extended this to its logical and necessary conclusion by identifying which chromosome has this defective gene and why the defect is there. Blue eyes incidentally are genetically determined does that make them a disease?

ADHD may be (again) due to biochemical imbalance? Not one piece of evidence exists to indicate this. Indeed where biochemical imbalances are suggested there is again a signal lack of empirical evidence to support the theory. (Empirical means that it can be repeated, tested, measured, verified.)

ADHD may be (and again) hereditary? Just as in quoting spurious “genetics” this is meaningless at best and deliberately misleading at worst. Criminal behavior is also hereditary, criminal fathers more often than not are followed by criminal sons (and daughters) The behavior is learned and just as musical parents produce musical children and enthusiastic sports loving parents produce sporting offspring this is no indicator of genetics or hereditary cause. It should be noted that Chinese children have a propensity to grow up speaking Chinese if they grow up in China. Those that have been adopted as infants by western parents and taken to America for instance have not as yet spontaneously begun to speak Chinese because it is hereditary or genetic for them to do so. Language like behavior is learned.

What about the weakest form of evidence, circumstantial. Ah, well here at last the ADHD proponents have something. Children misbehave and run about wildly, they are defiant and get bored easily. Er, yes they always have done. The circumstances of this “aberrant” behavior suggest to these ADHD observers that something is wrong, the child must be “ill”. It perhaps should be put to them that the children are fine, it is they that are suffering from “Observational Inaccuracy and Distortion Disorder”

What about the famous suggestion that these children have “different” or smaller brains? Well the studies that came up with that theory look good until you spend five minutes reading them. After five minutes the reader will notice that the “research cohort” is in fact mixed, some children on medication, some not. Some of the “normal” children are several years older than those with the smaller brains. The statistics invite the well known scientific and legal observation “correlates are not causes”. This is the kind of science that concludes that oranges are different to avocados based on the fact that oranges are less green than avocados. How much more enlightened these “scientists” would become if they actually tasted the fruit.

The language of the ADHD lobby is a wonderful indicator of how exact the science is that created it. “ADHD may be…” “ADHD is probably?” “Studies indicate?” “Scientists believe…”. Not one piece of evidence exists to categorically place this condition in any classification of diseases.

The three kinds of evidence mentioned above are the categories of legal evidence. They are the material that decides the case for or against, guilty or not guilty. There is one that has been missed out.

Hearsay evidence is that which is reported second or third hand. Its value to probandum (actual proof) is severely limited as it cannot be tested by the normal methods employed to examine the other kinds of tangible evidence. The person that relates it does not know the facts, only the facts as they were reported to them. Just like the Connors rating for ADHD. Little Johnny is hyperactive says the teacher. Give him Ritalin says the doctor. Little Jimmy can’t concentrate on his schoolwork says the teacher. Give him Adderal says the doctor. Little Sally misbehaves in class says the teacher. Give her Concerta says the doctor. How many doctors prescribe insulin to patients because their neighbour reports that they have seen them drinking lots of water and heard that their feet often tingle?

If in the future the proponents of ADHD find themselves indicted for inflicting this scourge onto the world they will surely demand that their accusers bring strong evidence before they are convicted.  Rest assured they would complain about rights abuses if they were convicted on circumstantial and hearsay evidence. What an irony that such poor evidence is sufficient to convince them they are right now, so right in fact that on hearsay and circumstantial evidence alone they will give addictive and dangerous medicines to children some of whom are barely out of infancy

Those of us who oppose this outrageous abuse of medical science do not need to justify our position. We do not need to produce evidence that ADHD does NOT exist any more than we need to produce evidence that Santa Claus does not exist. The proponents need to answer these questions.

– What is the etiology of ADHD?
– Where is the hard evidence? (objective, scientific and empirically validated)
– If it is actually a disease, why is no one looking for a CURE?

In the lack of coherent answers to these questions ADHD is a belief system only, like believing in fairies or Santa Claus, not a disease or any other kind of medical condition.

The author is a Lecturer in Medical Ethics and Law at the University of Lincoln, United Kingdom, Criminal Litigator and Mental Health Law Consultant.