Chapter One

FIVE SLIPPERY WORDS

It depends on what the meaning of the word "is" is. -President Bill Clinton

Discussions about attention-deficit/hyperactivity disorder (as well as oppositional defiant disorder and early onset bipolar disorder) can get complicated very quickly. The complications generally involve one or more of five slippery words: believe, real, work, have, and know.

As I was walking out of an auditorium in Lexington, Kentucky, where I had just spoken to some three hundred people, mostly parents, a woman approached me and said, "So I take it you don't believe in ADHD."

During the presentation, I had done my best to debunk some widely held falsehoods concerning ADHD, including that it is an inherited or gene-based condition. Because the diagnosis had become so ubiquitous, I realized that several parents in the audience would have questions.

"What does believing in ADHD require?" I asked her.

She looked at me with a slightly embarrassed smile. "Well, you know ... that it's real."

I could tell this was going to be a somewhat thorny conversation. Before I could answer her, we had to come to agreement concerning what the word real means with regard to this supposed disorder. Does it mean that ADHD has objective reality, that it is the behavioral result of physical anomalies that can be seen and measured? Some psychologists, physicians, and researchers believe that it does and is. They believe that ADHD can be seen in brain scans, detected by electroencephalography, that it exists in the form of structural abnormalities in the brain and/or imbalances in the brain's chemistry. The emphasis in the previous two sentences is meant to draw attention to the fact that in the field of ADHD, belief is all there is. Science, however, is not about belief. It is about objective, verifiable, replicable evidence, of which there is none where ADHD is concerned.

One of the characteristics of postmodernity-the curious times in which we twenty-first-century Americans live-is that if enough people think something is true, it takes on a consensual reality that is as powerful, and sometimes more so, than a fact that can be verified by objective means of detection or measurement. Furthermore, once something has acquired consensual reality, people-and even people who ought to know better, people with scientific credentials-will often deny that facts are facts.

The fact is that none of the claims that ADHD has a biological cause has been verified through scientific experiments that upon replication yield the same results. On that basis, therefore, ADHD is not real, not yet at least. Then again, one can ignore all the claims of genes, microscopic brain lesions, and chemical imbalances and limit the notion that ADHD is real to its phenomenology-to the undeniable fact that large and ever-increasing numbers of children display the defining behaviors (or "symptoms," as delineated in the most recent revision of the Diagnostic and Statistical Manual, the diagnostic guidebook for the mental health professions) to a significant degree. From that perspective, ADHD is very real indeed.

But is ADHD a "disorder"? Does its nomenclature accurately reflect that there is something amiss with the children in question, that for whatever reason-biological or otherwise-they can't "think straight," and thus their behavior is often chaotically disorganized? Or is attention-deficit/ hyperactivity disorder simply a more scientific-sounding way of referring to what, not so long ago, people simply called a spoiled brat? Is the term just one more example of how political correctness has corrupted language? This point of view has it that the ADHD child's behavior problems are indeed real but that there is nothing inherently wrong with the child. In many ways, the hurricane of controversy that swirls around the topic of ADHD is in fact an argument concerning whether or not it is real, and if so, in what sense of the term.

Since I didn't have enough time to help this woman understand these sorts of distinctions, I simply said, "I think ADHD is very real in the sense of the behavior problems that are being described. I just don't believe that the things many, if not most, diagnosing and treating professionals are saying about ADHD are factual."

"So you don't believe the medicines really work?" she asked.

Ah! The third of our slippery terms-work. This mother had likely been persuaded that if administration of a drug like Ritalin results in significant diminishment of symptoms for several hours, we have prima facie evidence that ADHD does indeed have biological reality (i.e., the drugs supposedly correct a fictitious biochemical imbalance).

I said, "The answer to that question depends on whether you are defining work in the short-term or the long-term sense."

"But why would the medicines work at all if ADHD wasn't real?" she astutely challenged.

"Has one of your children been diagnosed with ADHD?" I asked her, fairly certain of the answer.

"Our five-year-old son," she said. "My husband has been diagnosed with it as well, and we suspect that our second child may also have it, but it's too early to tell for sure. He just turned two."

Now I knew where she was coming from. As the parent of a child diagnosed with ADHD, she was trying to determine whether or not I agreed with what therapists had told her, and if not, why. Her last question-why do the medicines work at all if ADHD isn't real?-reflects the circular logic characteristic of the Establishment's rhetoric. In the final analysis, the Establishment's ability to continue to profit from the "diagnosis" and "treatment" of ADHD is entirely dependent on mixing claim and fact as if they were one and the same, thus arriving at predetermined conclusions. To wit:

Unsubstantiated CLAIM: Attention-deficit/hyperactivity disorder is a genetically transmitted disease.

Unsubstantiated CLAIM: Attention-deficit/hyperactivity disorder takes the form of a chemical imbalance and/or structural and functional abnormalities in certain areas of the brain.

Established FACT: Certain prescription drugs often reduce the defining symptoms of ADHD for a period of three to approximately twelve hours, depending on the drug, its dosage, and its form, at which point symptoms return. In other words, these prescription drugs do indeed seem to "work" for a period of time defined in hours; they do not, however, work in the sense of eventually eliminating symptoms altogether. Penicillin truly works by eliminating the disease; the medications in question do not eliminate ADHD. Further, as we discuss in chapter 5, they have the potential of causing more problems than they solve, if they solve any.

Established FACT: The drugs in question affect the central nervous system, which includes the brain, usually resulting in a longer attention span (enhanced ability to shut out distractions and focus on a single task) and, therefore, better impulse control.

Unscientific CONCLUSION: Since the drugs in question act on the central nervous system in ways that alleviate symptoms (albeit temporarily), ADHD must be a "disease" located in the brain.

