Clueless 102: Don’t Debunk ADHD Until You Know What It Is

Another ‘ADHD doesn’t exist’ article recently oozed from the blogosphere and stained the Internet with a combination of error and cruelty. Bad science–no matter how oft-repeated or popular the conclusion–is still bad science. I’ve loved science ever since I was a little kid; it pains me when it is mangled this badly.

His facts don’t have a ‘context problem’. They have a ‘science problem’.

I’ll reduce this blogger’s lengthy arguments to the two main points he made. First, he argued that behaviors that are normal at low levels don’t become abnormal simply because their frequency increases. Little kids are supposed to run around, so little kids who run around more than others aren’t abnormal, just more active versions of normal. ADHD, therefore is a fraud and doesn’t exist.

This logic, broadly applied, would eliminate much of modern medicine and save Medicare trillions of dollars:

Everyone gets tearful sometimes, so frequent tearfulness is actually normal. Depression doesn’t exist.

Everyone gets short of breath sometimes, so frequent shortness of breath is likewise normal. Heart failure and asthma don’t exist.

Everyone has some germs in the bloodstream, so more germs in the bloodstream is also normal. Septic shock doesn’t exist.

In each of these cases, it may be hard to pinpoint the exact line between normal and abnormal, but there is no question that abnormal amounts of each deserve compassionate treatment.

Second, he argued that behaviors that are normal in one context but abnormal in another are context problems, not medical conditions. He cited himself as an example. He said that the same behaviors that impaired his performance in chemistry class (which he flunked twice) have allowed him to excel in his current profession of blogging where debate and idea creation are rewarded. He recommended taking kids out of school to put them in a more stimulating environment where their ‘context problems’ just disappear.

If this line of reason made any sense, a lot of medical conditions that you thought were problematic are simply context issues:

Inability to climb stairs at 10,000 feet above sea level isn’t heart disease if it disappears at sea level. It’s a ‘context problem’.

Bathing naked at home is normal, so doing it in a public fountain isn’t exhibitionism, it’s a ‘context thing’.

Inability to hear conversation in a noisy restaurant can’t be hearing loss if it disappears when there’s no background noise. Just stop conversing in the wrong context and there’s no problem.

The ‘context problem’ argument is often used in ADHD-doesn’t-exist discussions. Pulling ADHD kids out of traditional school and placing them in a more compelling environment can help them succeed, but it doesn’t train them to work in the variety of environments—both stimulating and not—that adults need to work in. Adults who can calculate their interesting bonus checks, but not their boring taxes don’t have to worry about their ‘context problem’ as much as their ‘legal problem’.

The particular blog post that I’m excoriating here was packed full of scientific error. The blogger didn’t know that neuroscientists have found numerous abnormalities in ADHD brains. He didn’t know the science behind diagnostic symptom assessments and assumed they were arbitrary. Unfortunately, he didn’t understand the concept of impairments. He thought the word impairments means “causes hassles for lazy adults”. He didn’t appreciate that impairments refers to ruined lives: suicide, school failure, job loss, depression, auto accidents, addictions, incarcerations and relationship failures.

In short, another blogger flunked the science of ADHD. This is not surprising, given his results in high school chemistry and disinterest in improvement. Publishing bad science on the Internet doesn’t make him a scientist, even if readers agree with him. His facts don’t have a ‘context problem’; they have a ‘science problem’.

In school, class clowning can deflect attention away from one’s ignorance. In adulthood, inflammatory blogs appear to have the same purpose.

About Oren Mason MD

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

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Posted in ADHD, ADHD myths, Clueless