The problem, as we will examine in greater detail later, is that anyone's attention span-adult or child-is likely to improve after taking a therapeutic dose of a stimulant. The Establishment's argument leads to the conclusion that everyone has something wrong with their brain and needs stimulants to correct whatever that something is. Preposterous, indeed, but at least one well-known ADHD Establishment professional questions whether there is such a thing as a "normal" brain.

Back to my conversation with the woman in Lexington. After I explained that just because medicines appear to "work" in the short term doesn't prove the existence of a disorder, she responded, "Well, I do agree it's overdiagnosed."

"Agree with whom?" I asked.

She paused, taken slightly aback, and then replied, "Well, you think it's overdiagnosed, right?"

"Again," I said, "that depends on just exactly what it is we're talking about. For example, you think ADHD is a real physical disorder in some objective sense. I have yet to see proof of that. Therefore, I think that even one diagnosis is overdiagnosis. But if you define ADHD as simply a set of behaviors that describe significant numbers of children of this generation, behaviors listed in the Diagnostic and Statistical Manual, I would have to say that ADHD is grossly underdiagnosed."

"How so?" she asked, obviously perplexed.

"Because a lot more children display that set of behaviors than have been diagnosed with ADHD. I'd estimate that five out of ten of today's kids fit the DSM description to a degree sufficient to justify the diagnosis, especially during their preschool years.

"Now let me ask you something," I continued. "Do you think it's possible that nearly half of America's children have something seriously wrong with their brains, some kind of inherited chemical imbalance? And if the something in question is genetic, then why do teachers who taught before 1960 testify that they hardly ever saw kids who fit the description?"

"I really don't know," she admitted.

"I understand," I said, nodding reassuringly. "Those are the sorts of questions I'm trying to get people to think about." And with that, and a courteous smile, I told her it was nice talking with her and went on to the other folks who were waiting to ask questions of me.

Until that conversation in that lobby in Lexington, I'd been struggling with how to begin this book. I realized we now had our beginning. My exchange with that mother reflected, in a nutshell, the problems inherent in any attempt to have a productive, logical conversation with someone who believes in ADHD. Quite simply, there is no logic to the positions taken by the ADHD Establishment, not to mention that objectivity is completely lacking. To put it bluntly, many of the professionals who specialize in the diagnosis and treatment of ADHD simply cut ideas from whole cloth. Where they lack objective evidence to support their claims, they invent fiction.

When I ask the parent of an ADHD child how the diagnosing professional explained the origin of the problem, the most common response is that the child inherited it from the father. When I ask, "Inherited what exactly?" the most common answer is "a biochemical imbalance."

Let's take a closer look at what it means to have a so-called biochemical imbalance. The term implies that there exists a measurable state of biochemical balance. The fact is no such state exists. The biochemistry of the brain, of the central nervous system, is in a state of ongoing ebb and flow, wax and wane, flux. One set of neurochemical proportions gives way to another, then another, then another, and so on. Anger is characterized by one set of chemical proportions, happiness by another. But within any episode of anger, at any given moment in the episode, the brain's chemistry may be different than it will be one second later or was one second before. Furthermore, the biochemistry of anger or any other emotion varies from person to person. What then does it mean that a person has a "chemical imbalance"? Relative to what?

And thus we come to the fifth of our slippery terms-know.

A child psychiatrist, irritated that I wasn't blithely accepting his point of view, once insisted, "We absolutely know that ADHD is an inherited disease, that it has to do with problems in the brain, and that it can only be effectively treated with medical interventions!"

Know? In reality, this irritated psychiatrist and his colleagues in the ADHD Establishment know nothing of the sort. They believe ADHD is inherited, that it involves problems located in the structure and chemistry of the brain-premises that support the conclusion that the treatment of ADHD (and therefore the larger share of the resulting income stream) belongs to medical doctors. For more than thirty years, researchers supported by grants, taxpayer dollars, and apparently inexhaustible pharmaceutical company funds have been trying to find objective evidence to support these beliefs, and for more than thirty years and counting, they have come up empty-handed. Meanwhile, scientists have solved far more complex medical problems. This is of no significance, however, to many of these researchers (some of whom have claimed to have found "proof" that ADHD is a disease when subsequent analysis of their research reveals they have found nothing of the sort). They believe, and they are scientists; therefore, they know.

The bottom line: the ADHD Establishment cannot recruit believers to their position with facts, because there are no facts that support their position. As you will soon see, the cold, hard facts support another position entirely. So the ADHD Establishment recruits believers by appealing to people's emotions-specifically and primarily, the emotions of parents of children who have been diagnosed with ADHD. It goes without saying that people are emotional concerning their children.

In this book, our premise is simple and straightforward: ADHD, as defined by the ADHD Establishment, is a fiction. To support this fiction, the ADHD Establishment spins a web of elaborate theories unsupported by verifiable data or even common sense. We will see that the same set of attention span-adult or child-is likely to improve after taking a therapeutic dose of a stimulant. The Establishment's argument leads to the conclusion that everyone has something wrong with their brain and needs stimulants to correct whatever that something is. Preposterous, indeed, but at least one well-known ADHD Establishment professional questions whether there is such a thing as a "normal" brain.

Back to my conversation with the woman in Lexington. After I explained that just because medicines appear to "work" in the short term doesn't prove the existence of a disorder, she responded, "Well, I do agree it's overdiagnosed."

(Continues...)

Excerpted from "THE DISEASING OF AMERICA'S CHILDREN" by John Rosemond Bose Ravenel. Copyright (C) by John Rosemond Bose Ravenel. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.